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.