Colo-rectal Cancer Management - Surgical Treatment

The surgical options for colon or rectal cancer depend on the location and the extent of the Tumor.

Surgical Options for Colon Cancer

Surgery is the most common treatment for all stages of colon cancer. The options available are:

Local excision: If the cancer is found at a very early stage removal of the tumor is performed through a Colonoscope. This is called a local excision. If the cancer is found in a polyp (a small bulging piece of tissue), the operation is called a polypectomy.

Segmental resection: Also referred to as Partial Colectomy and Hemicolectomy. It is the most commonly performed surgery and is used to treat 80-90% of colorectal cancer patients. In this procedure the segment of the colon that contains the tumor and the nearby lymph nodes are removed and healthy segments of the colon are reconnected. This procedure may be performed through a large incision in the abdomen (called open surgery) or through several small incisions (called laparoscopic surgery).

Segmental Resection and Colostomy: If after segmental resection of the colon the doctor is not able to approximate the 2 ends of the colon back together, a stoma (an opening) is made on the outside of the body for waste to pass through. This procedure is called a Colostomy. A bag is placed around the stoma to collect the waste. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed this is referred to as a Temporary Colostomy. However if the doctor needs to remove the entire lower colon, then it becomes a Permanent Colostomy.

Surgical options for Rectal Cancer

Surgery is the most common treatment for all stages of Rectal Cancer.

Local transanal resection: Here the tumor as well as some surrounding normal rectal tissue is removed. If the cancer is found in a polyp removal of the polyp namely polypectomy is done. Polypectomy and Local transanal resection are done with instruments inserted through the anus, without making a surgical opening in the skin of the abdomen.

Low anterior resection: This surgery is performed through the abdomen and is used for cancers in the upper two thirds of the rectum, close to where it is connected with the colon. In this procedure the tumor can be removed without affecting the anus. After low anterior resection, the colon will be attached to the anus and the waste will be eliminated in the usual way through the anus.

Abdominoperineal resection: This is the procedure of choice if the cancer is in the distal third of the rectum (the part nearest to the anus) and especially if it is growing into the sphincter muscle (the muscle that keeps the anus closed and prevents stool leakage). Here the surgeon makes incisions in the abdomen as well as in the perineal area around the anus. Here the anus and the tissues surrounding it including the sphincter muscle are removed. To facilitate removal of stools a permanent colostomy is done.

Surgical procedures used to treat metastatic colorectal cancer may include partial hepatectomy (removal of part of the liver) and oophorectomy (removal of the ovaries).

Some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery to increase the chances of a cure is called Adjuvant Therapy.