Colorectal cancer surgery

Specialty of Surgery

What is colorectal cancer surgery?

Colorectal cancer, also known as bowel cancer, is the cancer of the large intestine (colon). The large intestine makes up the end of the digestive tract, and cancer usually starts as a cluster of cells called polyps. Not all polyps are cancerous, and therefore it is important to closely monitor them and have them removed before they become cancerous.

Colorectal cancer surgery involves the removal of the cancerous part of the colon, which is known as a colectomy. Depending on what stage the cancer is at, surgery can range from minimally-invasive polyp removal, to the removal of both the colon and rectum. Depending on the type of surgery, local or general anaesthetic will be used.

If colorectal cancer is identified early on, surgical treatment can often cure the cancer and prevent it from returning, however, this is not always possible. Surgery is often combined with other treatments such as chemotherapy and radiotherapy.

What causes colorectal cancer?

Exact causes of colorectal cancer are unknown, however, there are associated risk factors that can increase the likelihood of developing it. These include:

  • Age – people over the age of 60 are more likely to be diagnosed with colorectal cancer.
  • Family history – if a direct relative has had colorectal cancer, chances of developing colorectal cancer are increased.
  • Smoking & alcohol
  • Diet – evidence has suggested that diets containing large portions of red meat have an increased chance of colorectal cancer developing.
  • Obesity
  • Digestive disorders – people suffering chronically from disorders such as Crohn’s disease are more likely to suffer from colorectal cancer.
  • Genetic conditions – there are genetic syndromes that increase the number of polyps formed, increasing the chance of these polyps becoming cancerous over time. These syndromes are called familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC).

What does surgery involve?

Surgery for early-stage colorectal cancer usually involves the removal of a small section of the colon lining. This is called a local excision.

However, if the cancer has spread into the surrounding muscle, a whole section of the colon will need to be removed. This is called a colectomy. Colectomies can be carried out in the following ways:

  • Laparoscopically – a special instrument is guided by cameras through small incisions in the abdomen.
  • Robotically – keyhole surgery carried out by a special robotic instrument.
  • Open surgery – a large incision is made in the abdomen so that part of the colon can be removed.

Whilst surgery is carried out, it is common for nearby lymph nodes to be removed as well and will be tested for cancer. During a colectomy, the surgeon will reconnect the healthy parts of the colon. If these cannot be reconnected, then the surgeon will have to carry out stoma surgery. This diverts the faeces away from the colon towards an opening in the abdomen and into a stool bag that is fitted to the opening. The stoma will either be temporary or permanent, depending on how well the colon heals after surgery.

How to prepare for surgery

Depending on the type of surgery, you might be required to a follow a special diet before surgery, or to empty your bowels. On the day of surgery, you won’t be able to eat or drink. It is common that prior to surgery you will be given a dose of antibiotics to prevent the possibility of infection.

If you are going to have a stoma, then you will have met a stoma specialist to explain how they work.

Post-operative care

Immediately after surgery, the care team will try to get you moving to prevent blood clotting. It is common to expect some pain and nausea. Patients can generally return home in around three to seven days after surgery, and a check-up appointment would be booked in to discuss recovery and any further treatment required.

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