Surgery is the most common treatment for all stages of colon cancer. Rectal cancer most often is treated by a combination of radiation therapy, chemotherapy and surgical resection. Metastatic disease (that which has spread to other organs) is sometimes amenable to surgical resection. More often, combination multimodality therapy is used.
Local excision: If cancers are small, located close to the anal opening and are determined to be of an early state, your doctor may advise local excision. this procedure removes the cancer through the anal opening and avoids an incision in your abdominal wall to reach the rectum. Risks and recovery time are typically lower with this type of procedure. It is not advisable for later stage tumors as it does not remove bowel-associated lymph nodes and may lessen the chance of long-term cure and survival.
Sphincter sparing surgery/low anterior resection: for larger cancers, surgery involves removing a portion of the rectum through an abdominal incision. typically patients are treated with combination chemotherapy and radiation therapy prior to surgical resection as this has been shown to decrease tumor bulk, decrease the chance of local recurrence of the cancer and improve long-term survival. Advances in chemoradiation therapy, in addition to the technical surgical expertise of colorectal surgeons, allow most rectal cancer patients to undergo sphincter sparing procedures which maintain continence, sexual function and normal bowel emptying function.
Abdominoperineal resection (APR): When rectal cancers involve the sphincter muscle or other pelvic organs such as bladder or vagina, it is not possible to spare the sphincter. In these cases, an abdominal and perineal approach is used to remove the cancer. This necessarily leaves the patient with a permanent colostomy - a surgical opening in the lower abdominal wall through which the colon is attached to allow waste to pass into a bag. Fortunately, few rectal cancer patients require a permanent colostomy.
Colon resection/partial colectomy: A portion of the colon including the cancer is removed through an abdominal incision. The resection (removal) includes a margin of normal colon tissue on either side of the cancer and the lymph nodes associated with that section of intestine. Adequate lymph node removal is essential to accurately stage colon cancers and is one of the nationally recommended standards to which our colorectal surgeons adhere. Once the cancer is removed, the surgeon connects the two ends of the colon back together to maintain normal intestinal continuity and bowel emptying function. colostomies are rare in the treatment of colon cancer. Sometimes they are used in cases of obstruction or perforated cancers. In these cases, they are typically temporary and can be revered at a later date.
For Metastatic Disease
Colon cancer which has metastasized (spread to other organs) such as liver and lung, may sometime be removed with surgery. This depends on the location of the disease, number of metastatic lesions and patient's overall medical condition. complete surgical resection can slow progression of the disease, improve long-term survival and potentially cure the patient. Often times, surgery is combined with other treatments, such as cancer tissue destruction by radiofrequency ablation or cryosurgery (freezing) , locally infused chemotherapy or conventional chemotherapy.
Minimally Invasive Surgery/Laparoscopic Procedures
Minimally invasive surgery uses a series of very small incisions (5-10 mm) in the abdominal wall, a camera (laparoscope), and specialized instruments to perform intra-abdominal procedures, such as colon resection. This approach results in shorter hospital stays, faster recovery, and faster return to work and other activities of daily living. Laparoscopic colon cancer surgery has been shown to be equal to open procedures in the length of colon removed, adequacy of number of lymph nodes retrieved and 5-year cancer survival rates. In fact, laparoscopic surgery of colon cancer may even provide a slight survival advantage in certain states of the disease. At the Colorectal Program at St. Joseph Hospital, our surgeons use minimally invasive surgery for more than 75% of our colon cancer patients.