Find out about surgery for advanced bowel cancer.
Advanced bowel cancer means the cancer has spread to other parts of the body from where it started in the large bowel (colon) or back passage (rectum). Your cancer might be advanced when it is first diagnosed. Or the cancer may come back after you were first treated.
Once a bowel cancer has spread to another part of the body it is not likely to be curable. But treatment might keep the cancer under control for quite a long time. The choice of treatment depends on:
- the type of cancer
- the number of secondary (metastic) cancers
- where the seconday cancers are
- treatment you have already had
- your general health
Surgery for a blocked bowel
Sometimes cancer can grow so that it completely blocks the bowel. This is called a bowel obstruction. The waste from the food you have digested can't get past the blockage.
To relieve symptoms, it is sometimes possible to unblock the bowel by putting in a tube called a stent. The surgeon puts a tube with a light at the end (endoscope) into your bowel through the back passage (rectum). This is called a colonoscopy. The surgeon uses the endoscope to see where the blockage is and pushes a stent through it. The stent expands and holds the bowel open so poo can pass through again. The stent stays in place to keep the bowel open. It relieves symptoms and gives your surgeon time to plan surgery to remove the blocked part of the bowel.
Your surgeon might be able to remove the blocked section of bowel and attach the two ends of the bowel together. Or they might need to bring the upper end of the bowel out into an opening in the skin of your tummy (abdomen). This is called a stoma. If the opening is from your large bowel (colon) it is called a colostomy. If the opening is from your small bowel (ileum) it is called an ileostomy. You wear a small bag over the stoma to collect your poo.
Surgery to remove small secondary cancers
If bowel cancer spreads, it often goes to your liver or lungs. It can be carried there by the bloodstream or lymphatic system.
Sometimes, if there are only 1 or 2 small areas of cancer spread (secondaries) in the liver or lungs you can have surgery to remove them. This is not suitable treatment for everyone. It is done more often for cancer spread to the liver than to the lungs. If you have this type of surgery, you might also have chemotherapy before and after the operation.
You can only have this type of surgery if you have just a few areas of secondary cancer in either your liver or your lungs. To decide if this treatment is suitable for you, your doctor will look at:
- your general health
- how advanced your cancer was when diagnosed
- how quickly your cancer has come back
- how many secondary cancers you have
- the size of the secondary cancers
- the position of the cancers
- how close they are to major blood vessels
About having the surgery
You will have scans such as a CT scan, or an MRI scan. You might also have a test to look at the blood supply to the area (an angiogram) to make sure the operation is possible.
Removing secondary cancers from the liver is very specialised surgery and is carried out in major liver cancer centres. There are centres throughout the UK, so talk to your own specialist about this if you think it might help you. If this treatment is right for you, your specialist can refer to your nearest surgery centre.
Removing liver secondaries can be very successful for some people. About 40 out of 100 people treated (40%) are alive 5 years later. You might be able to have treatment again if the cancer comes back in the liver. You can have more than half of your liver removed if necessary because liver tissue can grow back after surgery.
Treatment is less likely to be successful if:
- you have cancer in the lymph nodes near the liver
- you have cancer that has spread to another body organ
- your surgeon cannot completely remove all of the liver secondaries
If you have surgery to remove secondaries in the lungs, you might have this as part of a clinical trial. Doctors want to find out about how helpful this treatment is for advanced bowel cancer and how surgery affects quality of life.
Specialist surgery for secondary liver cancer
There are special types of surgery for treating secondary liver cancer.
Your doctor will consider different factors when deciding if they are suitable for you. Some factors are:
- your general health
- how quickly your cancer came back after other treatments
- whether you have secondary cancer anywhere else that cannot be removed
Your doctor will talk to you about the possible benefits and risks of these treatments in your situation. If your bowel cancer has spread anywhere else in your body, your doctor is not very likely to suggest these treatments. They will probably suggest chemotherapy instead because it circulates throughout the body and so treats all areas of the cancer.
Hepatic artery chemoembolisation
Doctors put an oily liquid into the main artery taking blood to the liver. The liquid helps to block the blood vessels taking blood to areas of the liver containing the cancer. This cuts off the supply of oxygen and nutrients to the cancer and damages the cells. The oily liquid also contains chemotherapy. High levels of chemotherapy stay in the area of the cancer for a few hours. This kills the cancer cells and shrinks the cancer.
You might have medicine to make you drowsy (sedation). The surgeon injects a local anaesthetic into the skin over a blood vessel at the top of your leg. Using x-ray pictures, they slide a thin plastic tube into the blood vessel. They push the tube gently upwards until the tip is in the artery taking blood to the liver. When the tube is in the position the surgeon injects the chemotherapy drug mixed with the oily liquid. The surgeon then removes the tube.
