Surgery for Colorectal Cancer

There are different approaches to colorectal cancer surgery depending on whether you have colon or rectal cancer. If you have been diagnosed with colon cancer, the first treatment may be surgery to remove the primary tumour. In advanced (metastatic) colon cancer, you may begin your treatment with chemotherapy and/or targeted therapy before surgery.

If you have been diagnosed with rectal cancer, you may be treated with chemotherapy, targeted therapy and/or radiation prior to surgery.

The majority of colorectal cancers begin as a growth on the inner lining of the colon or rectum known as a polyp. Some polyps may develop into cancer over time (usually many years), but not all polyps become cancerous. During a colonoscopy, polyps are removed and sent to pathology for testing to determine the cancer stage. Colorectal cancer in these stages is contained to the original location and has not spread to neighbouring tissues such as the lymph nodes.

When polyps are detected with Stage 0 and some Stage I colon or rectal cancers, local removal of the polyp during a colonoscopy avoids higher-risk abdominal surgery. This is called a polypectomy.

When the cancer has invaded the wall of the colon and surrounding tissues, surgery usually involves removal of the cancerous parts of the colon and the surrounding tissue including the lymph nodes. This surgical procedure is called a colectomy. Once the cancerous parts of the colon are removed, the two resulting ends of the remaining colon are rejoined to allow normal bowel function. This process is called anastomosis.

Surgery to remove part of the colon is called a hemi-colectomy or partial colectomy.

Surgery to remove the whole colon is called a total colectomy.

Your surgeon may perform an open colectomy, where a vertical incision is made down the abdomen to open the abdominal cavity and access the colon. After the removal of cancerous parts, the incision is closed with staples or sutures.

A laparoscopic colectomy or minimally invasive colectomy may also be performed. Several small incisions are made in the abdomen, through which your surgeon passes a tiny video camera and special surgical tools to remove the affected parts of the colon. This technique allows the surgeon to operate from outside the body, reducing healing time and surgical risks such as infection.
For stage II-III rectal cancer, most people will get both chemotherapy and radiation therapy (chemoradiation) as their first treatment, or radiation alone. This is usually followed by surgery (see above: TEM, LAR, APR).
Sometimes, complete removal of the rectum (proctectomy) is needed.

In some cases, such as after a proctectomy, an ileostomy or colostomy are permanent. Your surgeon will avoid this as much as possible, though it will depend on where the cancer is in your colon or rectum and your overall state of health. Sometimes it is not possible to know before the surgery whether you will need a permanent stoma, as the surgeon will only be able to determine if it is necessary during the operation.

Having a stoma, even temporarily, requires an adaptation period in a person’s life. A stomal therapy nurse will discuss all aspects of living with a stoma and give you the information you need.

If your cancer has spread to another organ or part of your body such as the liver, lungs or peritoneum (membrane forming the lining of the abdominal cavity), surgery may still be a treatment option. In this case, a variety of techniques can be used to treat your cancer. To help control the cancer you will likely be offered chemotherapy, possibly in combination with a targeted therapy. These treatments may be used before and/or after surgery to improve the effects of surgery.

There is now a much better prognosis for stage IV colorectal cancer patients. For instance, liver-only metastases have been shown to be successfully managed through surgical resection and adjuvant treatment.

For patients with colorectal cancer, the liver is the dominant site of metastasis. Although many patients’ cancer spreads beyond the liver, some patients have disease that is isolated to the liver. For these patients, regional treatment approaches such as surgical resection may be considered in addition to chemotherapy alone. Your doctor will discuss the best option available to you. It is very important to discuss all your surgical options and goals of your treatment together with your doctor.