For some patients, surgery alone can eliminate the cancer.
“Colon and rectal cancer can be treated in a number of ways,” says Elliot Newman, MD, chief of surgical oncology at Lenox Hill Hospital, Northwell Health System. “The mainstay of treatment is generally surgery.”
When colon and rectal cancer is caught early, it’s generally contained to just a small portion of the colon or rectum. This makes surgery ideal: Removing the affected area is an effective way to rid the body of the cancer cells, since the cancer has not spread beyond the colon yet.
Of course, if the cancer has started to spread, additional treatments may be necessary to treat colon cancer. Therefore, surgery for colon cancer can’t always “cure” the patient, but it may be one step in the process.
Surgeries to Treat Colon Cancer
“For colon cancer, there are different operations, depending on where the tumor is located,” says Dr. Newman. The surgery also depends on the stage (or severity) of the colon cancer.
The simplest surgery for colon cancer can be done during a colonoscopy. If the cancer is localized in a single polyp on the colon wall, the doctor can perform a polypectomy (removing the polyp) using a wire loop attached to the colonoscope. This is a simple procedure that doesn’t involve any incisions through the abdomen—and is a good example of why it helps to catch colon cancer early.
However, colon cancer that has progressed beyond a single polyp may require a more extensive surgery called a colectomy, which removes either a portion or the entirety of the colon.
There are different types of colectomies, depending on the patient’s needs. The most common is a partial colectomy, which removes only the affected part of the colon. A typical partial colectomy removes about one-fourth to one-third of the colon, according to the American Cancer Society.
For most partial colectomies for colon cancer, the surgeon can immediately attach the two ends of the colon together; however, some patients may need more time to heal, and they will need a second surgery to attach the two ends of the colon back together. In the meantime, the surgeon will create an ileostomy—an opening in the abdomen where the colon can empty bowel movements into an exterior pouch called an ostomy bag.
Although less common, some patients may need a total colectomy, which removes the entire colon. For example, this may be used in a patient who has both colon cancer and inflammatory bowel disease.
Additionally, these surgeries can be performed in a few different ways:
An open surgery is the traditional style of surgery in which a long incision is made in the abdomen to perform the surgery.
A laparoscopic-assisted surgery is a newer style of surgery in which several smaller incisions are made in the abdomen to allow the surgeon to use long and thin tools to remove all or part of the colon. This is considered a minimally invasive procedure because it affects the body less and improves recovery time.
A robot-assisted surgery is another minimally invasive procedure with several small incisions. Instead of a surgeon manually performing the surgery, they control a special robot that removes all or part of the colon.
“The big advantage of minimally invasive surgery, whether it’s done laparoscopically or robotically, is quicker recovery: Patients spend less time in the hospital so that they can get back to their lives, get on to treatments if that’s what they need afterwards, and moves them along in a much faster manner than we saw traditionally with open surgery,” says Dr. Newman.
What Happens After Surgery
While the patient is recovering, the healthcare team stays busy: The removed tumors get sent to pathology, where it’s examined more closely. “Based on that analysis, we then know what the prognosis is for that patient, and what additional treatments are needed,” says Dr. Newman.
For example, patients with later-stage cancers (especially if the cancer has affected the lymph nodes in the body) will likely need a treatment like chemotherapy, which is more effective at treating cancers that have metastasized, or spread, beyond the original tumor site.
While surgery for colon and rectal cancer can be highly effective, prevention is the best option. Here are ways to lower your risk of colon cancer, and learn more about colon cancer screening guidelines here.
Dr. Newman is the chief of surgical oncology at Lenox Hill Hospital, Northwell Health System, and a professor at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
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Colon and rectal cancer can be treated in a number of ways.
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The mainstay of treatment is generally surgery.
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We usually like to remove the area that's affected.
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The goal of treating colorectal cancer with surgery
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is to cure the patient of the disease.
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That is not always possible, but that's our goal. (knocking)
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How you doing?
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Hi, Dr. Newman.
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How do you feel?
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I feel good, yeah.
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Everything working okay?
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And the pain has resolved?
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Almost no pain.
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I don't have any pain.
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Great. Okay, let me get you to lie back.
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For colon cancer, there are different operations,
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depending on where the tumor is located.
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If the tumor's in the right side of the colon,
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we'll generally take out that portion of the colon,
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and that operation can be done as an open procedure.
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It can be done as a minimally invasive procedure.
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And minimally invasive procedures today can either be laparoscopic or robotic,
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and the definition of a minimally invasive procedure
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is that small, little incisions, usually 4 or 5 little incisions,
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to be able to take out the area of the colon that we're interested in,
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as opposed to a large, bigger incision that was done traditionally, years ago.
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The big advantage of minimally invasive surgery,
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whether it's done laparoscopically or robotically,
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is quicker recovery.
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Patients spend less time in the hospital so that they can
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get back to their lives, get on to treatments
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if that's what they need afterwards, and moves them along
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in a much faster manner than we saw traditionally with open surgery.
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After patients have surgery, the piece of the colon or the rectum
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that is removed is sent to pathology,
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where an analysis of the specimen is done.
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And based on that analysis, we then know what the prognosis is
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of that patient, and what additional treatments are needed.
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Certain patients with early-stage tumors do not need additional treatments.
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Patients with later-stage tumors,
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especially those where there's lymph node involvement,
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will require additional treatment in the form of chemotherapy,
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and all that will be determined after the pathology,
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and in a multidisciplinary meeting that goes over the results of the surgery
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and the additional treatments that are needed.
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Patient education: colon and rectal cancer (beyond the basics). Waltham, MA: UpToDate, 2019. (Accessed on December 2, 2019 at https://www.uptodate.com/contents/colon-and-rectal-cancer-beyond-the-basics.)
Surgery for colon cancer. Atlanta, GA: American Cancer Society. (Accessed on December 2, 2019 at https://www.cancer.org/cancer/colon-rectal-cancer/treating/colon-surgery.html.)