This page discusses the use of surgery for the treatment of colorectal cancer. For a thorough review of surgical procedures for the treatment of cancer, please see the surgery treatment monograph .

If colorectal cancer has not spread beyond the colon or lymph nodes, surgical removal of the tumor is the most common treatment. The purpose of surgery is to remove the section of the colon that contains the tumor or cancer cells, and then reattach the colon to the healthy section.

Surgical procedures for rectal cancer are more complex than for colon cancer, because more tissues and muscles related to urinary and sexual functions are involved.

Depending on your individual condition, your doctor may choose one of the following surgical treatment methods:

Local Excision

Local excision is a method to remove superficial cancers and some nearby tissue from the inner layer of the rectum. A tube is inserted up the rectum into the colon, and the cancerous tumor is removed. This procedure is used when the cancer is found at an early stage.

A local excision, though considered very appropriate in certain circumstances, is not commonly done as a cancer surgery. Therefore, it is very important that an experienced surgeon perform this procedure. In some cases—for example, if the tumor is larger than 2 cm, invades through the bowel muscle, or appears aggressive under the microscope—follow up radiation therapy (with or without chemotherapy ) will be necessary. When the tumor has any of these features, there is a real chance of spread to the lymph nodes and the local excision does not give the surgeon the opportunity to evaluate the lymph nodes.

After this procedure, you may be given antibiotics and anti-nausea and pain medications.Your rectum will require some time to heal before it will function properly again. Initially, you'll receive nutrition through an IV. As your tolerance of food and liquids improves, you'll slowly be advanced through liquid and soft diets to a regular diet.

Resection: Colectomy and Anastomosis

Colectomy is the removal of part of the colon. If the cancer is large, both the tumor and a small amount of healthy tissue and nearby lymph nodes and blood vessels will be removed. This is called a hemicolectomy.

The lymph nodes that are removed are examined under a microscope to see if they contain cancer cells. The surgeon will remove as much of the colon or rectum as is necessary to give you the best chance of cure. An experienced surgeon will never compromise the extent of surgery to protect your anal function, however. In other words, if your tumor is very close to the anus and the surgeon needs to remove that structure and give you a permanent colostomy, they will do just that. No matter how much radiation or chemotherapy you get, there is no substitute for the correct surgical procedure.

In many cases after a colectomy, the healthy portions of the colon and rectum are reconnected. This reconnection procedure is called anastomosis. If your surgeon can possibly preserve your anal function (and ultimately avoid the need for a permanent colostomy) that is generally considered a preferred procedure. A surgical procedure requiring a permanent colostomy has never been shown to be better or more curable than a procedure where you can retain normal bowel function.

Care after the Procedure

You may be in the hospital for three to seven days after this procedure, depending on your case. You may be given antibiotics and anti-nausea and pain medications. In addition, tour intestine will require some time to heal before it will function properly again. Initially, you'll receive nutrition through an IV. As your tolerance of food and liquids improves, you'll slowly be advanced through liquid and soft diets to a regular diet.

Resection and Colostomy

If it is not possible to reconnect the colon, a temporary or permanent colostomy is necessary. A colostomy is a surgical opening (stoma) through the wall of the abdomen into the colon, which provides a path for waste material to leave the body. After a colostomy, you will wear a special bag to collect body waste.

The colostomy may be either temporary or permanent. Sometimes the colostomy is needed only until the lower colon has healed, and then it can be reversed. If the doctor needs to remove the entire lower colon, however, the colostomy may be permanent.

Surgical Resection of a Colorectal Tumor Mass

Surgical Resection of a Colorectal Tumor Mass
© 2009 Nucleus Medical Art, Inc.

Care after the Procedure

After this procedure, you may stay in the hospital from five to seven days. You'll be given antibiotics and anti-nausea and pain medications as needed. Your intestine will require some time to heal before it will function properly again. Initially, you'll receive nutrition through an IV. As your tolerance of food and liquids improves, you'll slowly be advanced through liquid and soft diets to a regular diet. In addition, you may be given special compression stockings to wear after surgery to decrease the possibility of blood clots forming in your legs.

Care for a Colostomy

If you have a colostomy created, the surgery will change some aspects of the way your intestine functions.

  • An enterostomal nurse (ETN) or your surgeon will teach you how to care for the ostomy site.
  • In the first weeks after your operation, avoid high-fiber foods, including corn, celery, apples, nuts, popcorn, grapes, and other foods with hulls, peels, and seeds. When your doctor says you may eat these foods again, begin with small amounts, so you can see how your intestine adjusts to digesting them.
  • Alert your physicians and pharmacist that you cannot take medications that are considered long-acting or sustained release.
  • Do not use laxatives, because post-colostomy stools are usually quite liquid.
  • Drink eight 8-ounce glasses of liquid a day (not including caffeinated beverages), to replace the extra fluid that will be lost in your stool.