Colon cancer is a cancer that begins in the colon, which is another name for your large intestine. Health experts often use the term colorectal cancer to refer to cancer that’s in the colon or the rectum, or the final part of the large intestine.
Nearly 148,000 adults were expected to be diagnosed with colorectal cancer in 2020, according to the American Society of Clinical Oncology. Excluding skin cancer, it’s the third most common cancer diagnosed in both men and women, the ASCO reports.
If colon cancer hasn’t spread to other areas of the body, the most common treatment is surgery. Surgery involves removing the part of the colon that has cancer.
How to Prepare for Colon Cancer Surgery
Once you’re diagnosed with colon cancer, you may want to have surgery right away. It’s normal to feel that way, but it’s better not to rush into surgery, says Dr. George Chang, chair of colon and rectal surgery in the division of surgery at the University of Texas MD Anderson Cancer Center in Houston.
Instead, he advises taking your time to get any other exams done before surgery and to get comfortable with your surgeon and health care team. “Have good discussions with your providers (about the surgery) so you can ask questions and know what to expect,” Chang says.
Before surgery, you will have to get examined by different doctors to make sure the rest of your body, including your heart and lungs, are healthy enough for surgery, says Dr. Julian Sanchez, a colorectal surgeon in the department of gastrointestinal oncology at Moffitt Cancer Center in Tampa.
Stay as healthy as you can. Patients with the best results from surgery are usually nonsmokers and not obese, Sanchez says. Eating healthy and exercising regularly can go a long way in helping you have a good surgical result. If you’re a smoker, your surgeon will want you to quit to help reduce your chance of complications after surgery. Ask your health care team for help to quit smoking if it’s a struggle.
In the day or so before surgery, most surgeons will want you to empty your bowels of any stool, similar to what’s done before a colonoscopy. Your health care providers will give you instructions on how to do this. That may include special drinks that will make you use the bathroom a lot. Your surgeon also may give you antibiotics to take the night before the surgery to cut down the risk for an infection.
Some surgeons give patients a special carbohydrate and electrolyte drink to have two to four hours before surgery, says Dr. Ronald Bleday, section chief in the division of colorectal surgery at Brigham and Women’s Hospital in Boston. This is similar to sports drinks like Gatorade or Powerade. The carbohydrates in the drink are long-acting and will prevent you from coming to surgery hungry, Bleday says.
Types of Surgery for Colon Cancer
For colon cancer that’s been detected in its early stages, such as stage zero or early stage 1, surgeons can perform essentially the same procedure as a colonoscopy. With a colonoscopy, surgeons use a long tube called a colonscope that has a video camera at the end. The scope is inserted in the rectum and then guided up to the colon. With special long tools such as a wire loop inserted through the colonscope, surgeons can remove polyps, which are abnormal tissue growths, as well as small cancers in the colon lining.
For colon cancer that’s too large to remove via colonoscopy, surgeons will remove the area of the colon with cancerous growth, as well as some of the healthy tissue surrounding it. Then, they will attach the two separated parts of the colon together. You can think of it like attaching two pipes together, Sanchez describes.
The surgery to remove part of the colon is called a colectomy. The more specific surgical name will depend on what part of the colon is removed. These names include:
- Left hemicolectomy.
- Low anterior resection.
- Right hemicolectomy.
- Sigmoid colectomy.
- Total colectomy, which is a complete removal of the colon. This isn’t needed very often.
Surgeons also will remove lymph nodes that are near the area of the tumor to study them under a microscope. Lymph nodes are small structures that help to fight off infection that are located throughout the body. Cancer can spread to the lymph nodes, and that’s why surgeons remove them. A closer look at the lymph nodes helps determine the stage, or severity, of the cancer. If cancer has spread to the lymph nodes, you will probably need chemotherapy at some point after surgery.
