If colorectal cancer has not spread beyond the colon, rectum, or lymph nodes, surgical removal of the cancer is the most common treatment. The goal is to remove as much of the cancer as possible and preserve as much colon and/or rectal function as possible. It is common to combine surgery with radiation therapy and/or chemotherapy to attempt to remove all of the cancer.
Polypectomy and Local Excision
A colonoscope is placed through the anus and rectum, up into the colon. The scope allows the doctor to see inside the colon. Instruments are inserted through the colonoscopy tube to remove polyps and/or early stage cancer if it has not invaded into the deeper layers of the colon wall. Tissue samples of the colon will also be taken for biopsy.
If the cancer is larger, both the tumor and a small amount of healthy tissue and nearby lymph nodes will be removed. This is called a partial colectomy. In many cases, the healthy portions of the colon (and rectum) can be reconnected. This procedure is called anastomosis. This is generally the preferred procedure because it preserves anal function and avoids the need for a permanent colostomy.
In some cases, it is possible to remove part of the colon and nearby lymph nodes through several small incisions in the abdomen. Laparoscopes are equipped with cameras that allow the surgeon to see inside the abdomen. Special instruments are inserted through tubes to remove tumor. Healing time and recovery are somewhat faster than with an open colectomy.
A total colectomy is the removal of the entire colon. The last part of the small intestine, called the ileum, is then connected to the rectum. In some cases, a small pouch is made from the ileum to store stool. This pouch mimics the function of the rectum. This surgery preserves anal function and eliminates the need for a permanent colostomy.
If it is not possible to reconnect the colon and rectum, a colostomy is necessary. A colostomy is a surgical opening (stoma) through the wall of the abdomen into the colon. This creates a path for stool to leave the body. After a colostomy, a special bag will be worn outside of the body to collect body waste. The colostomy may be either temporary or permanent. In cases where the entire colon is removed, the small bowel will be used to create the stoma.
Rectal surgery is more complex because more non-colon tissues and muscles are involved, such as those related to urinary function.
Polypectomy and Local Excision
A colonoscope is placed through the anus and rectum. The scope allows the doctor to see inside the rectum. Instruments are inserted through the colonoscopy tube to remove polyps and/or early stage cancer if it has not invaded into the deeper layers of the rectal wall. Tissue samples of the rectum will also be taken for biopsy.
Local Transanal Resection
This procedure is also called a full-thickness resection. Like the local excision procedure, a colonoscope is placed through the anus, and into the rectum. The surgeon removes both the cancer and some surrounding healthy tissue. Local transanal resection is used for early stage cancers that are small and closer to the anus.
Transanal Endoscopic Microsurgery (TEM)
TEM is a highly specialized procedure that can be used for early stage cancers farther away from the anus. A magnifying scope and instruments are placed through the anus, and up to the rectum. In this procedure, the surgeon also removes the cancer and some surrounding healthy tissue. The remaining hole in the wall of the rectum is closed.
Low Anterior Resection
Low anterior resection is used to remove cancers high in the rectum closer to the colon. Access is gained through the abdomen. Part of the rectum where the cancer is, along with surrounding healthy tissue and lymph nodes, are removed. The colon is attached to the remaining part of the rectum. This surgery does not affect the anus or stool elimination.
If you have chemotherapy or radiation therapy before this procedure, you may have a temporary ileostomy. An ileostomy brings the last portion of the small intestine out through a hole in the abdominal wall. After an appropriate amount of time, the procedure may be reversed.
Proctectomy with Colo-anal Anastomosis
This procedure requires removal of the entire rectum because of the location of the cancer. Generally, this is done when the cancer is in the middle or lower third of the rectum. Once the rectum is removed, the colon is then attached to the anus. In some cases, a small pouch is made from the colon to store stool.
A temporary ileostomy may be necessary. Stool will pass form the small intestine through the stomach wall to a bag outside of the body. This allow the bowel time to heal. After an appropriate amount of time, the procedure may be reversed.
Abdominoperineal (AP) Resection
An AP resection may be necessary if the cancer has spread from the rectum into the anal area. The surgeon removes the anus, the anal sphincter muscle, and surrounding tissue. After this procedure, you will need a permanent colostomy.
If the cancer has spread beyond the rectum into nearby organs, a more extensive procedure will be necessary. The surgeon removes the rectum, along with the bladder, prostate, or uterus. After this procedure, a permanent colostomy will be necessary. If the bladder is removed, you will also need a urostomy. A urostomy is an opening in the abdominal wall that allows for the passage of urine.
Surgery for Metastatic Colorectal Cancer
Metastatic colorectal cancer cannot be cured with surgery, but some procedures may help prolong life by treating tumors in other parts of the body. These methods are most often used for cancer that spreads to the liver, but it can also be used on other tumor sites. Options include:
Ablation is the destruction of cancer cells without removing the tumor from the body.
- Radiofrequency ablation —A CT-guided probe is inserted through the skin and into the abdomen. The probe emits high energy radio waves which kill cancer cells with high heat.
- Ethanol ablation—Concentrated alcohol is injected directly into the tumor with a needle that is guided with an imaging test. This may also be called a percutaneous ethanol injection (PEI).
- Cryosurgery—An ultrasound-guided probe is inserted through the skin into the abdomen. Cancer cells are killed by freezing them.
Tumors grow and spread using the body's blood supply. During embolization, substances are injected to slow or stop blood flow to the tumor.
- Arterial embolization—A catheter is threaded through an artery in the thigh to the liver's main artery. A substance is injected into the hepatic artery to block blood flow.
- Chemoembolization—Tiny beads with chemotherapy drugs are threaded through the catheter and into the hepatic artery. The drugs will eventually block blood flow.
- Radioembolization—Tiny beads with radiation are placed near the tumor. Over a period of time, the beads release radiation and kill the tumor.
- Reviewer: Mohei Abouzied, MD
- Review Date: 05/2015 -
- Update Date: 12/03/2015 -