Colorectal Cancer: Surgery
Surgery is often part of the treatment for colorectal cancer. Different kinds of surgery
may be done. Which type you have depends on the type of cancer, where it is, how much
it has spread, and other factors.
When surgery may be an option
Colorectal polyps and early stage colorectal cancers are often first seen during a
colonoscopy. If you have a colonoscopy, your healthcare provider may see a polyp that
might turn into cancer or might already have cancer. He or she might be able to completely
remove the polyp by passing small tools through the tube or colonoscope. No surgical
cut or incision is needed.
In other cases, surgery might be needed:
You've had a colonoscopy, but your healthcare provider could not completely remove
a polyp. Surgery is then needed to remove the rest of the polyp. That's because it might contain
cancer cells that could spread to other areas. The only way to know if a polyp has
cancer is to remove all of it and check it under a microscope.
You've had a polyp completely or partly removed, and that polyp has invasive cancer
cells in it. Your healthcare provider will be able to tell this by looking at the polyp under a
microscope. Surgery may be needed because the cancer may have spread beyond the polyp.
If your provider thinks the cancer has not spread, you may not need surgery.
You have a stage I, II, or III colorectal cancer. These cancers have not spread to distant sites, so surgery may be able to remove all
of the cancer. Other treatments such as chemotherapy or radiation therapy may be needed
You have stage IV (advanced) colorectal cancer, but it has only spread to areas of
the liver or lungs that can also be removed with surgery. Surgery on both the main tumor and the site where it has spread may be able to remove
all of the cancer in certain cases. Other treatments such as chemotherapy or radiation
therapy may be needed as well.
You have advanced cancer that threatens to block or obstruct the colon or cause other
major problems. In these cases, surgery may be used, but not to try to cure the cancer. Instead it
may be used to fix the problem and ease symptoms. For example, if the colon is blocked
by a tumor, surgery may be done to create a colostomy. This connects the part of the
colon before the blockage to an opening in the skin of the belly. This allows waste
to leave the body.
Types of surgery
The type of surgery you have depends on the stage and location of the tumor, your
health and preferences, and other factors. Surgery for colon and rectal cancers may
This is the removal of a polyp, often done during a colonoscopy. It does not require
an incision in the skin.
This is the removal of the cancer and a small area of the tissue around it. It is
typically done during a colonoscopy to remove very shallow tumors. It may also be
done in the operating room.
Surgical resection of the tumor
This is the removal of part of your colon or rectum and nearby lymph nodes. It is
most often done through an incision (or incisions) in your belly. The type of surgery
depends on whether the cancer is in your colon or rectum:
Colon cancer. The most common surgery for colon cancer is called a colectomy or hemicolectomy. The
surgeon removes the part of the colon that has cancer, as well as a small amount of
normal colon on either side. Nearby lymph nodes are removed as well and checked for
cancer. This surgery can be done through 1 long incision in the belly, called an open
colectomy. Or it can be done by using long, thin surgical tools passed through several
smaller cuts in the belly. This is called a laparoscopic-assisted colectomy.
Rectal cancer. There are several different types of surgeries for rectal cancer. The type of surgery
will depend on the stage of cancer and where it is in your rectum. Some early stage
cancers can be treated with transanal resection and transanal endoscopic microsurgery
(TEM). They use tools passed through the anus. There is no surgical cut in the skin.
Other more extensive rectal cancer surgery options include:
LAR or lower anterior resection. This surgery removes the part of the rectum that has cancer.
Proctectomy with colo-anal anastomosis. Removes the whole rectum. The colon is then joined to the anus.
APR or abdominoperineal resection. Removes the anus and the tissues surrounding it, including the sphincter muscle. This
surgery results in a permanent colostomy.
Pelvic exenteration. Removes the rectum as well as nearby organs if the cancer has spread there. These
include the bladder, the prostate in men, or the uterus in women. This surgery results
in a permanent colostomy.
Risks and possible side effects
All surgery has risks. Some of the risks of any major surgery include:
Risks from colorectal surgery
Along with the risks above, colorectal surgery can sometimes cause these problems:
Colorectal surgery increases your risk of infection because of the bacteria in your
colon. Treatments before surgery can help reduce this risk. But a small portion of
people who have colorectal surgery get an infection, either at the incision site on
the skin or inside the abdomen. Healthcare providers can treat some skin infections
by letting them drain and by using clean dressings. More serious infections can occur
inside the abdomen. These may require additional surgery. Antibiotics are very helpful
to treat infections.
After the surgeon removes a section of colon, he or she often links the two ends together.
A leak can occur at this connection. Then what's in your intestine can leak into your
abdomen. If the leak is small, the only treatment may be to watch the area and to
be careful about your diet, letting the colon heal itself over time. If the leak is
large, it can be life-threatening. You may need surgery to correct it. Leaks occur
in a small number of people who have a colorectal resection.
Sometimes your colon develops scar tissue or adhesions while it heals. This can block
your intestines and cause symptoms such as pain, bloating, nausea, and vomiting. If
these adhesions block the intestines, you may need surgery to fix the problem.
