Surgery for advanced bowel cancer
This page tells you about surgery for advanced bowel cancer (colorectal cancer), including bowel cancer that has spread to the liver. You can find the following information
Surgery for advanced bowel cancer
It may be possible to remove a cancer that comes back in the bowel. This is unlikely to cure it. But removing the bowel tumour may relieve any symptoms that you have. And it may be some time before the cancer starts to grow anywhere else.
Surgery for a blocked bowel
Sometimes bowel cancer can completely block the bowel. This causes symptoms such as pain, vomiting and constipation. You may have an operation to unblock the bowel and make an opening onto your abdomen for your bowel movements to pass into a bag (a colostomy). This is quite a big operation and if you are not well enough to have that, your surgeon can sometimes put in a tube called a stent to keep the bowel open.
Medicines such as somatostatin or octreotide can help to control the symptoms of a blocked bowel instead of an operation. Unfortunately, this treatment is only likely to control your symptoms for a limited time.
Surgery to remove small secondary cancers
If bowel cancer spreads, it often goes to the liver or lungs and is called secondary cancer. If the secondary cancers are small and there are only one or two, you may be able to have surgery to remove them. Surgeons are able to operate more often for cancer spread to the liver than to the lungs.
There are also some specialised surgical treatments for cancer that has spread to the liver, such as
- Giving chemotherapy or radiation directly into the liver and cutting off the blood supply to the tumour (chemoembolisation or radioembolisation)
- Radiofrequency ablation
- Freezing therapy (cryotherapy)
- Microwave ablation
- Laser therapy
- Injecting alcohol into the tumour
You can view and print the quick guides for all the pages in the treating bowel cancer section.
Sometimes, when a colorectal cancer comes back in the bowel, it is possible to remove it. This is unlikely to cure the cancer because there are usually cancer cells elsewhere in the body that are too small to show up on a scan. But removing the bowel tumour may relieve symptoms and help you to feel better. And it may be some time before the cancer starts to grow anywhere else.
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. This causes quite a few symptoms such as
- Feeling bloated and full
- Vomiting large amounts
- Feeling sick
- Being unable to pass wind
To relieve the symptoms, it is sometimes possible to unblock the bowel by putting in a tube called a stent. To put the stent in, the surgeon puts a flexible tube with a light at the end (called an endoscope) into the bowel through your back passage. This is called a colonoscopy. The surgeon uses the endoscope to see where the blockage is and pushes the stent through it. The stent expands and holds the bowel open so that bowel motions can pass through again. The surgeon leaves the stent in the bowel to keep it open. As well as relieving symptoms, this procedure gives doctors time to plan an operation to remove the blocked part of the bowel.
If you are well enough, you can have surgery to remove the blocked part of the bowel. It may be possible to close up the cut ends of the bowel again during this operation. Or the surgeon may need to bring the upper end of the bowel out into an opening made in the skin of your tummy (abdomen). The opening is called a stoma or colostomy. You wear a special waterproof bag over it to collect waste from the bowel. We have information about having a colostomy in this section.
You may want to talk to your close family and friends, as well as your doctor and nurse, about whether to have this type of surgery. It is likely to be quite a big operation. If you choose not to have the operation, your doctor can use medicines to control your symptoms. The medicines somatostatin or octreotide can reduce the amount of fluid that builds up in your stomach and digestive system and so stop you feeling sick or vomiting. Unfortunately, this treatment is only likely to control your symptoms for a limited time.
If bowel cancer spreads, it often goes to the liver or lungs, carried there in the bloodstream or the lymphatic system.
Sometimes, if there are only 1 or 2 small areas of cancer spread (secondaries) to the liver or lungs you can have surgery to remove them. This is not suitable treatment in every situation. It is done more often for cancer spread to the liver than to the lungs. If you have this type of surgery, you may 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 came back
- How many secondaries you have and their size
- Where the secondaries are in the liver or lungs
- How close they are to major blood vessels.
Removing secondary cancers from the liver is very specialised surgery and is carried out in major liver surgery 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 you to your nearest liver surgery centre.
Removing liver secondaries can be very successful for some people. Generally, about 40 out of 100 people treated (40%) are alive 5 years later. You may be able to have treatment again if the cancer comes back in the liver. You can have more than half 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 secondary cancers in the lungs, you may have this as part of a clinical trial. Doctors want to find out more about how helpful this treatment is for advanced bowel cancer, and how surgery affects quality of life.
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There are other types of specialised surgery to destroy secondary liver cancer. These include
- Hepatic artery chemoembolisation
- Selective internal radiation therapy (SIRT)
- Radiofrequency ablation (RFA)
- Microwave ablation
- Laser therapy
- Alcohol treatment
Your doctor will take several factors into account before deciding whether any of these types of treatment are possible for you, including
- 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 unlikely to offer you these types of treatment. They will probably suggest chemotherapy instead because that circulates throughout the body and so treats all areas of cancer spread.
For this treatment, the doctor puts an oily liquid into the main artery taking blood to the liver. The liquid helps to block the blood vessels taking blood to the 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 tumour.
For this treatment, you may have medicine to make you feel drowsy (sedation). The surgeon then injects a local anaesthetic into the skin over a blood vessel at the top of your leg. While using X-ray pictures the surgeon slides a thin plastic tube into the blood vessel. They push the tube gently upwards until the tip is in the artery that takes blood to the liver. When the tube is in position the surgeon injects the chemotherapy drug mixed with the oily liquid. The surgeon then removes the tube.
The 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 (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 causes little damage to the surrounding healthy tissue.
About 1 or 2 weeks before you have the treatment, you will 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 cause damage to healthy tissue.
The treatment itself takes about an hour, and you will need to stay lying down for about 4 hours afterwards to prevent bleeding. You may 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 will have 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.
We have more information about SIRT.
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.
Doctors use RFA to 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 may 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 may 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 may have a local anaesthetic or general anaesthetic. The 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 may have a general anaesthetic. If you have the sedative, your doctor will inject 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.
Doctors use laser therapy to 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 may 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 may 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 using a CT scan or ultrasound scan to make 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.
You can read about other treatments for advanced bowel cancer in this section.
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