A diagnosis of colon or rectal cancer leads to questions about treatment and what happens next. Will I need surgery? What type of surgery can cure me? Will I need other treatments? What are the risks and side effects of surgery?
Options for colorectal cancer treatment depend on several factors, mainly whether the tumor is located in the colon or rectum and the stage of the cancer. Your colorectal cancer doctor can describe your treatment choices, including colon and rectal cancer surgeries, and the expected results.
Who’s a Candidate for Colorectal Cancer Surgery?
Treatment recommendations are based on the type of colorectal cancer you have, its location and stage, your age and overall health status, and your personal preferences about treatment. Surgery is most commonly recommended for patients who have an early-stage colorectal cancer diagnosis. The gastrointestinal surgeon reviews your test results and discusses surgery options and timing with the oncologist.
Although surgery may not be recommended for late-stage colorectal cancer, in some cases, it is used to relieve pain and other symptoms and extend life span.
Surgical Options for Colorectal Cancer Surgery Include:
Polypectomy
Polypectomy (polyp removal) is used on early-stage colorectal cancer (stage I) that has not spread outside a polyp. This is performed during a colonoscopy, which examines your colon and rectum via a lighted viewing tube during sedation.
Local Excision
Local excision can also be performed during a colonoscopy, but tools are used through the colonoscope to remove small tumors on the inside lining of the colon. A small amount of healthy tissue on the colon's wall is also removed.
Colorectal cancer removed using polypectomy or local excision does not require the surgeon to cut into the abdominal area. The goal is to remove the tumor in one piece. If some cancer is left behind or if there are chances of it spreading, a colectomy might be the next surgery.
Colectomy
Colectomy removes either a part of or the whole colon, usually along with nearby lymph nodes.
A partial colectomy is used with colorectal cancers that are not in a polyp or that have spread into or through the colon but not to surrounding lymph nodes (generally, a stage II cancer). Partial colectomy removes the cancerous section of your colon, plus a margin of tissue around the cancer. Depending on the size and location of the cancer, about 25% to 35% of the colon is removed. By removing surrounding lymph nodes, they can be checked for cancer cells.
Cancer that has spread to nearby lymph nodes but not to other parts of the body is stage III. Partial colectomy is often used for these cases and is usually followed by chemotherapy.
A total colectomy surgery removes the entire colon. It’s rarely needed to remove colorectal cancer. Total colectomy is used when there are multiple polyps, the patient has a rare inherited disease called familial adenomatous polyposis, or to treat inflammatory bowel disease.
A colectomy can be an open surgery that requires a long incision in the belly. Another method of performing a colectomy is through laparoscopic surgery. This method uses smaller incisions and a long, thin, lighted tube with a camera and light on the end called a laparoscope to see inside the abdomen and perform the surgery.
Laparoscopy has the advantages of being less invasive and patients recovering more quickly compared to open surgery. It’s helpful to have a gastrointestinal cancer surgeon on your care team to determine the best removal method.
Colostomy and Ileostomy
Colostomy or ileostomy may also be required for partial colectomy patients. If the surgeon is not able to reconnect the healthy ends of the colon after the cancerous section is removed, an ostomy will be created. This opening in the abdomen allows waste to leave the body through an external bag.
Two types of ostomies can be created. Colostomy creates an opening from the large intestine; an ileostomy is an opening from your small intestine. Both types of ostomies may be temporary or permanent to allow your colon to heal. Both methods can be reversed to reconnect the ends of the colon, if appropriate. Your body needs to heal for two to six months before reversal surgery. An ileostomy is used in cancers of the small intestine; colostomy treats cancers in the colon, rectum, or anus.
Surgery for Colorectal Cancer That Has Spread
Surgery is also used to reduce symptoms caused by advanced colorectal cancer, or cancers that cannot be surgically removed because of their location or the patient’s health status.
Surgery is rarely used for metastatic colorectal cancer – cancer that has spread to other organs and tissues, commonly the liver. The lungs, the brain, the lining of the abdominal cavity, and distant lymph nodes are other common places where stage IV cancers can spread. While surgery is unlikely to cure stage IV cancer, if the spread is limited to only a few small cancerous areas that can be surgically removed, along with the colorectal cancer tumor, then surgery may be an option.
What are the Risks and Side Effects of Colorectal Surgery?
As with any surgical procedure, risks and possible side effects can cause short- or long-term problems.
Short-term risks depend on what surgery you have, the extent of your cancer, and your age and overall health. The risks of infection at the surgery site, bleeding, or blood clots in your legs depend on your situation. You will have some pain after surgery that requires medication for a few days.
Your colon needs time to recover from surgery. You may only be allowed to consume liquids – no solid food for a few days. You may have nausea or vomiting. Expect a slowed bowel that doesn’t work for a while. It’s usually caused by anesthesia or too much pain medication.
Long-term side effects can include leaking where the colon was reconnected. This causes severe pain, a hard belly, fever, and loss of appetite. If the leak causes an infection, you’ll need another surgery.
Scar tissue inside your abdomen can cause internal organs or tissues to stick together (adhesions). Rarely, adhesions can make the bowels twist, blocking the bowel. This causes pain and belly swelling. Surgery will be needed to remove the internal scar tissue.
Feeling self-conscious about having an ostomy bag is another long-term issue. Your care team can help you learn to manage your ostomy. Training from ostomy nurses and community support groups will provide additional skills and tips to manage your condition.
Adjuvant Treatments Can Improve Surgery Outcomes
Nonsurgical treatments (adjuvant therapy) may be needed to treat colorectal cancers that have spread too much or cannot be removed with surgery. The following non-surgical treatments may be used in combination with surgery:
- Chemotherapy, which uses drugs to kill cancer cells, may be used after surgery to kill cancer that has spread to lymph nodes and/or to destroy cancer cells that remain after surgery. Chemotherapy can reduce your risk of cancer returning. Before surgery (neoadjuvant therapy), chemotherapy is used to shrink large tumors, which makes them easier to remove surgically. Chemotherapy is also used to relieve symptoms of inoperable or metastasized cancers.
- Radiotherapy uses beams of radiation to kill cancer cells. It can be administered externally or internally (brachytherapy). Before surgery, radiation is used to shrink tumors to facilitate removal. It’s often used with chemotherapy to improve outcomes.
- Targeted therapy uses drugs that attack specific chemicals in the cancer cells, helping the cancer cells to continue growing and reproducing. It is used to treat advanced colorectal cancers and is often combined with chemotherapy. Read our blog to learn more about how biomarker testing changed the future for colorectal cancer patients.
- Immunotherapy can boost the body’s immune system, helping kill cancer cells. It’s used with advanced colorectal cancer and when the tumor has dMMR or MSI-H. These two markers indicate that the patient’s DNA-repair system is not functioning correctly, allowing immunotherapy to strengthen your immune system.
Personalized Colon and Rectal Cancer Treatment Plans at Compass Oncology
Compass Oncology's colorectal cancer specialists will develop an individualized plan for your needs. You’ll meet with a medical oncologist, gastrointestinal oncology surgeon, radiation oncologist, and other medical professionals to discuss the recommendations proposed for your care. Be an active partner in planning your colorectal cancer treatment and understanding your options.
