What is Bowel Cancer Surgery?
A surgical procedure employed to treat bowel cancer is referred to as bowel cancer surgery. Surgery is often the most common treatment for bowel cancer. The type of surgery employed depends on the stage of the cancer and its location in the bowel. The surgery mostly involves removing a section of the affected colon and nearby lymph nodes as lymph nodes are often the first place a cancer spreads.
Bowel cancer, also called colorectal cancer, refers to cancer of the colon or rectum, the last parts of the digestive tract. It occurs from uncontrolled multiplication of the cells in the inner lining of the bowel. Bowel cancer often develops from polyps, which are small abnormal growths in the walls of the colon, but not all polyps develop into cancer.
Different Surgical Approaches for Bowel Cancer
Surgical approaches for the treatment of bowel cancer depends on the size of cancer, where it is located in the bowel, and whether it has spread or not to the adjoining or nearby structures.
The different surgical approaches include:
- Local resection: This is a procedure employed to remove early-stage colon cancers. During this operation, the surgeon uses a colonoscope (a long flexible tube with a small video camera at the end) that is passed through the rectum to remove the cancerous tissue from the lining of the bowel.
- Polypectomy: This is a surgical procedure to remove abnormal growths of tissue called polyps from the inside of the colon. This is generally done by passing a wire loop through the colonoscope to cut the polyp off the wall of the colon with an electric current.
- Colectomy: This is a surgical procedure to remove all or part of the colon including nearby lymph nodes. Removing the colon in its entirety is called a total colectomy. Removing a part of the colon is called a hemicolectomy or partial colectomy. Colectomy can be performed in 2 ways, open surgery or laparoscopic surgery.
- Open surgery: The surgery is done through a single long surgical cut (incision) in the tummy (abdomen). The incision goes down in a line from just below the sternum (breastbone) to just below the level of your navel (tummy button).
- Laparoscopic surgery: In laparoscopic (keyhole) surgery, the surgeon makes 4 or 5 small cuts in the tummy rather than one big cut. A laparoscope (a thin flexible tube containing a light and camera) is passed into the tummy through one of the cuts and specially designed surgical tools are inserted through the other cuts to remove cancer.
- Colostomy or ileostomy (stomas): During surgery to remove bowel cancer, an opening is sometimes made through the abdominal wall to connect the bowel to the surface of the tummy. This is called a stoma. The stoma functions by discharging the faecal matter into a disposable bag that is worn over the stoma. A stoma may be temporary or permanent based on your condition. When an opening is made for the colon, it is called a colostomy, and if an opening is made for the small bowel (ileum), it is called an ileostomy.
- Treatment for a blocked bowel (bowel obstruction): Sometimes, colon cancer can narrow the bowel, stopping bowel movements from passing through. This can be treated in one of two ways.
- Stenting: The surgeon uses a colonoscope to insert an expandable plastic or metal tube (stent) into the blockage. The tube is then expanded to keep the bowel open and relieve the blockage. Cancer-causing the blockage is usually removed with operation at a later date.
- Surgery: if a stent cannot be placed in blocked bowel, surgery is performed to remove the blocked section of bowel. After the surgery, a temporary or permanent stoma is created from the abdominal wall to discharge the stools. Cancer-causing the blockage can be removed at the same time or at a later date.
- Surgery for advanced bowel cancer: The liver and the lungs are the most common areas of the body that bowel cancer can spread to and chemotherapy is the first line of treatment to shrink cancer and control it. However, surgery is offered when chemotherapy fails to control the spread of cancer.
- Liver resection: If the bowel cancer has spread to the liver, a surgery called liver resection is performed to remove the section of the liver affected by cancer.
- Lung resection: If the bowel cancer has spread to the lung, lung resection surgery is offered to remove the affected section of the lung.
Preoperative Assessment
As part of the preparation for bowel cancer surgery, a pre-assessment clinic visit is recommended to evaluate your fitness for surgery. During this visit, a series of tests are conducted including blood pressure check, blood tests, and ECG to detect any cardiac abnormalities. Other steps involved prior to surgery include:
- You are advised to refrain from smoking to reduce the risk of chest infection and to help enhance wound healing post-surgery.
- You will be asked not to eat or drink anything for at least 8 hours prior to the surgery.
- Antibiotics will be administered prior to surgery to prevent infection during and after surgery.
- You will be placed on a special diet prior to surgery and laxatives may be used to clean out your bowel.
- You will be provided with TED stockings to wear during and sometime after surgery to prevent blood clots in the legs.
- The pros and cons of the surgery will be explained in detail and a signed consent form is obtained.
Postoperative Care and Instructions
Postoperative care and instructions will involve the following steps:
- You will be moved to the recovery area where you will be closely monitored by nurses until you are awake.
- Once you are awake, you may feel some pain and nausea so pain medicines and anti-nausea medications will be administered for your comfort.
- Fluids will be administered through an intravenous line to keep you hydrated.
- Your nurses encourage you to get you moving as soon as possible to help prevent blood clots and chest infections.
- Instructions on diet, bathing, incision site care, driving, and exercises will be provided.
- If you have a stoma from the surgery, management and care of the stoma will be explained by your nurse.
- You will be able to go home in 3 to 7 days following your surgery.
- A follow-up appointment will be scheduled to monitor your progress and to discuss any further treatment if required.
Risks and Complications of Bowel Cancer Surgery
Some of the potential risks and complications of bowel cancer surgery include:
- Bleeding
- Infection
- Blood clots
- Pain
- Fever
- Scar tissue
- Adhesions
- Damage to nearby organs
- Failed anastomosis (the surgical connection between parts of the intestine)
