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Your Guide to Colon Cancer Surgery Key Terms and FAQs

Medically reviewed by Saurabh Sethi, M.D., MPH — By Jacquelyn Cafasso on September 22, 2022Share on PinterestOhlamour Studio/Stocksy UnitedColon cancer is a type of cancer that starts in your large intestine (colon). Colon cancer happens when cells in the colon grow out of control. Surgery is the main form of treatment for colon cancer. During the surgery, a doctor removes a part of your colon. Depending on the stage of the cancer, a doctor may also combine surgery with other treatments, such as chemotherapy, radiation, and immunotherapy. The type of surgery and your outlook will depend on a few factors, including which part of the colon is affected, the stage of the cancer, and how far the cancer has spread. In this article, we’ll answer common questions about colon cancer surgery, including what to expect, how to prepare, and what recovery looks like.

What type of colon cancer surgery do I need

Depending on the stage of your cancer, there are three surgical options for colon cancer:Polypectomy: A surgeon will remove potentially cancerous polyps from your colon. This can be preventive as polyps may develop into cancer.Local excision: If cancer hasn’t yet spread outside the lining of the colon, your doctor might be able to remove just a small piece of the lining of the colon wall.Colectomy: Once cancer has spread into the tissue surrounding the colon, a doctor will likely have to remove a part of the colon. This is called a colectomy or a large bowel resection. Your doctor might be able to treat early-stage colon cancer (stage 0 or stage 1) with a polypectomy or local excision. These are minimally invasive and often outpatient procedures. That means you usually don’t have to stay in the hospital overnight. Stage 0 colon cancer means that cancer hasn’t grown beyond the inner lining of the colon. Stage 1 means that cancer has spread deeper but is still contained in the layers of the colon wall. Later stages of colon cancer may require a colectomy. There are a few different types of colectomies. The type needed depends on the location of the cancer:Partial or subtotal colectomy: removes part of the colonHemicolectomy: removes the entire right or entire left part of the colonSigmoid colectomy (sigmoidectomy): removes only the last part of your colon, known as the sigmoid colonProctocolectomy: removes both the colon and the rectumTotal colectomy: removes the entire colon Total colectomies are less common. A doctor would typically only recommend a total colectomy if there’s an underlying condition, such as inflammatory bowel disease, affecting the part of the colon without cancer.

What is the procedure for a polypectomy or local excision

A polypectomy removes a cancerous growth (polyp) without an incision. A doctor can do this as part of a colonoscopy. During a colonoscopy, they’ll slowly and gently guide a long flexible tube with a camera into your anus, through the rectum, and into the colon. Polypectomy is typically a simple, painless procedure. Still, doctors consider it surgery. A local excision is similar to a polypectomy but is a bit more complex. It’s also part of a colonoscopy, but a surgeon will use tools to remove cancerous tissue from the lining of the colon. They’ll also remove small sections of nearby healthy tissue.

What is the procedure for a colectomy

A colectomy is when a surgeon removes a part of your colon. They then connect the remaining parts of the colon. They may also remove several nearby lymph nodes. There are three ways to perform a colectomy:Open colectomy: A surgeon makes a large cut into the stomach and removes a section of your colon and nearby lymph nodes.Laparoscopic colectomy: A surgeon makes small incisions in the abdomen and uses special instruments, guided by a camera, to remove a section of your colon and nearby lymph nodes. Laparoscopic surgery is also called keyhole surgery. This is minimally invasive surgery since there’s no large incision.Robotic surgery: This is a type of laparoscopic surgery in which the surgeon uses a robot to guide the surgery. This technology may or may not be available in your hospital. Open and laparoscopic colectomies are both effective at removing cancer. But laparoscopic colectomies often have a faster recovery time and cause less pain. You should speak with your doctor to find out whether laparoscopic surgery is right for you.

