Colorectal cancer affects about 140,000 people every year, making it the third most common cancer in both men and women. Colorectal cancer is most often treated with surgery to remove the tumor, and possibly, chemotherapy and radiation.
Colorectal Cancer Surgery Terms
- Polypectomy is a procedure in which polyps -- small growths on the inner lining of the colon -- are removed during a colonoscopy, a procedure in which a special instrument (the colonoscope) is inserted into the rectum to view the rectum and colon.
- Local excision can be used to treat cancers in the rectum (the lowest portion of the colon). The procedure involves removing the cancer and some tissue of the wall of the rectum. It may be done through the anus (the opening of the rectum) or through a small cut in the rectum. The procedure does not require major abdominal surgery.
- Resection involves the removal of part, or all, of the colon along with the cancer and its attaching tissues.
- Laparoscopic surgery The word "laparoscopy" means to look inside the abdominal cavity with a special camera or scope. To perform laparoscopy, between 3 and 6 small (5-10 mm) incisions are made in the abdomen. The laparoscope and special laparoscopic instruments are inserted through these small incisions. The surgeon is then guided by the laparoscope, which transmits a picture of the intestinal organs on a video monitor.
What Is Laparoscopic Surgery?
Until recently, all bowel or intestinal surgery was done through long abdominal incisions, which often resulted in a painful and lengthy recovery. In the early 1990s, doctors started using a laparoscope, an instrument that had primarily been used to treat gynecological problems and gallbladder disease, to perform certain types of bowel surgery. Rather than making long incisions common in traditional "open" surgery, laparoscopic surgery requires only small incisions to perform the same operation. Another type of laparoscopic surgery is called hand-assisted and allows for one of the surgeons hands to be inserted into the abdominal cavity while still viewing the procedure with the laparoscope.
The benefit of using a laparoscopic approach is that you will likely experience less pain and scarring after surgery, a more rapid recovery, and less risk of infection than with an open surgery through a large incision.
Colorectal surgeons have used laparoscopy to treat the following conditions:
- Crohn's disease
- Colon cancers
- Familial polyposis
- Certain colon polyps that cannot be removed by colonoscopy
- Bowel leakage or fecal incontinence
- Rectal prolapse
- Ulcerative colitis
- Certain rectal cancers
Surgery Options for Colorectal Cancer
There are several types of surgery which may be used to treat colorectal cancer:
- Partial colectomy. As the name suggests, this is when the surgeon removes only part of the colon. The remaining parts will be joined together in a procedure that doctors call anastamosis. If you have a partial colectomy, then your bowel habits should go back to being pretty much the way they were before you had the cancer.
- Right colectomy, or Ileocolectomy. During a right colectomy, the right side of the colon is removed. During an ileocolectomy, the last segment of the small intestine - which is attached to the right side of the colon, called the ileum, is also removed.
- Abdominoperineal resection. This is an operation in which the anus, rectum, and sigmoid colon are removed. A permanent colostomy is required, as the anus is removed.
- Proctosigmoidectomy. In this operation, the diseased section of the rectum and sigmoid colon is removed.
- Total abdominal colectomy. A total abdominal colectomy is an operation that removes the entire large intestine.
- Total proctocolectomy. This is the most extensive bowel operation performed and involves the removal of both the rectum and the colon. If the surgeon is able to leave the anus and it works properly, then sometimes an ileal pouch (see below) can be created so that you can go to the bathroom as you did before you had cancer. However, often a permanent ileostomy (see below) is needed, particularly if the anus must be removed, is weak, or has been damaged.
Other Procedures for Colorectal Cancer
- Stomas or ostomies. A stoma is an opening of some part of the bowel onto the skin. A colostomy is an opening of the colon onto the skin and an ileostomy is an opening of the ileum (or small intestine) onto the skin. A colostomy or an ileostomy may be permanent or temporary. Permanent stomas are made when stool cannot go through its normal route after surgery. Temporary stomas are made to keep stool away from a damaged or recently operated area while healing occurs. The stool that comes out of a stoma is collected in a bag.
- Fecal diversion. This procedure is used to create an ileostomy (opening between the surface of the skin and the small intestine) or colostomy (opening between the surface of the skin and the colon). This is often used as a temporary measure to allow for healing of an infection, recent surgery, or chronic inflammation.
- K pouch. The K pouch is also known as the "continent ileostomy." Unlike the J pouch (see below), which is attached to the anus to allow you to go to the bathroom the usual way, the K pouch is a fancy form of an ileostomy. Unlike a usual ileostomy which needs to be attached to a bag outside the body, the K pouch provides a reservoir for the stool and adds a nipple valve to prevent the stool from leaking. The pouch is emptied by inserting a stiff catheter through the stoma, which is covered with gauze in between emptying. One problem with the pouch, and the reason it is not very popular among surgeons, is that the valve often comes undone, or slips, and another operation is needed to repair it. The surgery is very complex and long-term problems are common. This is usually only used if the ileal pouch (see below) is not an option.
- Ileal (J) pouch. To replace the rectum and provide a place to store the stool before going to the bathroom after a total proctocolectomy (see above), surgeons can sometimes create a pouch out of the end of the small intestine called the ileum. There are different forms of the ileal pouch, named after the shape in which the end of the small intestine is placed before it is sewn (or stapled) to make a pouch. The most common form is the "J" pouch. Creating the pouch is complicated and it sometimes doesn't work. To improve your chances, the surgeon will make a temporary ileostomy to allow the pouch to heal without having to defend itself from a stream of stool. Usually, the temporary ileostomy can be reversed after about two to three months.