This treatment takes from 30 minutes to a couple of hours. Afterwards, you may have some pain, feel or be sick, and have a high temperature. Your nurse will give you medicine to help with this.
Selective internal radiation therapy
Selective internal radiation therapy (SIRT) is also called radioembolisation. It is a newer type of treatment for cancer in the liver. The doctor (radiologist) puts tiny radioactive beads called microspheres into the main artery taking blood to the liver. These beads give off high doses of radiation to the tumour but cause little damage to the surrounding healthy tissue.
About 1 or 2 weeks before you have the treatment, you have an angiogram. This test looks at the flow of blood to the liver, which is different in different people. The radiologist blocks off small blood vessels that go to other organs of the body. This is so that when the radioactive beads are put in, they won't go anywhere else in the body and damage healthy tissue.
The treatment itself takes about an hour, and you need to stay lying down for about 4 hours afterwards to prevent bleeding. You might stay in hospital overnight. Side effects include tiredness, loss of appetite, a high temperature, pain in your abdomen and feeling or being sick.
Due to the radiation, you need to avoid long periods of close contact with young children and pregnant women for about 10 days after treatment. Your doctor will advise you about this before you go home. Most of the radiation has gone after 2 weeks, and has gone completely after a month. The beads stay in the liver permanently but are harmless.
Radiofrequency ablation uses radio waves to destroy cancer cells in the liver by heating them to high temperatures. You usually have a sedative to make you drowsy but some people have a general anaesthetic. If you have the sedative, your doctor injects a local anaesthetic into the skin of your tummy (abdomen) to numb it. They then push a thin needle through the skin and into the centre of each tumour. They use a CT scan or ultrasound scan to make sure the needles are in the right place. Then they pass radio waves through the needle to heat the tumours and destroy them.
RFA can treat tumours up to 5cm (2 inches) in size. It takes about 10 to 15 minutes. Usually, you can go home a few hours afterwards. You might need to have the treatment repeated. The main side effects are pain and a high temperature for a few days. Your doctor or nurse will give you painkillers to take at home. They will also give you instructions on what to do if you get a high temperature.
Cryotherapy is also called cryosurgery. It destroys the cancer by freezing it. It is only suitable for small tumours, usually up to 4 cm. It takes about 30 to 60 minutes. You might have it as part of open surgery under general anaesthetic or using keyhole techniques under local or general anaesthetic.
The surgeon puts one or more cryotherapy probes (called cryoprobes) through a small cut in the skin and into the cancer. The surgeon uses a CT scan or ultrasound scan to make sure each probe is in the right place. The tip of the cryoprobe is then cooled to below freezing.
The probe creates an ice ball within the surrounding tissue that aims to destroy the cancer cells. Sometimes the area is thawed for 10 to 15 minutes and then frozen again.
You will have some pain afterwards and possibly a high temperature, but you will have painkillers to help. You usually have a short stay in an intensive care unit followed by around 2 days in the specialist liver treatment ward.
Microwave ablation uses microwave energy to produce heat and kill cancer cells. It is a newer type of treatment. You can have this treatment for more than one secondary liver tumour. You might have a local anaesthetic or general anaesthetic.
Your doctor puts a thin needle into each tumour. They use a CT scan or ultrasound scan to make sure the needles are in the right place. Then they connect the needles to a microwave generator. The microwaves are released through the needles to destroy the cancer cells. The most common side effects include pain and a high temperature.
Laser therapy is also called laser ablation. The surgeon uses a very high powered beam of light to destroy cancer cells in the liver, by heating them to high temperatures. You usually have a sedative to make you drowsy but you might have a general anaesthetic.
If you have the sedative, your doctor injects a local anaesthetic into the skin of your abdomen to numb it. They then push a flexible tube that carries the laser light through the skin over the liver and into the centre of each tumour.
The doctor uses a CT scan or ultrasound scan to make sure the tip of the tube is in the right place. Then the laser heats the tumours and destroys them.
Laser therapy can treat tumours up to 5cm (2 inches) in size. It takes about 10 to 15 minutes. Usually, you can go home a few hours afterwards. You might need to have the treatment repeated. The main side effects are pain and a high temperature for a few days afterwards.
This treatment uses sterile alcohol to destroy cancer cells. It is only suitable for liver tumours smaller than 4 to 5cm. You might have medicine to make you drowsy. The surgeon then injects local anaesthetic into the skin over the liver. They push a thin needle through the skin and into the tumours. A CT scan or ultrasound scan makes sure the needle is in the right place. Then they inject the alcohol directly into the tumour.
You can have this treatment for more than one tumour in the liver. It can be painful, so you take painkillers for a while afterwards. Some people feel drunk for about 10 to 15 minutes after the injection.
You usually stay in hospital for a few hours after your treatment, in case you have any bleeding or pain. You can have the treatment again some time later if the tumours grow back.