What is a colostomy

Sometimes, cancer can block your colon, or the tumor causes a hole in the colon. In these cases, your doctor may not be able to reconnect your colon after a colectomy. Instead, the top end of the colon is attached to a hole (called a stoma) in the skin of the stomach. This is called a colostomy. Your stool will come out of this opening into a bag attached to your skin. A doctor or nurse will teach you how to empty and change your colostomy bag. A colostomy is usually temporary. Your doctor may reconnect the two ends of the colon after a few months. Most people who have colon surgery won’t need a colostomy. Fewer than 10% of people with colon cancer will end up having a permanent colostomy.

If your colon cancer has spread

Sometimes colon cancer spreads (metastasizes) outside the colon to other parts of the body, such as the lungs or liver. If this happens, you might need additional treatments, including surgery, chemotherapy, and radiation to treat these tumors in addition to surgery in the colon. Your doctor may decide to cut the colon above the cancerous part and place the healthy portion through a hole in the abdomen called the stoma. This is called a diverting colostomy. Your stool will come out of the stoma into a bag attached to your skin. A diverting colostomy can help you recover enough to start other treatments for cancer that has spread to other parts of your body.

What are the risks of colon cancer surgery

After surgery, you might experience some pain. You may not be able to eat solid food for a few days to allow time for the colon to heal. For a few weeks after the surgery, you might also have issues with your bowel movements, such as diarrhea, constipation, or fragmented stools. Some people experience pain while using the restroom the first few times after surgery. Possible risks and complications of colon cancer surgery include:bleedingblood clotsinfectionileus, lack of movement in your intestines, which can lead to an obstructionleaking at the site of anastomosis (reconnection), which can cause an infectionadhesions from scar tissue in the abdomen that causes organs or tissue to stick together

How do I prepare for colon cancer surgery

Colon cancer surgery requires a clean and empty bowel. Your doctor will ask you to follow a special diet before surgery. You’ll likely have to drink laxatives or use an enema to remove all the stool from your colon before the surgery. This prep is very similar to what you’d do before a colonoscopy. Be sure to tell your doctor about medications you’re taking, especially any blood thinners, and alert them to any medications that you’re allergic to. Your doctor might ask you to stop taking certain medications in the days or weeks leading up to your surgery.

What does recovery from colon cancer surgery look like

When you wake up from a colectomy, you’ll likely experience some pain. Your doctor will try to manage this pain with medications. You’ll likely have a drip into your arm (IV infusion) to give you fluids and medications until you’re able to eat and drink again. You might also have a catheter (flexible tube) inside your bladder to drain urine and a tube going down your nose into your stomach. A nurse will be monitoring your health. You will have to stay in the hospital for about 2 to 4 days following the surgery. It may take up to 6 weeks to fully recover. You’ll want to avoid strenuous activities, heavy lifting, and contact sports to give time for your incisions to heal. Recovery for a polypectomy or local excision is usually much shorter than for a colectomy.

Eating and drinking

You won’t be able to eat or drink after a colectomy. You’ll receive fluids through an IV drip. Your doctor will tell you when you’re allowed to start eating and drinking again. You’ll start with small sips of water and gradually build up. Depending on your type of surgery, you might have to start with a liquid diet and work your way up to solid foods over the course of a few days. You’ll meet with a dietician in the hospital to discuss your diet. If you’ve had a polypectomy, you can start eating and drinking right away. But you may be asked to avoid food and drinks that might irritate your digestive system for a few days, such as coffee, soda, alcohol, and spicy foods.

Colostomy

If your surgery included a colostomy, you’ll have to change the bag and keep the stoma clean. A specially trained nurse or doctor will go over how to do this while you’re still in the hospital. Taking care of a colostomy bag can take some getting used to. Though you might be worried about the appearance of the bag, the bag isn’t usually noticeable and can be hidden under clothing. A colostomy bag may be temporary or permanent. Be sure to discuss this with your doctor.

