Surgery
The type of operation you have will depend on:
- where the cancer is in the bowel
- the type and size of the cancer
- whether the cancer has spread.
How long you stay in hospital will depend on the type of operation you have.
Surgery to remove part of the bowel is called a colectomy. If the left side of the bowel is removed, it is called a left hemicolectomy.
Left hemicolectomy
If the middle part of the bowel is removed (the transverse colon), it is called a transverse colectomy.
Transverse colectomy
If the right side of the bowel is removed, it is called a right hemicolectomy.
Right hemicolectomy
If the sigmoid colon is removed, it is called a sigmoid colectomy.
Sigmoid colectomy
After your surgeon removes the part of the bowel containing the tumour and the surrounding lymph nodes, the ends of the colon are joined back together. The place where they join is called an anastomosis. Sometimes, to give the area time to heal, the surgeon makes a temporary colostomy or ileostomy higher up the bowel (see below for explanations of colostomy and ileostomy). You will have the temporary stoma repaired in another operation several months later.
This is called a stoma reversal. In the meantime, you will have a colostomy bag over the opening of the bowel.
If you have a large amount of colon removed (total colectomy), your surgeon may not be able to join together the ends of the bowel that are left. You may need to have a permanent ileostomy or stoma.
Colostomy
If, for some reason, the bowel cannot be rejoined, the upper end can be brought out onto the skin of the abdominal wall. This is called a colostomy and the opening of the bowel is known as a stoma. A bag is worn over the stoma to collect the stool (bowel motions). Sometimes a colostomy is only temporary and another operation to rejoin the bowel can be done a few months later.
The operation to rejoin the bowel is known as stoma reversal. If it is not possible to reverse the colostomy, the stoma is permanent. However, only a small number of people with cancer of the colon will need a permanent colostomy.
Ileostomy
Some people need to have an operation called an ileostomy, in which the end of the small bowel (ileum), or a loop of ileum, is brought out onto the right side of the abdominal wall. As with a colostomy, stools are then collected in a bag worn over the stoma.
Sources: CancerHelp UK and Macmillan Cancer Support UK
Surgery for rectal cancer
You may have radiation treatment or chemo-radiation (see the 'Other treatment' page for more information) to shrink a tumour before surgery to make it easier to remove.
Total mesenteric excision (TME)
During most surgery for rectal cancer, the surgeon removes the tumour and some surrounding rectal tissue. They also remove the fatty tissue around the bowel and a sheet of body tissue called the mesentery. This lowers the risk of the cancer’s coming back.
For cancers in the upper part of the rectum, your surgeon will remove the part of the rectum containing the tumour. This is called a low anterior resection.
If your tumour is in the middle part of the rectum, your surgeon may remove most of the rectum and attach the colon to the anus. This is called a colo-anal-anastomosis. Sometimes the surgeon can make a small pouch by folding back a short section of colon, or by enlarging a section of colon. This small pouch then works as the rectum did before surgery. During this operation you will probably have a temporary colostomy or ileostomy made. You have the temporary ileostomy for some months while the bowel heals. You then have a second operation to close the stoma opening.
If the cancer is in the lower part of your rectum, your surgeon will not be able to leave enough of the rectum behind for it to work properly, so they will remove your anus and rectum completely. This is called an abdoperineal resection (AP resection). Then the surgeon will make a permanent colostomy opening on your abdomen. After this type of surgery you have two wounds — a wound on your abdomen and a second wound around the anus, where it has been closed.
Abdoperineal resection
Keyhole bowel surgery
For small bowel cancer the surgeon can use keyhole surgery (laparoscopic resection). The surgeon makes several small cuts in your abdomen instead of making one large cut. The surgeon passes a long tube called a laparoscope and other instruments through these cuts. They look through the laparoscope to do the operation. The surgeon then removes the tumour through as small a cut as possible. This type of surgery takes longer than a traditional open operation. However, the stay in hospital may be shorter.
If the cancer blocks the bowel
Usually, your surgery for colorectal cancer would be planned in advance, after your tests have found the cancer. But sometimes the cancer completely blocks the bowel and this is called a bowel obstruction. In this situation you need an operation straight away. The surgeon may put a tube called a stent into the bowel during an endoscopy. The stent holds the bowel open so that it can work normally again. You may have immediate surgery to remove the cancer from the bowel or a stoma may be formed to relieve the obstruction.
Side effects of surgery
An operation on your bowel is a major procedure and you may feel tired for weeks or even months afterwards. You may find that you will need to take four to six weeks off work, and will be unable to lift heavy objects.
You may have altered bowel habits after surgery; for example, more frequent, looser motions. It can take up to a year for your bowel habits to settle into a routine because the bowel has been shortened. You may also find that your bowel produces more wind than before, and this can sometimes build up in the abdomen and cause pain. Drinking peppermint water or taking charcoal tablets can help to reduce this. Your doctor can prescribe these for you, or you can get them from your chemist. Some people find that their bowel may always be more active than before their surgery, and that they have to eat carefully to control their bowel movements.
Source: Macmillan Cancer Support UK
Talk to your doctors and nurses about what you can expect. You may find it helpful to talk to a dietitian about what to eat. There are medications available to help manage changes in your bowel habits. For advice on what suitable foods to eat and other tips, read the Cancer Society’s booklet Eating Well/Kia Pai te Kai. You might find the sections on diarrhoea, a low fibre diet and a low residue diet useful to read. Call the Cancer Information Helpline 0800 CANCER (226 237), or contact your local Cancer Society office to receive a copy. You can read this booklet online (or print it off) on the Cancer Society’s website.
Managing your stoma
If you have a stoma, the stomal therapists (specialist nurses) will manage your stoma bags initially, and then work with you to teach you how to do this yourself. Ostomy bags and appliances are supplied free when you are at home if you are a New Zealand citizen. You may find it helpful to get in touch with someone else who has had a stoma and talk to them about how they cope. Your stomal therapists, local Ostomy Society or Cancer Society will be able to help.