Surgery often is the main treatment for colon cancer. Surgery options range from simple procedures done during a colonoscopy to more complex surgeries such as colectomy, where part or all of the colon is removed. The type of surgery that's right for you depends on the cancer's location and stage and the goal of the surgery. Your healthcare team considers your overall health and preferences when recommending the best approach.
In addition to surgery, your healthcare team might recommend other treatments, such as chemotherapy, immunotherapy or radiation therapy. These therapies may be used before, during or after surgery. They can be used to shrink cancer or help kill any remaining cancer cells that were not removed with surgery.
Types of colon cancer surgery
The types of surgery commonly used to treat colon cancer include:
Polypectomy
The purpose of a polypectomy is to remove growths in the colon, called polyps. The aim is to remove them before they can turn into cancer or to catch cancer early if it's just starting to grow. A polypectomy can be done during a colonoscopy. A colonoscopy uses a tiny camera on the end of a flexible tube, called a colonoscope, to visually examine the colon. During the colonoscopy, a medical specialist threads tools through the tube to remove the polyp.
Most polyps aren't cancer yet, but some can become cancerous over time if left alone. Removing them prevents that risk. If a polyp already shows signs of early cancer that hasn't spread, removing it might stop the cancer completely.
Colectomy
A colectomy, also known as a colon resection, is a surgical procedure to remove the cancerous part of the colon and the associated lymph nodes. When part of the colon is removed, the surgery is known as a partial colectomy. A total colectomy involves removing the entire colon.
To ensure the complete removal of cancer cells, healthy sections of the colon on each side of the cancerous section are removed. Nearby lymph nodes also are removed. After a colectomy, the remaining healthy ends of the colon may be connected, allowing waste to leave the body through the colon. This step is known as anastomosis.
A colectomy can be done using a single, long cut in the belly. This is called open surgery. Or it can be done using special tools through smaller cuts. This is called laparoscopic or robot-assisted surgery. The type of colectomy depends on the location and extent of the cancer.
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Partial colectomy.
In this procedure, only the diseased part of the colon is removed. There are a few types of partial colectomy, depending on which section of colon is removed. Right or left hemicolectomy is removal of the right or left side of the colon. Sigmoid colectomy is removal of the sigmoid colon. Segmental resection is removal of a specific segment of the colon where the cancer is.
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Total colectomy.
This procedure involves removing the entire colon while leaving the rectum intact. A total colectomy may be recommended for people with colon cancer who have a coexisting health condition, such as inflammatory bowel disease, Lynch syndrome or familial adenomatous polyposis.
Colostomy and ileostomy
The colon plays an important role in removing stool from the body. If the healthy ends of the colon cannot be connected during colectomy or another surgery, stool cannot pass through the colon as it typically would. When this happens, the surgeon may perform an ostomy procedure. An ostomy lets stool pass from your body without going through your colon or anus. Colostomy and ileostomy are common ostomy procedures used in colon cancer treatment.
During an ostomy, the surgeon brings a part of the intestine through an opening created on the belly, called a stoma. This allows waste to exit the body through the stoma rather than the rectum. The stoma typically appears as a red, moist and slightly bulging piece of the intestine. A special pouch is attached to the stoma outside the body to collect waste. The pouch provides a discreet and hygienic way to manage passing stool.
Colostomies and ileostomies are similar. But they differ in the location of the stoma and the part of the intestine involved. A colostomy involves the colon, while an ileostomy involves the last part of the small intestine, called the ileum. For many people, these procedures are temporary and can be reversed once the colon heals. However, for some people, the procedure may be permanent.
Surgery for colon blockage
Sometimes the cancer grows and blocks the colon. This is called a bowel obstruction. If this rare complication happens, you might need surgery right away to fix it. A blockage can prevent the passing of stool or cause severe symptoms, such as pain, bleeding and vomiting. If the cancer is growing but hasn't totally blocked the intestine, surgery may be planned to clear the blockage and prevent complications.
The most common surgery for colon blockage is a colectomy to remove the blocked section of the intestine. That sometimes is followed by a colostomy or ileostomy. Depending on the situation, one of these simple ostomy procedures may be done without removing part of the colon.
For some people, colectomy isn't an option. This could be due to the size and location of the cancer, a person's health, or because there are multiple tumors. Other types of surgery include:
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Bypass surgery. A bypass procedure connects a part of the intestine above the blockage to a part below the blockage. That bypasses the obstructed area and creates a new, clear pathway for waste. This allows the digestive system to function as it typically would despite the blockage. A bypass procedure most often is used to ease symptoms.
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Stenting. Stenting is a minimally invasive procedure done with a colonoscope. It involves placing an expandable metal tube in the colon to keep the colon open and allow waste to pass through. Stenting can be a temporary or permanent solution. This procedure helps relieve symptoms of obstruction and can serve as a bridge to surgery. Stenting most commonly is done for cancer growing in the left side of the colon.
Sometimes, a bypass or stenting procedure may be done first, followed by a colectomy at a later time.
Surgery for cancer spread
Colon cancer that has spread to other parts of the body is called metastatic colon cancer. It most often spreads to the liver or lungs. But it also can spread to other places such as the brain, distant lymph nodes or the lining of the abdominal cavity, called the peritoneum.
Treating metastatic colon cancer may involve more than one surgery. Removing the original cancer, called primary cancer, may be done first. That may be followed by a separate surgery to remove the metastatic cancer. Sometimes, only one surgery is needed to remove all the cancer. Chemotherapy, radiation or other therapies may be used before, during or after surgery to help shrink cancers or kill cancer cells.
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Resection.
Resection is a surgical procedure that involves removing cancerous tissue. Liver resection, which involves removing a part of the liver, is a common surgery for metastatic colon cancer. Depending on the extent of the cancer, resection may improve the prognosis or even cure the cancer.
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Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, also called HIPEC. This is a specialized combination treatment used for cancer in the abdominal cavity, called the peritoneum. Cancerous tumors are first surgically removed from the peritoneum. The cavity is then bathed with hot chemotherapy — heated to 42 degrees Celsius — to kill any microscopic cancer cells that remain.