What is the outlook for people with colon cancer after surgery

Your outlook depends on the stage of your cancer and if the surgeon is able to remove all of it. According to 2016 research, a recurrence or relapse occurs in about 30% to 40% of people after their initial surgery. Most recurrences occur during the first 2 years after treatment. Doctors classify colon cancer recurrence as local, regional, or distant metastatic recurrence:Local recurrence: a relapse occurs at the site of the original tumorRegional recurrence: cancer has spread to the lymph nodes near the site of the original tumorDistant metastatic recurrence: cancer has spread to other parts of the body, such as the liver, bones, or brain If you experience a recurrence, your doctor may recommend additional surgery or treatment, like chemotherapy or immunotherapy. According to 2020 research, the 5-year survival rate is about:90% for localized recurrence70% for regional recurrence10% for distant metastatic recurrence Keep in mind that these are estimates. Some people with recurrent colon cancer survive much longer than 5 years. New advances in treatments, including immunotherapies, will continue to improve the rates.

Are there alternatives to surgery for colon cancer

Surgery is the standard treatment for all stages of colon cancer. If the tumor is large, your doctor might recommend that you receive radiation therapy before the surgery. You might also have radiation after surgery if the surgeon wasn’t able to remove all the cancer cells. For later stages of colon cancer, your doctor might use chemotherapy and immunotherapy alongside surgery or after the surgery. This is called adjuvant therapy. But if your doctor doesn’t think you’re healthy enough for surgery or if the colon cancer has spread too far for surgery to be effective, you might have radiation treatment or chemotherapy instead of surgery.

Frequently asked questions

How long does colon cancer surgery take

Colon cancer surgery takes about 3 hours but can range from 2 to 8 hours. It depends on how much of the colon your doctor needs to remove and if they perform an open or laparoscopic colectomy. Following a colectomy, you’ll have to stay in the hospital for at least 2 to 4 days.

Will I be under anesthesia during colon cancer surgery

During a colectomy, you’ll be under general anesthesia. That means your whole body will be sedated, not just one part. An anesthesiologist will give you sedatives through your IV line, and you’ll fall asleep. If you’re having a polypectomy, you likely won’t need anesthesia.

Can my colon cancer come back after surgery

Even with surgery, there’s a chance cancer will come back (recur). Research suggests that 30% to 40% of people experience a relapse after surgery. But the risk of relapse is lower if you receive a diagnosis and treatment in the early stages. Most recurrences occur during the first 2 years after treatment.

Will I need a colostomy bag after colon cancer surgery

Most people don’t need a colostomy bag after colon cancer surgery. You’re more likely to need a colostomy bag if you have another underlying condition affecting the part of your colon that doesn’t have cancer, such as inflammatory bowel disease (IBD). You may only need a colostomy for a short time (2 to 6 months) to allow your bowel to heal.

How long after colon cancer surgery does chemotherapy start

If you need chemotherapy after surgery, your doctor will likely start chemo once your wounds heal and you have recovered your strength. This is typically within 6 to 8 weeks. Your doctor might want to start chemo sooner or delay it by several months, depending on several factors, including the tumor stage and overall health.

Takeaway

Surgery to remove a portion of the colon or rectum is the main form of treatment for colon cancer. There are several types of surgery to treat colon cancer. Your specific type will depend on the cancer stage and how much of your colon doctors need to remove. Your recovery time will depend on the type of surgery you have. Be sure to discuss the risks and benefits of surgery with your doctor. After surgery, attend all follow-up appointments to ensure that you’re healing well from the surgery. Last medically reviewed on September 22, 2022

How we vetted this article

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bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01618-6Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Sep 22, 2022 By Jacquelyn Cafasso Edited By A. L. Heywood Medically Reviewed By Saurabh Sethi, MD, MPH Copy Edited By Stassi Myer - CE Share this articleMedically reviewed by Saurabh Sethi, M.D., MPH — By Jacquelyn Cafasso on September 22, 2022

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