Colorectal Cancer

Surgery

Surgery to remove cancer is almost always the main treatment for colorectal cancer. The type of surgery depends on the size and location of your cancer.

Side effects are common after surgery. You may be able to reduce the severity of your side effects at home. For more information, see the Home Treatment section of this topic.

Surgery Choices

• Local excision. When colorectal cancer is discovered in its very early stages, it can be removed during a sigmoidoscopy or colonoscopy. The surgeon cuts out not just the polyp, but also a small amount of tissue around it. The surgeon does not need to cut into the abdomen.
• Bowel resection. This operation involves cutting out the cancer as well as the sections of the colon or rectum that are next to it. Then the two healthy ends of the colon or rectum are sewn back together. The surgery can be done in two ways:
  • Open resection. The surgeon makes a long incision in the abdomen, completes the bowel resection, and closes the incision. Open resection is the best option for cancer of the rectum.¹²
  • Laparoscopic surgery. Instead of needing a large incision in the abdomen, laparoscopic surgery requires only 3 to 6 small incisions. The surgeon inserts a camera, or laparoscope, and other operating instruments through these incisions to perform the operation. Because the incisions are smaller, there usually is less pain and recovery is faster. In some cases, the surgeon may make 1 or 2 of the incisions a little bigger during surgery in order to complete the procedure, but the opening is still far smaller than in an open resection. Open resection is best for cancer of the rectum, but for other colon cancers, laparoscopic surgery is equally effective.¹² However, laparoscopic surgery cannot always be done, such as when the cancer has spread to areas outside the colon.

What To Think About

Polypectomy or local excision is used when the cancer has been caught in its early stages. Bowel resection is used when the cancer is larger. Sometimes after this major operation, the two ends of the colon or rectum cannot be sewn back together. When this happens, a colostomy is performed. Most people do not need a colostomy.

For more information, see:

Caring for your ostomy.

Colorectal cancer comes back after surgery in about half of people who have surgery to remove the cancer.¹⁰ The cancer may be more likely to come back after surgery if it was not discovered in an early stage. Even if your doctor thinks that all the cancer has been removed during surgery, radiation therapy or chemotherapy may be recommended to destroy any remaining microscopic areas of cancer.

Clinical trials are designed to find better ways to treat people with cancer and are based on the most current information. Some people who meet the criteria for participation choose to enrol in such clinical trials.

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Author:	Douglas Dana Shannon Erstad, MBA/MPH	Last Updated: March 19, 2007
Medical Review:	Adam Husney, MD - Family Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology Arvydas D. Vanagunas, MD - Gastroenterology
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