1. What are the symptoms of colon cancer?
2. What is the surgical approach for colon cancer?
3. What are the treatment options available depending on colon cancer stage?
4. What are the surgeries performed to treat colon cancer?
5. What is the surgery performed to prevent metastatic colon cancer?
6. What are the possible side effects of colon cancer surgery?
Colon cancer is the third most commonly known cancer in both men and women. Large bowel tumors are the most common type of digestive cancer and account for a large proportion of all gastrointestinal (GI) surgeries. Colon cancer is mostly treated with surgery to remove the tumor. Over the past few decades, there are many new advances, such as the use of laparoscopic methods, and there is a drastic improvement in laparoscopic-based diagnostic and screening procedures. Furthermore, advances in genetics now carry the exciting promise of earlier diagnosis and more accurate prediction of survival.
Depending on the location of the tumor, symptoms of colorectal cancer include:
Surgery is the optimal treatment approach for colon cancer. The results turn out to be good depending on the preoperative preparation, performing an appropriate and safe operation, and postoperative care. The choice of surgery is based on the anatomic location of the lesion.
The surgical procedure requires the removal of the tumor and also the surrounding healthy tissue. This is also called surgical resection. It is the foremost treatment for colon cancers in the early stages. A surgical oncologist is a specialist in treating cancer using surgery. The type of surgery employed depends on the stage and location of cancer. Any type of colon surgery shall be performed on a clean and empty colon. Until surgery, the patient may have to take a strict diet and will need to use laxative drinks and enemas to get all the stool out of the colon. The preparation of the intestines is much like the one before a colonoscopy.
Principle points to be considered before the surgery of colon cancer include:
In addition to surgical resection, the options of surgical treatment for colon cancer include:
There are different stages of colon cancer. These stages 0, I, II, and III are usually often curable with surgery. Most people with stage III colon cancer, and those with stage II, are undergoing chemotherapy after surgery to increase the chance of eliminating cancer. Patients with rectal cancer in stage II and III can also undergo chemotherapy radiation therapy, either before or after surgery. Stage IV is not always curable, but it is treatable and can control cancer growth and disease symptoms.
At this stage, surgery cannot cure cancer, but it can help relieve the blockage of the colon or other problems related to cancer. There is a possibility of a complete cure if colon cancer has only spread into the liver and if surgery is necessary before and after chemotherapy. Also, if cancer cannot be cured, surgery can be of great help to add months or even years to the life of a patient.
Polypectomy and local excision
A colonoscopy can remove some early colon cancer (stage 0, and some early stage I tumors) and most polyps. This technique uses a long and flexible tube with a small video camera on the end which is inserted in the rectum of the person and the entire colon is visualised. These surgeries may be conducted during a colonoscopy:
The doctor need not cut into the abdomen when cancer or polyps are taken this way.
Colectomy
A colectomy is a surgery that removes all or part of the colon along with the nearby lymph nodes. If only part of the colon is cut it is called hemicolectomy or partial colectomy or segmental resection. The surgeon removes the section of the colon with cancer on either side and a small portion of the normal colon. Depending on the size and location of cancer, about one-fourth to a third of the colon is normally removed. The rest of the colon sections are then reattached. At least 12 lymph nodes in the area are also removed to check for cancer.
If the entire colon is removed, it is called a total colectomy. It is mostly used when there is another problem in the colon with cancer, such as hundreds of polyps or inflammatory bowel disease like ulcerative colitis.
How is it performed?
A colectomy can be performed in two ways:
Since the incisions are smaller than in an open colectomy in a laparoscopic-assisted colectomy, patients often recover more rapidly than in the aftermath of open colectomy. However, this kind of procedure involves a skilled, trained and experienced doctor and may not be the right choice for all. In general, survival rates and the risk of cancer recurrence between an open colectomy and a laparoscopic colectomy are almost the same. The removed portion of the colon is extracted through a small incision using a wound protector.
Abdominoperineal Resection
That is a procedure that removes the anus, rectum and sigmoid colon. It needs a permanent colostomy as the anus is removed.
Proctosigmoidectomy
In this surgery, the diseased section of the rectum and sigmoid colon is removed.
Total Proctocolectomy
It is the most extensive bowel procedure carried out and includes both the rectum and the colon removal. When the surgeon can leave the anus and it functions properly, an ileal pouch can be created. However, a permanent ileostomy is often required, particularly when anus has to be removed, or is weak, or damaged.
Metastatic colon cancers are the one that spread to other parts of the body and also have tumors blocking the colon. The surgery may be done to remove the blockage without removing the part of the colon with cancer. Instead, the colon is given an incision through the tumor and attached to a stoma to expel stool. This is called a diverting colostomy. This can help the patients to recover and start with other treatments such as chemotherapy to avoid recurrence of colon cancer.
Some patients require colostomy (or ileostomy) after surgery temporarily or permanently. This may take a while to get used to and may require changes in lifestyle. A patient needs to learn how to manage if they have a colostomy or ileostomy. This may be achieved by specially qualified ostomy nurses or enterostomal therapists. They normally see the patient before the procedure in the hospital to address the ostomy and mark the opening site. They can go to the patient’s house or visit them in an outpatient setting to provide with more training after the procedure.
There are many considerations to the possible complications and side effects of the surgery, chemotherapy or radiation therapy including the duration of the procedure and general health before the surgery. Problems can include vomiting, infection and blood clots on the legs during or shortly after surgery.
Compared to traditional open surgery treatment for colon cancer, the advanced methods such as Robotic Surgery involves smaller incisions which help many cancer patients to recover faster and aid in the speedy return of their bowel function.
About Author –
Dr. K. Sreekanth, Consultant Surgical Oncologist, Yashoda Hospital, Hyderabad
MS, M.Ch (Surgical Oncology)
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