The type of surgery you have for cancer of the large bowel (colon) depends on the position and the size of the cancer in your bowel.
Surgery to the large bowel (colon) is different from surgery to the back passage (rectum).
Types of surgery
There are different types of surgery for colon cancer. The operation that is most suitable for you depends on:
- where your cancer is
- the type and size of cancer
- whether your cancer has spread to other parts of your body
Types of colon cancer surgery include:
- surgery to remove a small part of bowel lining - this is called a local resection
- surgery to remove all or part of your bowel - this is called a total or partial colectomy
- having a colostomy or ileostomy
- surgery for a bowel blockage (bowel obstruction)
Surgery to remove a small part of bowel lining (local resection)
This surgery is for small, early stage cancers. Your surgeon removes the cancer from the bowel lining, along with a border of healthy tissue (margin). The surgeon uses a flexible tube called a colonoscope to do the operation.
Surgery to remove all or part of your bowel (colectomy)
Your surgeon might remove the part of the colon containing the tumour. This is called a colectomy. How much your surgeon takes away depends on the exact position and size of the cancer.
The operations have different names depending on where the cancer is. Surgery to remove part of the colon is called a hemicolectomy or partial colectomy. Surgery to remove the whole of the large bowel (colon) is called a total colectomy.
After your surgeon removes your cancer, they join the ends of the bowel back together. Sometimes to give the bowel time to heal, the surgeon brings the end of the bowel out as an opening on your abdomen called a stoma.
Having a stoma
Sometimes to give the bowel time to heal, the surgeon brings the end of the bowel out as an opening on your abdomen called a stoma. There are two different types of stomas:
- ileostomy – the cut made in the small bowel is put through the lining of the abdomen
- colostomy – the cut made in the large bowel is put through the lining of the abdomen.
The stoma is usually temporary and you have another operation to repair the stoma after a few months (a stoma reversal).
The surgeon might have to make a permanent stoma if they remove a lot of your bowel. But most people don't need a permanent stoma.
Sometimes your surgeon can't tell if you will need a permanent stoma until during the operation. They may not know how big the cancer is, or how much of the bowel it affects. Your surgeon will explain this and how likely is it that you’ll need a permanent stoma to you before the operation.
Surgery if cancer blocks the bowel
Sometimes bowel cancer can cause a blockage. This is called bowel obstruction.
If this happens you will need an operation straight away. Your surgeon may put a tube called a stent into the bowel. This holds the bowel open allowing it to work properly again. Or your surgeon may remove your tumour from the bowel.
How you have surgery
This means your surgeon makes one long cut down your abdomen to remove the cancer.
Keyhole (laparoscopic) surgery
Your surgeon makes several small cuts in your abdomen. They pass a long tube with a light and camera through one of the holes. Surgical instruments are put into the other holes and are used to remove the cancer.
Generally, with keyhole surgery, people recover quicker.
Your surgeon might offer you keyhole surgery if they need to remove part of your bowel. But it depends on your situation, and some people aren’t able to have keyhole surgery. Sometimes the surgeon has to switch from keyhole to open surgery during the operation. Your surgeon will talk to you about this before your operation.
Some surgeons use a robotic system to help with keyhole surgery. The surgeon sits slightly away from you and can see the operation on a magnified screen. The robotic machine is next to you. The machine has 4 arms. One arm holds the camera, and the others hold the surgical instruments. The surgeon controls the arms of the machine to remove the cancer.
Robotic surgery is still a new technique and not all hospitals in the UK have this. Doctors hope that robotic surgery might lower the risk of:
- your surgeon needing to switch to open surgery
- complications during and after surgery
But at the moment, specialist doctors are still looking into the overall benefit of robotic surgery in bowel cancer compared to open and keyhole surgery.