Colostomy or ileostomy
Depending on the stage and location of the cancer, the surgeon might not always be
able to reconnect the ends of the intestines after removing the tumor. In these cases,
the piece of the colon (or the ileum, the last part of the small intestine) above
the tumor is linked to a small hole or stoma made in the belly. This lets waste out
of the body. A small bag is then placed over the stoma to collect the waste. For some
people, an ostomy (colostomy or ileostomy) might only be needed for a short time until
the bowel can heal itself. Then the ostomy is reversed, and the ends of the intestines
are reconnected in another surgery at a later time. Other people may need a permanent
Changes in bowel function or what you can eat
Some people might need to change their diets and might have different bowel patterns
after surgery (see below).
There are also some specific risks that can come from surgery to remove a tumor from
Ureteral injury. The tubes that carry urine from your kidney to your bladder are called ureters. Sometimes
they can be damaged during surgery. If they are, the healthcare provider can usually
fix them during the procedure. If the damage isn't noticed, sometimes there can be
Erectile dysfunction. In men, the rectum is close to the prostate. The nerves that are involved in sexual
function wrap around the prostate. Sometimes these nerves are damaged. This can cause
problems with getting an erection, or erectile dysfunction.
Even with these possible problems, the benefits of removing a tumor usually outweigh
Getting ready for your surgery
A few days before your surgery, your healthcare provider will prescribe laxatives
and enemas to help clean out your colon. Your healthcare provider will tell you when
and how to use these. You may also be told to follow a special diet.
Before you have surgery, you will meet with your surgeon to talk about the procedure.
After you have discussed all the details of the surgery, you will sign a consent form.
This gives the healthcare provider permission to perform the surgery.
You will also meet with the anesthesiologist. This is the provider who will give you
general anesthesia, the medicine that puts you to sleep so that you won't feel any
pain during surgery. He or she also monitors you during surgery to keep you safe.
He or she will ask about your medical history and your medicines.
What to expect during surgery
When it is time for your surgery, you will be taken into the operating room. Your
healthcare team will include the anesthesiologist, the surgeon, and nurses.
During a typical surgery:
You will be moved onto the operating table.
Someone will place special stockings on your legs. These are to help prevent blood
You will have electrocardiogram (EKG) electrodes put on your chest. These are to keep
track of your heart rate. You will also have a blood pressure cuff on your arm.
You will be given anesthesia through an IV or intravenous line into your arm or hand.
When you are asleep, the surgeon will do the surgery.
A urinary catheter will be put into the bladder during surgery.
What is removed during surgery and where your incisions are will depend on the type
of surgery you have. This is based on where the tumor is.
What to expect after surgery
You will wake up in a recovery room. You will be watched closely by healthcare providers.
You will be given medicine to treat pain.
You may have to stay in the hospital for up to 7 days, depending on the type of surgery
you have. People who have a laparoscopic-assisted colectomy can often go home sooner.
That’s because they have smaller incisions that can usually heal faster.
You can slowly return to most normal activities once you leave the hospital. But you
should not lift heavy things for several weeks. Always follow the instructions you
get from your healthcare provider or nurse.
It will take time to get back to eating normally and having regular bowel movements.
If you have an ostomy, you'll also learn how to take care of your hole or stoma. You
will still have the urinary catheter in your bladder to drain urine. It is usually
removed before you go home.
After surgery, you may feel weak or tired for a while. The amount of time it takes
to recover after surgery will vary for each person. But you will probably not feel
like yourself for a few months. You will be able to get your incision wet. But to
reduce your risk of infection, don’t take baths or go swimming. You likely won't be
able to drive for a while, as directed by your healthcare providers.
If you had an open surgery, you may have a 5 to 7-inch scar running up and down through
your belly button. This will likely heal into a thin scar.
After surgery, you may have either chemotherapy or radiation to reduce the chance
that any remaining cancer cells will spread. Treatment after surgery is called adjuvant
Eating after surgery
You may not be able to eat for the first few days after surgery. You may get some
nutrients through an IV line that’s put into one of your veins. At first, you will
be on a clear liquid diet until there are signs that your bowels are moving again.
Then you may be able to add some soft foods and then normal foods. It may take your
colon several months to heal after surgery. To rest your bowels, your healthcare provider
may advise that you eat a low-fiber diet. Be sure you talk about your diet with your
provider. He or she may refer you to a nutritionist or dietitian to help you plan
Bowel function after surgery
After having a section of your colon removed, you may have more bowel movements than
normal. Some people have 7 or 8 a day in the first months after surgery. You may also
have a more urgent need to have a bowel movement. This means that once you feel the
urge, you may have to get to the bathroom quickly to avoid leaking. These side effects
usually get better over time. It may take as long as 2 years to fully adjust. Even
then, you’re likely to have bowel movements several times a day. And you may still
have bowel urgency.
If your tumor was in the rectum, your surgeon may have made a special pouch called
a J-pouch. It holds stool as your rectum did before surgery. Your surgeon forms the
J-pouch during the same surgery to remove your rectum. The surgeon loops the colon
back on itself and staples it together. This creates a pouch that looks like the letter J.
Stool collects there until you can get to a bathroom. This helps you to get back to
a stable bowel pattern more quickly after surgery. You may be able to have stable
bowel function after a few months.
Depending on the type of surgery you had, your healthcare provider may have created
an ostomy in your belly. This allows waste to leave your body. This may be short-term
or permanent. If you have an ostomy, a specially trained therapist can help you learn
how to care for it and adjust to having one.