After your diagnosis, you will normally undergo a range of test in order to determine the size and exact location of your tumour. In most cases, surgery will be necessary to remove the tumour from your bowel, either as a sole treatment, or in conjunction with chemotherapy and/or radiotherapy
What methods of surgery are used?
There are different surgical methods, depending on the size and location of the cancer within the bowel, and whether or not it has spread. Depending on which sort of operation you require, the surgery can either be done in the traditional open surgery method, or via laparoscopic surgery (commonly known as keyhole surgery). Your consultant will discuss the best options with you for your treatment.
The colon is the upper part of the large bowel. Usually for tumours in this area, the surgeon will completely remove the tumour, along with a portion of healthy tissue either side in order to ensure that all of the cancerous cells have been removed. Depending on how much of your bowel has been removed, the surgeon may be able to rejoin the ends of the colon. However in some cases a stoma may have to be fitted.
The most common types of colon surgery are:
Right hemi-colectomy – the right half of the bowel is removed, and the ends joined back together
Left hemi-colectomy – the left half of the bowel is removed, and the ends joined back together
Sigmoid colectomy – the sigmoid colon is removed and the two ends are then joined back together.
Hartmann’s procedure – the sigmoid colon and upper rectum are removed, resulting in an end colostomy.
Total colectomy – the entire colon is removed, leaving behind only the rectum. This procedure also results in a colostomy
Pan proctocolectomy – the colon, rectum and anus are all removed, which results in a permanent ileostomy
As with colon surgery, there are different surgical methods available, depending on the size and location of your tumour. For tumours in the rectum, surgery may be given as a treatment alongside chemotherapy and/or radiotherapy which help to shrink the tumour either before or after surgery, and offer a better long-term prognosis on the chances of the cancer returning. For small tumours which are located in the lower part of the rectum, your surgeon may perform a technique called local transanal resection, which involves removing the tumour via the anus, without the need for surgical incisions. Other techniques for removing very small tumours involve inserting either an endoscope, or sigmoidoscope into the anus, in order to remove the tumour without the need for open surgery.
In some cases, however it will be necessary to remove either whole or part of the rectum in a Total Mesorectal Excision (TME). This has proven to be the most effective form of rectal surgery to reduce the chances of the cancer recurring.
The most common types of TME are:
Colo-anal ‘J pouch’ surgery – the rectum is removed and the colon reattached directly to the anus. In some cases it is possible for a new rectum to be formed from the colon. Usually a temporary stoma is fitted to allow for healing.
Abdomino-perineal resection – the rectum and the anus are completely removed and a permanent stoma (colostomy) is fitted on the lower abdomen.
High or Low anterior resection – depending on the exact location of the cancer within your rectum. Usually during this procedure a temporary stoma (ileostomy) is fitted for a few months to allow the rectum to heal.
How should I prepare for surgery?
Your consultant will advise on the best way to prepare for your operation. In some cases you may be able to eat up until a few hours before surgery, but in other cases you may have to fast or take laxatives in order to clear your bowel. It is important to stay hydrated, so drink plenty water unless advised otherwise.
What happens next after surgery?
Recent research has shown that getting patients moving again as soon as possible after surgery helps speed recovery. You will be encouraged to sit up, stretch your legs, and stand up and walk around as soon as you feel able to do so.
You may be given a low-fibre or low-residue diet for the first few weeks after your operation, in order to allow the bowel to heal properly, or if you have had a stoma fitted then your specialist may give you specific dietary advice relating to this. A low-fibre diet will help reduce the size of your stools, which will help to minimise any pain around the area of surgery. Usually you will only stay on this diet for a few weeks, before gradually increasing your fibre intake.
Will I require a stoma after surgery?
Depending on the type of surgery required to remove your tumour, it may be necessary for the surgeon to form a stoma on your abdomen, which is an opening for waste to pass through. These may either be temporary to allow the bowel to heal; or permanent if a larger section of the bowel has been removed. Normally your surgeon will discuss with you before the operation whether you will need a stoma, and will be able to answer any questions you may have. You will also meet with a stoma care nurse who will be able to run through aftercare procedures for your stoma.
There are different types of stoma, which again depends on the type of surgery required. The two main types are as follows:
Ileostomy – this type of stoma is formed by creating an opening from the small bowel (ileum) out through your abdomen. Normally this is only temporary to allow for healing after rectal surgery, and the procedure can be easily reversed, allowing waste to pass through your bowels again as normal.
Colostomy – a colostomy is a type of stoma that is formed from your colon (large bowel), allowing waste to pass out through your abdomen. These can either be temporary or permanent, depending on whether the surgeon is able to reattach the remaining sections of the bowel.