Surgical Procedures: Surgery and Staging for Colon Cancer
What is staging and how is it performed?
When there are malignant (cancerous) cells in the colon, this is referred to as colon cancer. The colon, or large bowel, measures approximately 5 feet in length. It is part of the body’s digestive system, which is responsible for nutrient processing and waste excretion.
Most commonly, colon cancers start in adenomatous polyps of the colon, a precancerous condition which at times can develop into a cancer and potentially invade the intestinal wall. The most common type of colon cancer is adenocarcinoma. Other types include:
- Carcinoid tumors.
- Gastrointestinal stromal tumors (GISTs).
Once a diagnosis of cervical cancer has been made, you will need testing to determine the stage (extent) of your cancer. These tests can include:
Physical Exam: Your provider will examine your body and talk to you about health issues you have had in the past.
Fecal Occult Blood Testing: A guaiac-based fecal occult blood test (gFOBT) and fecal immunochemical test (FIT) are done to check for blood in the stool.
Stool DNA testing: This test evaluates for abnormal DNA found within the stool.
Blood testing: Blood is drawn to check the function of the kidneys and liver, as well as a complete blood count (CBC). A carcinoembryonic antigen (CEA) level may be checked, as this may be an indication to the presence of colon cancer.
Imaging: Imaging such as a chest X-ray, CAT scan (CT scan), magnetic resonance imaging (MRI), positron emission tomography scan (PET scan) and/or a virtual colonoscopy may be used to further evaluate the extent of your cancer.
- Colonoscopy: During a colonoscopy, a colonoscope (lighted, flexible tube) is inserted into the rectum, looking at the whole colon for any abnormalities. Biopsies may be done during a colonoscopy.
- Sigmoidoscopy: During a sigmoidoscopy, a sigmoidoscope (lighted, flexible tube) is inserted into the rectum and the lower portion of the colon (sigmoid colon) to look for any abnormalities. Biopsies can be done during a sigmoidoscopy.
- Double-contrast barium enema: Also known as a lower GI series, this test uses the liquid enema contrast barium, to evaluate under X-ray changes in the lower gastrointestinal tract which includes the colon and the rectum.
- Biopsy: The removal of a piece of tissue to be looked at with a microscope to look for cancer cells.
Colon cancer spreads to other parts of the body through the tissue, lymph and blood systems. Cancer stage determines how extensive the cancer is, how far it has spread and what treatment course will be recommended. Colon cancer is described as stages 0 through stage IV disease, with higher stage being more advanced.
Surgical Procedures for Colon Cancer
There are many types of surgery used to treat colon cancer. The type of surgery you have will depend on your health and how extensive your cancer is. Some surgeries include:
- Polypectomy/Local Excision: A colonoscope (as in the colonoscopy) is used to remove a polyp or abnormal area of cancer. During a polypectomy, only the present polyp is removed, whereas during a local excision (also known as an endoscopic mucosal resection), some of the tissue on the colon wall is also removed.
Colon resection: During a colon resection, the larger cancer will be removed by way of a colectomy. There are two types of colectomy:
- Partial colectomy: Also called a hemicolectomy or segmental resection, this procedure removes the cancer and some surrounding healthy tissue. This procedure will require either an anastomosis or colostomy. When the surgeon sews the two ends of the colon back together, this is referred to as an anastomosis. In some cases a permanent or temporary colostomy or ileostomy is required. This will allow for waste (stool) to be passed through an external opening (stoma) into a colostomy collection bag. Lymph nodes may also be removed during this procedure.
- Total Colectomy: During a total colectomy, the entire colon is removed. Lymph nodes may also be removed during this procedure. This may require a permanent colostomy to remove waste (stool) from the body.
- Laparoscopy: At times, the use of minimally invasive or laparoscopic surgery, may be recommended. During this procedure several small incisions are made to allow for the passage of special surgical tools (lighted cameras, cutting tools) which will remove the abnormal areas.
- Palliative surgery: The goal of surgery is not to remove the cancer, but to relieve symptoms like pain caused by the effects of cancer, such as blockages. For example, a diverting colostomy (ostomy placed above the colon tumor) may be performed to relieve the symptoms of a blockage.
- Surgery for metastatic disease: At times, colon cancer may spread to other parts of the body, such as the lungs or liver, and it may be recommended that these areas be removed.
- Radiofrequency ablation: During this procedure, electrodes kill cancer through a probe inserted through the skin or an abdominal incision.
- Cryosurgery: During cryosurgery, abnormal cells are frozen and killed.
What are the risks associated with colon cancer surgery?
As with any surgery, there are risks and possible side effects. These can be:
- Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it and manage pain. Reactions can include wheezing, rash, swelling and low blood pressure.)
- Blood clots.
- Fistula formation (abnormal hole).
- Damage to surrounding organs like the intestines, bladder, blood vessels and ureter.
- Development of adhesions/scar tissue.
- Bowel obstruction.
- Incisional hernia.
- Anastomotic leak (leakage from the joined colon or anastomosis site).
What is recovery like?
Recovery from colon cancer surgery will depend on the extent of the procedure performed. Most often, a 3-4 day hospital stay is required.
You will be told how to care for your incisions before you go home.
Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, constipation prevention and/or other conditions.
Your healthcare provider will discuss your particular activity restrictions depending on the surgery you have had.
Common activity restrictions and instructions for a colectomy include:
- No heavy lifting (anything over 10 pounds) for 4 to 6 weeks following surgery.
- Avoid straining to have a bowel movement.
- Take all medications as directed.
- Resume your normal activities such as work (dependent on type of work), light physical activity, driving, walking up stairs and sexual activity when advised, typically in 1-3 weeks.
- Driving should be avoided while taking narcotic medications; speak with your healthcare team for additional information
- Do not submerge your incision in a tub or other body of water until instructed to do so.
- Advance your diet as instructed; you may be asked to eat a low-residue diet for 4 weeks following surgery.
- Drink 8 to 10 glasses of water per day unless otherwise instructed.
Contact your healthcare team if you have:
- Worsening pain or pain which is unrelieved by your pain medications.
- Persistent vomiting, worsening abdominal pain or swelling.
- Signs of infection such as incisional redness, swelling, bleeding or drainage.
- Lack of bowel movement for 2 to 3 days.
- Any other concerns or questions you may have.
What will I need at home?
- Thermometer to check for fever which can be a sign of infection.
- Loose clothes and underwear.
- Incision and/or ostomy care items, often times supplied by the hospital/physician office.
How can I care for myself?
You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.
Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.
There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.
Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.
- Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.
National Cancer Institute. Colon Cancer Treatment (PDQ®)–Patient Version. 2018. Found at: http://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq.
Mayo Clinic Staff. Colon Cancer. 2018. Found at: http://www.mayoclinic.org/diseases-conditions/colon-cancer/home/ovc-20188216
American Cancer Society. What is Colorectal Cancer? 2018. Found at: http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-what-is-colorectal-cancer
The University of Chicago Medicine. Frequently Asked Questions About Colectomy (Colon Resection) Found at: http://www.uchospitals.edu/specialties/colorectal/services/colectomy.html#P75_10158
American College of Surgeons. Colectomy Surgical Removal of the Colon. Found at: https://www.facs.org/~/media/files/education/patient%20ed/2015%20colectomy%20brochure%20final.ashx