Colorectal Cancer: Colon Cancer Surgery, Rectal Cancer, Colostomy
What Is It?
Colorectal cancer is a wide-reaching term that describes many different cancers affecting the colon and large bowel or rectum and the appendix. It is one of the more common types of cancer and a leading cause for death especially in the West. In fact, colon cancer kills more than one-half million people in the world annually, and is the second leading cause of death in the United Kingdom, second only to lung cancer. Often colon cancer arises from untreated polyps in the colon, which can be treated early if detected early through routine colonoscopy.
A colonoscopy is an exploratory procedure that involves the use of a scope passed through the large intestine under light anesthetic to view the lower bowel. Most patients present with symptoms including fatigue and weight loss. Symptoms usually do not arise until cancer has already been present for some time.
A colostomy is the primary treatment for colon cancers in their early stages. This procedure is also known as hemicolectomy and segmental resection, because it involves removing parts of the colon and sometimes surrounding lymph nodes especially if there is suspicion the cancer may have spread to these areas or might spread to these areas. The surgery may be performed traditionally or by using special instruments depending on the patient and the severity of the disease. Colon cancer in the earliest stages is most treatable and curative. The later stage cancers are most difficult to treat and may require adjunct or additional treatments including chemotherapy and radiation, which result in additional side effects including nausea, vomiting, weakness, fatigue and lethargy.
During the procedures the surgeon creates an incision in the abdomen and removes a segment of the colon that is normal, and then up to one third of the colon although more may be removed depending on how widespread the cancer is. In some cases one fourth of the colon is removed. The surgeon then reattaches the colon and then may remove surrounding lymph nodes for biopsy as well. Typically a surgeon will remove 12 or more lymph nodes surrounding the colon.
Alternatives to Surgery
Some patients with early stage cancer will not require a full colostomy. Instead they can have a polypectomy performed, where polyps are removed by surgery during a colonoscopy. Here a GI specialist removes polyps from the colon during a colonoscopy by cutting the polyps stalk. These polyps are concerned pre-cancers that have not fully developed yet. This is an outpatient procedure usually that patients recover from very quickly.
Some patients also receive rectal surgery, and radiation and chemotherapy following rectal surgery.
Before The Operation
Before surgery patients are asked to remove all contents from the bowels usually by performing an enema or by using laxatives prescribed by their physician. Physicians also prescribe anesthesia to patients before surgery, so most patients will need to fast up to 12 hours prior to surgery to prevent complications from anesthesia.
After The Operation
Patients will receive pain medications and will receive intravenous medications and fluid for up to three days. Patients are not able to eat for the first few days following surgery because the colon needs time to heal. Usually clear liquids are started approximately three days following surgery.
Some patients will have a hole in their colon resulting from a tumor in the colon which will require attachment of a special bag to the colon and abdomen that will allow removal of waste products and fecal matter from the body. Then a second procedure known as a colostomy reversal is performed to reattach the ends of the colon, because during the first surgery this will not be possible because of the hole in the colon.
Other complications from surgery may include bleeding, blood clots forming in the legs or damage occurring to nearby organs that may occur during the actual surgery. Sometimes the surgery may fail if the surgeon fails to connect the ends of the intestine together properly. Other times the patient may develop an infection following surgery, which is a common complication of any surgery. Other times patients may develop adhesions in the abdomen, which can result in pain and discomfort following surgery.
These may also cause bowel blockages which may necessitate additional surgeries. Other patients need permanent colostomies following surgery which results in permanent lifestyle adjustments. Other patients realize changes in sexual performance or fertility changes resulting from colorectal surgery. These complications more often affect male fertility than female fertility.
Some patients will be able to undergo a less invasive procedure known as a laparoscopic-assisted colostomy if in the earlier stages of the disease, where the surgeon makes several small incisions instead of one longer incision in the abdomen to perform surgery. Through these smaller incisions the surgeon can pass a small camera through the abdomen and remove the diseased parts of the colon and lymph nodes and then reattach the colon.
This may allow for faster recovery and less pain following surgery. This type of surgery requires surgical expertise. A skilled surgeon must be able to handle this type of surgery so be sure to shop around for a surgeon that knows what he or she is doing before undergoing this type of procedure.
Estimated Costs for Colorectal Cancer Surgery