Surgery for colorectal cancer

The types of surgery used to treat colon and rectal cancers differ slightly so they are described separately.

Colon surgery

Surgery is often the main treatment for earlier stage colon cancer. The surgery is called a colectomy or a segmental resection. Usually the cancer and a piece of normal colon on either side of the cancer (as well as nearby lymph nodes) are removed. The 2 ends of the colon are then sewn back together. For colon cancer, a colostomy (an opening on the belly for getting rid of body wastes) is not usually needed, although sometimes a short-term colostomy may be done to let the colon heal. To learn more, please see our document, Colostomy: A Guide.

Most often, surgery is done through a cut (incision) in the belly (abdomen), but for some earlier stage cancers a different approach might be an option. In laparoscopic-assisted colectomy, instead of one long incision in the abdomen, the surgeon makes several small ones. Special long instruments are put into these small openings and used to remove part of the colon and lymph nodes. This method seems to be about as likely to cure the cancer as the standard approach for earlier stage cancers, and patients usually recover faster than they do after the usual operations. But the surgery calls for special skill. If you are thinking about laparoscopic surgery, be sure to look for a skilled surgeon who has done a lot of these operations.

When you wake up after surgery, you will have some pain and most likely will need pain medicines for 2 or 3 days. For the first couple of days, you will be given intravenous (IV) fluids. During this time you may not be able to eat or you may be allowed small amounts of liquids, as the colon needs some time to recover. But a colon resection rarely causes any major problems with digestive functions, and you should be able to eat solid food again in a few days.

Some very early colon cancers (stage 0 and some early stage I tumors) or polyps can be removed using a colonoscope (the same thin, flexible scope used to do a colonoscopy). When this is done, the surgeon does not have to cut into the abdomen. Early stage cancers that are only on the surface of the colon lining can be removed along with a small amount of nearby tissue. For a polypectomy, the cancer is cut out across the base of the polyp's stalk, the area that looks like the stem of a mushroom.

Rectal surgery

Surgery is usually the main treatment for rectal cancer, although radiation and chemo will often be given before or after surgery. There are several types of surgery for rectal cancer.

Operations (such as polypectomy, local excision, and local transanal resection) can be done with instruments placed into the anus, without having to cut through the skin. One of these methods might be used to remove stage I cancers that are fairly small and not too far from the anus.

For some stage I, and most stage II or III rectal cancers, other types of surgery may be done. These are described here:

Low anterior resection: This approach is used for cancers near the upper part of the rectum, close to where it connects with the colon. The surgeon makes the cut in the belly. Then he removes the cancer and a small amount of normal tissue on either side of the cancer, along with nearby lymph nodes and a large amount of fatty and fibrous tissue around the rectum. The anus is not affected. After the surgery, the colon is reattached to the anus and waste leaves the body in the usual way.

Proctectomy with colo-anal anastomosis: For some stage I and most stage II and III rectal cancers in the middle and lower third of the rectum, the entire rectum and the colon attached to the anus will need to be removed. This is called a colo-anal anastomosis (anastomosis means "connection"). This is a harder operation to do. For a short time, an ostomy (an opening on the belly for getting rid of body wastes) is needed to allow healing after surgery. A second operation is done later to close the ostomy opening.

Abdominoperineal (AP) resection: For cancers in the lower part of the rectum, close to its outer connection to the anus, an abdominoperineal (AP) resection is done. For this the surgeon makes a cut in the belly (abdomen), and another in the area around the anus. Because the anus is removed, a colostomy is needed. A colostomy is an opening of the colon in the front of the abdomen. It is used as a way for the body to get rid of solid body waste (feces or stool). The usual hospital stay for an AP resection is 4 to 7 days, depending on your overall health.

Pelvic exenteration: If the rectal cancer is growing into nearby organs, more extensive surgery is needed. In a pelvic exenteration the surgeon removes the rectum as well as nearby organs such as the bladder, prostate, or uterus if the cancer has spread to these organs. A colostomy is needed after this operation. If the bladder is removed, a urostomy (an opening to collect urine) is also needed.

Side effects of colorectal surgery

Side effects of surgery depend on several factors like the extent of the operation and a person's general health before surgery. Most people will have at least some pain after the operation, but it most often can be controlled with medicines if needed. Eating problems usually get better within a few days of surgery.

Other problems may include bleeding from the surgery, blood clots in the legs, and damage to nearby organs. Rarely, the new connections between the ends of the intestine may not hold together and may leak, which can lead to infection. After the surgery, you might have scar tissue forming around the bowel that can cause organs or tissues to stick together. These can later lead to the bowel becoming blocked.

Colostomy or ileostomy: Some people may need a temporary or permanent colostomy (or ileostomy) after surgery. This may take some time to get used to. If you have a colostomy or ileostomy, you will need help in learning how to manage it. Nurses with special training can do this. To learn more, please see our documents, Colostomy: A Guide and Ileostomy: A Guide.

Colorectal surgery and sex

If you are a man, an AP resection can cause you to have "dry" orgasms. That is, the feeling of pleasure will most likely still be there, but no semen comes out. In some cases an AP resection may make you unable to have erections or reach orgasm. In other cases your pleasure at orgasm may become less intense. Normal aging may cause some of these changes, but surgery can make them worse.

For some men, the surgery causes the semen to go backward into the bladder. This is not harmful. But if you still want to father a child, you should talk to your doctor about how the surgery will affect you and what might be done to achieve a pregnancy.

If you are a woman having colorectal surgery, you should not normally find any loss of sexual function. Scar tissue may sometimes cause pain or discomfort during sex. And if the uterus is removed, pregnancy will not be possible.

For men and women, a colostomy can affect your body image and your sexual comfort level. While you may need to make some adjustments, it should not keep you from having an enjoyable sex life.

For more information on dealing with the sexual impact of cancer and its treatment please see the American Cancer Society documents, Sexuality for the Man With Cancer and Sexuality for the Woman With Cancer.

Surgery for colorectal cancer that has spread

Sometimes surgery for cancer that has spread to other organs can help you to live longer or, depending on the extent of the disease, may even cure you. If the colorectal cancer has spread to a few areas in liver or lungs (and nowhere else), the cancer can sometimes be removed by surgery.

For spread to the liver, there are methods other than surgery which might be used to destroy the cancer. These include things like blocking the blood supply to the tumor or destroying the cancer by freezing it or killing it with high-energy radio waves. These methods are less likely to cure the cancer.

Since these cancers can often be hard to treat, you may also want to talk with your doctor about clinical trials of newer treatments that might be right for you.