Surgery
In the earliest stages of colorectal cancer (stage 0 and some stage I cases) polyps can be removed during a colonoscopy in a procedure called polypectomy. Early-stage superficial cancers that are not deep can also be removed through excision, where the cancer is cut out by inserting a tube into the rectum. Unlike colectomy, these procedures do not involve cutting through the abdominal wall.
Surgical removal of the tumor ("resection") along with any affected surrounding tissue is the standard initial treatment for potentially curable colorectal cancers (cancers that have not spread beyond the colon or lymph nodes). Drug and radiation therapy are often used for advanced cancers and are continuously being tested with surgery in different combinations and sequences.
Although choosing a qualified surgeon is critical, choosing a hospital experienced in procedures is also important. The more often colon cancer surgery is performed at a given hospital, the lower the mortality rate at that hospital is likely to be.
Colectomy
Unless cancer is very advanced, most tumors are removed by an operation known as colectomy:
- Colectomy involves removing the cancerous part of the colon and nearby lymph nodes.
- The surgeon then reconnects the intestine in a procedure called anastomosis.
- If the surgeon cannot reconnect the intestine, usually because of infection or obstruction, the surgeon will perform a colostomy. Colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. Stools moving through the intestine drain into a bag (ostomy pouch) attached to the abdomen. The need for colostomies is higher after surgery for rectal cancer. In most cases of colon cancer, colostomies are not needed. [See "Colostomy" below.]
- Stents, expandable metal tube-like devices, may be used as preparation before surgery to remove blockage and to keep the intestine open.
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The Surgical Approach. The standard technique for a colectomy is open, invasive surgery. Laparoscopy, sometimes called “keyhole surgery,” is a newer less invasive method.
- Open surgery uses a wide incision to open the patient's abdomen. The surgeon then performs the procedures with standard surgical instruments. This is the usual method for performing colectomy.
- Laparoscopy uses a few small incisions through which the surgeon passes a fiber optic tube (laparoscope) containing a small camera or tiny instruments. It is generally used for early colon cancer (for tumors less than 2 centimeters or for well-defined tumors less than 3 centimeters).
Previous Section
Review Date: 10/21/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
