Have you been diagnosed with colon or rectal cancer? If so, surgery will most likely be part of your treatment. In fact, according to the National Cancer Institute, surgery is the most common treatment for CRC. Surgery makes sense when it’s possible to remove solid tumors that are contained in one area.
Oncology surgeons perform two main types of surgery for colorectal cancer, says Dr. John Mansour, a surgical oncologist at the UT Southwestern Medical Center’s Simmons Comprehensive Cancer Center. The first type is removing the primary tumor in the colon or rectum. The other is removing CRC tumors that have spread (metastasized) to another organ. Most often, this is the liver.
[See: 6 Options for People Who Don’t Want a Colonoscopy.]
Surgery for Primary Tumors
Treatment for colorectal cancer always depends on the stage of the cancer at the time of diagnosis. In the very earliest stage, when the cancer is confined to a polyp on the cancer wall (stage 0), your doctor can remove the polyp during a colonoscopy (polypectomy), says Dr. Sreeram Maddipatla, medical oncologist/hematologist for the Liver Center and Pancreas Center at UF Health Cancer Center — Orlando Health.
Otherwise, if you have stage 1, 2 or 3 colorectal cancer, your surgeon can generally remove the entire tumor (resection) along with some healthy tissue around the tumor. This procedure is a colectomy. Your surgeon will also remove about 12 to 15 lymph nodes to check for signs of cancer. “The area where the tumor is has drainage down to central lymph nodes,” Mansour says. “We remove all lymph nodes which drain to [these central nodes]. Even early stage cancer can have lymph node metastases.” After removing the tumor and nearby surrounding tissue, your surgeon will sew the healthy ends of your colon back together again (anastomosis).
When your cancer is in two or more locations (such as the colon and the liver), it’s more difficult to cure, Maddipatla says. If the cancer is just in a few areas, it may be possible to remove the tumors through resection. Otherwise, you may need chemotherapy to shrink the tumors before removing them surgically.
Mansour says laparoscopic or robotic surgery has been a big revolution in colorectal cancer treatment. Patients who qualify for these minimally invasive surgeries have a decreased risk of developing wound infections and fewer pain medication requirements. “This is important in cancer,” Mansour says. “If patients can recover quickly with fewer complications, they can get adjuvant chemotherapy sooner [rather than waiting].” Adjuvant chemotherapy kills cancer cells left over after surgery and is recommended for some colorectal cancer patients.
Despite being minimally invasive, Mansour says laparoscopic or robotic surgeries are still major surgeries. “The majority of recovery is not based on the size on your incision,” he says. “It’s whether your intestine is working again.”
Mansour says there is still a role for traditional open surgery for patients who have scar tissue from earlier surgeries, for example, or who have large tumors that may be invading other structures in the abdomen.
Rectal cancer surgeries are more extensive, Maddipatla says. Because of the proximity of the rectum to other structures, removing a tumor may entail removing the whole bladder and other organs, depending on the size of the tumor and where it’s located.
Undergoing surgery for colon cancer does not usually change your eating habits. However, you will likely have more bowel movements than you used to, especially right after surgery.
[See: 14 Things You Didn’t Know About Nurses.]
When You Need an Ostomy
A small subset of patients, usually those with advanced disease, may need an opening (stoma) in their abdominal wall with a small bag to collect waste (ostomy) following surgery for CRC. For most patients, this is temporary. For example, if you have a large tumor that blocks or perforates the colon, you’ll need surgery right away, Maddipatla says. Instead of reattaching the ends of the colon immediately, your surgeon will give you an ostomy. “Less than 10 percent of patients require this,” Maddipatla says.
Patients with colon cancer worry about having an ostomy, Mansour says, but people can really do anything they want, even with an ostomy. “It doesn’t change [things] all that much,” he says.
In rare instances, if the tumor is very large, your surgeon will put a stent in your colon so you can eat and pass stool. Your doctor will use chemotherapy to shrink the tumor and then perform surgery. “This is not used frequently,” Maddipatla says. It gives patients an opportunity to get stronger before undergoing surgery.
[See: 7 Reasons to Call Off a Surgery.]
Hereditary Conditions May Prompt Colon Surgery
Some people have hereditary conditions that put them at very high risk for colorectal cancer, such as Lynch syndrome or familial adenomatous polyposis. Individuals with FAP have dense polyps throughout their colon. The only way to really prevent colon cancer is to remove the entire colon.
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What Does Surgery for Colon Cancer Involve? originally appeared on usnews.com