There are a few different approaches used for colon cancer surgery:
- Open surgery. This is done through an incision in the abdomen area and is considered a more traditional surgical approach. Surgeons still use open surgery for colon cancer in patients who have a large tumor or who have had multiple colon surgeries in the past, Bleday says.
- Laparoscopic surgery. This less invasive surgical approach uses smaller cuts in the abdomen compared with open surgery to insert a camera and instruments to remove the tumor.
- Robotic surgery. With robotic surgery for colon cancer, the surgeon uses a surgical system that offers more precision than the human hand. Robotic surgery also can be done with smaller incisions – about the size of a dime – compared with open surgery. The incision sizes for laparoscopic and robotic surgery are similar.
Both laparoscopic and robotic surgery are considered minimally invasive. Minimally invasive surgeries make it easier to recover and are associated with less scarring and pain, but they also take special surgical expertise. More than half of colon cancer surgeries are done with a minimally invasive approach, according to a 2015 study in the Journal of the National Cancer Institute. The percentage could be higher now, Chang says.
Typically, surgery for colon cancer takes two to three hours. Open surgery is usually faster than laparoscopic or robotic surgery.
If it’s not possible to connect the parts of the colon back together during surgery, surgeons perform what’s called a colostomy. Some patients need this because a larger portion of their colon is removed. This involves diverting the healthy part of the colon – and bypassing the damaged part of the colon – to an incision in the abdominal wall. The area where the opening sits is called a stoma. This is where waste matter will exit your body. A colostomy bag is then attached to collect the waste from your body.
Most patients having colon cancer surgery don’t need an colostomy bag. If they do, it’s usually only for a couple of weeks. Fewer than 10% of patients require one permanently, according to the Colorectal Cancer Alliance. A temporary colostomy allows for the reattachment of the colon at later point in time. It also allows the affected area to heal because stool is not passing through the area. Once the affected area has healed, you can undergo a colostomy reversal procedure.
What to Expect Immediately After Surgery
After surgery, you’ll rest at the hospital. The amount of time you’ll stay at the hospital will vary but could last about two or three days. You’ll probably leave the hospital sooner if you’ve had laparoscopic or robotic surgery.
Before you’re discharged, if you had a colostomy, a trained ostomy nurse will teach you how to care for the stoma and manage the bag.
Your digestive system will typically rest for a couple of days after surgery, so you’ll receive liquids by IV. Once your digestive system has output again, such as gas, it’s a sign that you can tolerate some regular food again, Sanchez says. Still, you may have to follow a clear liquid diet for a few days. Eventually, you should be able to return to a regular diet.
The medical staff will help you get up and walk around the day of or the day after surgery. Regular movement can help you and your digestive system recover more quickly.
Some patients feel pain after surgery but it’s usually mild, Sanchez says. You may receive stronger pain medication by IV for a day and then be switched to pain medication pills as needed. You also may feel bloated and uncomfortable until your digestive system starts working again due to trapped gas in the body.
Although complications aren’t common after colon cancer surgery, there’s always a risk. Just as with other surgeries, the most common potential complications include infection at the site of surgery as well as blood clots and healing problems. Healing problems are more common in those who are smokers, have diabetes, heart disease or who are obese, Chang says.
In the first three to seven days after surgery, let your doctor know if you experience:
- Nausea and vomiting.
- Pain in your abdominal area that’s getting worse.
These could be warning signs of an infection. “Don’t ignore it. If it’s persisting, contact your surgeon,” Chang cautions.
How Effective Is Surgery for Colon Cancer?
The goal of colon cancer surgery is to remove all of the tumor, Sanchez says. From that perspective, surgery is almost always successful.
If you have colon cancer, you may be focused on your chances of survival once you have colon cancer surgery. In most patients, colon cancer surgery removes the cancer and greatly decreases the chance of cancer returning in that part of the body. Five-year survival rates for colon cancer range from 14% to cancer that has spread to distant organs to 91% for colon cancer that hasn’t spread elsewhere in the body, according to the American Cancer Society.