Surgical Options for Colorectal Cancer

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If you have been diagnosed with colon cancer, your first treatment may be surgery to remove the primary tumor. In contrast, if you have been diagnosed with rectal cancer, your first treatment may be radiation and chemotherapy prior to surgery.


What to Expect

Before surgery:

  • your blood counts will be measured
  • your blood chemistry and CEA levels will be evaluated
  • you will have a CT scan of the chest, abdomen and pelvis, or a PET scan, to determine exactly where the cancer is located

These tests are frequently done after surgery, as well, to compare results.

Because surgery alone is not enough to fight stage III or IV colorectal cancer, you will undergo additional treatment.

Read more about chemotherapy, radiation and targeted therapies.


Questions to ask BEFORE your initial surgery:

  • What stage of cancer do my pre-surgical diagnostic tests indicate I have?
  • How many operations for this kind of cancer does the recommended surgical specialist perform each year? (Ideally you will work with a surgical oncologist, general surgeon, or colorectal surgeon who conducts a minimum of 12 operations on your type of cancer per year.)
  • Is the specialist a certified colorectal surgeon? (This training is especially important for the treatment of rectal cancer.)
  • Will a temporary or permanent ostomy be necessary?
  • Do I need chemotherapy and/or radiation therapy before surgery? After surgery?
  • How many lymph nodes will be removed during surgery? (A minimum of 12 should be removed.)

Questions to ask AFTER your initial surgery:

  • What is my post-surgical diagnosis? What is the stage of my cancer?
  • What additional tests should be done to increase the accuracy of my diagnosis and determine my need for additional treatment
  • What can I do to help recover from surgery?
  • If stage IV or recurrent:
    • Where do I have metastatic tumors?
    • Can they be removed or treated?
    • How do I obtain a copy of my pathology report and testing information?
    • If an colostomy was performed: can an ostomy expert on staff help me learn how to use the appliance?
    • What follow-up care or follow-up treatment will I need?

Common Surgery Options

Colectomy

Removes the cancerous part of the colon and nearby lymph nodes. Abdominal surgery removes the section of colon where the tumor is located, tissue containing blood and lymph vessels surrounding the colon (mesentery), healthy tissue margins on either side, and at least 12 lymph nodes, if possible. Then the remaining ends of colon are reconnected with sutures or staples. This connection is called an anastomosis.

Open colectomy:  An incision is made in the abdomen, surgery performed through the opening, and the incision closed with sutures and/or staples.

Laparoscopic colectomy:  Three small keyhole incisions are made to insert a lighted instrument and specially designed surgical instruments that can be manipulated within the abdomen. Sometimes an incision is made just long enough for the surgeon’s hand to assist during laparoscopy.

After the cancerous part of the colon is removed (called a resection), the two ends of the remaining colon are reattached to eliminate waste through the rectum.

Colostomy (Ostomy)

Creates a way for stool to be removed from the body when part of the colon is removed. In this procedure, a stoma (an opening) is made to the outside of the body and an ostomy pouch is placed around the stoma to collect and remove waste. An ostomy refers to the opening in the body for waste; while the stoma is the actual end of the intestine seen peeking through the abdominal wall. Learning how to care for your ostomy is essential for your well being after this procedure. A colostomy can be temporary and reversed, or be permanent.

Temporary Ostomy & Reversal Surgery

A colostomy reversal is possible if the colon can heal after the initial resection surgery. When healing is complete (after a few months to years), a reverse colostomy surgery (colostomy take-down) is performed so the stoma will no longer be necessary. Reverse colostomy involves reconnecting the healed colon to your digestive tract using sutures that will dissolve, allowing the colon to function normally again.

Low anterior resection (LAR)

LAR is common in rectal cancer. The tumor and part of the rectum is removed without affecting the anus. The colon is then attached to the remaining part of the rectum so that after the surgery, your bowels can be used in the usual way.

Abdominoperineal resection (APR) with ostomy

APR is common in rectal cancer. One incision is made in the abdomen and another in the perineal area to remove the anus and the tissues surrounding it, including the sphincter muscle. This is a more invasive surgery than the LAR because the anus is removed. With an APR you will need a permanent colostomy to allow stool a path out of the body.

 

Content medically-reviewed by members of the Fight Colorectal Cancer Medical Advisory Board, February 2014

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