Treatment for colorectal cancer depends on many factors. Some of these factors include the stage of cancer at diagnosis, your age, and your general health. Chemotherapy, radiation therapy, and surgery can be used alone or in combination.
Surgery is the most common treatment for colorectal cancer, but there are several different approaches. Your doctor will make a recommendation based on the extent of the cancer and other health considerations.
Continue reading to learn more about the surgical options for colorectal cancer.
Colonoscopy is a common procedure to screen for colon cancer. A flexible tube with a tiny camera on the end is inserted into your rectum and colon. This allows your doctor to view these on a screen.
If your doctor finds polyps, they can remove the growths during the same procedure. This is called a polypectomy. Polyps can be removed before they even have a chance to develop into cancer.
For the procedure, the doctor uses a special tool to cut the polyp from the wall of your colon. There’s no need for an abdominal incision.
In early stage colorectal cancer, a polypectomy may be the only treatment you need.
Local excision is a little more involved than polypectomy. But it can also be accomplished without an abdominal incision. The surgeon enters through the anus or a small cut in the rectum. They use a special cutting tool to remove the cancer, plus a small amount of tissue from the wall of the colon or rectum.
If polyps can’t be entirely removed during a colonoscopy, laparoscopic surgery may be an option. It’s a minimally invasive surgery performed through a few small incisions in your abdominal wall. The surgeon may also sample lymph nodes at this time to check whether the cancer has spread.
Sometimes it’s necessary to remove part or all of the colon and nearby lymph nodes.
A partial colectomy (hemicolectomy or segmental resection) is a major surgery in which the cancerous part of the colon is removed, plus a small margin of healthy tissue on each side of the cancer. Your surgeon may remove about one-fourth to one-third of your colon, and then stitch the remaining segments of colon. They’ll also remove nearby lymph nodes.
A total colectomy is surgical removal of the entire colon, but it isn’t needed very often. It may be an option if the cancer-free part of your colon isn’t healthy. For example, there are many polyps or damage from inflammatory bowel disease.
This surgery can be done through an abdominal incision or minimally invasive surgery.
A colostomy is a way to allow waste to leave your body. It can be a temporary measure (called a diverting colostomy) until you have a chance to heal from colon surgery. Or it can be permanent, such as when your entire colon must be removed.
In surgery, the end of the large intestine is brought out through an opening (stoma) in the abdominal wall. Then, stools can move through the stoma and collect in a special bag on the outside of your abdomen.
Local transanal resection
This procedure removes the cancer and some surrounding tissue from the rectal wall. The surgeon can insert the instruments through the anus, so you don’t need an abdominal incision or general anesthesia. It’s usually done with local anesthesia for early stage rectal cancer located near the anus. No lymph nodes will be removed. Depending on the specifics of the tumor, you may also need chemotherapy or radiation.
Transanal endoscopic microsurgery (TEM)
If the rectal tumor is too high to be reached with local transanal resection, the surgeon can use a special magnifying scope. This enables the surgeon to reach higher and with accuracy.
Low anterior resection (LAR)
This procedure is an option when cancer is located in the upper part of the rectum. This operation is done under general anesthesia with an abdominal incision. During the surgery, the cancerous part of the rectum is removed, along with a margin of healthy tissue. The surgeon then attaches your colon to the remaining part of the rectum so your bowels function normally.
Proctectomy with colo-anal anastomosis
This surgery is an option when cancer is in the middle to lower third of the rectum. The procedure requires general anesthesia. The surgeon makes an abdominal incision to remove the entire rectum and nearby lymph nodes. The colon is then connected to the anus. In some cases, a temporary colostomy may be necessary, but you should eventually experience normal bowel movements.
Abdominoperineal resection (APR)
In the surgery, the anus and surrounding tissues, including the sphincter muscle, are removed. You’ll need a permanent colostomy after this procedure.
When cancer has grown into nearby organs, you may need more extensive surgery. This procedure involves removal of the rectum, so you’ll also need a colostomy. If cancer has spread to your bladder, it will also be removed. That means you’ll need a urostomy, an opening in your abdomen through which urine can flow into a portable pouch. If cancer has invaded the prostate or uterus, these organs must also be removed.
Surgery when cancer has spread
If cancer has spread to your lungs or liver, tumors can sometimes be surgically removed. Whether or not this is an option depends on the number, size, and location of the tumors.