SURGICAL TREATMENTS FOR COLON CANCER:

In the early stages (Stage 0 and Stage 1) of colorectal cancer, polyps can be removed during colonoscopy by the procedure of polypectomy. Such superficial cancers can also be removed through excision (where the cancer is cut by inserting a tube into the rectum). Unlike colectomy, neither of these procedures involves cutting through the abdominal wall. Surgical removal of the tumor (resection) is often the standard initial treatment for curable colorectal cancers (those which havent spread to beyond the colon or the lymph nodes).

COLECTOMY: This is the procedure employed to remove most tumors, unless the cancer is very advanced. It involves the removal of the cancerous part of the colon and the nearby lymph nodes. It is followed by anastomosis (reconnecting the intestine). If, however, the intestine cant be reconnected due to any complications, the surgeon will go for a colostomy - an opening of the colon onto the skin and stool drains into a sack called the ostomy pouch. The need for colostomy is higher after a surgery for rectal cancer while as in most cases of colon cancer, it may not be needed. The standard technique for a colectomy is the open, invasive surgery which uses a wide incision to open the patients abdomen followed by the removal of infectious tissue. There is, however, a newer, less invasive method laparoscopy or key-hole surgery. It uses a few small incisions for passing a fiber optic tube (laparoscope) containing a camera and several instruments to carry out the suregry. Laparoscopy is generally used for early colon cancer with tumor sizes of between two to three centimeters. Depending on the extent to which the cancer has spread, colectomy can be of the following types: Partial colectomy which involves only a partial removal of the colon. The remaining parts are joined by anastomosis. After a partial colectomy, the patients bowel habits usually go back to the way they used to be before the cancer. Right colectomy involves the removal of the right side of the colon. Ileocolectomy is a case where the ileum (the last segment of the small intestine) is also removed. Abdominoperineal resection is an operation in which the anus, rectum and sigmoid colon are removed.

Proctosigmoidectomy involves the removal of the diseased section of the rectum and the sigmoid colon. Total Abdominal Colectomy is when the entire colon is removed preserving the rectum and the anus. Total Protocolectomy is the most extensive bowel operation performed and involves the removal of both, the rectum and the colon. If the anus is spared & it works properly, sometimes an ileal pouch (J-pouch) is created allowing the patient to resume bowel habits just as before the cancer. In the other case, however, a permanent ileostomy (opening of the ileum onto the skin) maybe the only option.

COLOSTOMY: A colostomy is performed when rectum is also removed alongwith the colon. The procedure involves creating a passage (called a stoma) through the abdominal wall that is connected to the colon. The passage is meant for passing the stool. The colostomy may be temporary or permanent (if the rectum along with the rectal sphincters need to be removed). In case of the former, the colostomy can be reversed by a second operation after about 3-6 months. The latter, although much rare these days, is required when the cancerous regions lie within 2-3 cm of the anus. In cases where permanent colostomies are done, the patient wears a colostomy pouch that sticks to the skin using a special glue. It is best to empty the pouch when about one third full.

SURGICAL TREATMENTS FOR RECTAL CANCER:

Surgical treatments for cancer in rectum are complex since they often involve muscles and tissue critical for the patients urinary and/or sexual function.

Local Excision or Polypectomy (in Early Stages): Here, the Stage 1 and Stage 2 tumors
maybe removed by local excision, preserving the function of the anal sphincter and preventing colostomy. The tumors are removed sparing a major portion of the rectum; in some cases the cancer recurs, but a second surgery is a possibility. The surgery is usually followed by chemo and radiation therapy for some period of time.

Radical Resection: Its the only option in most cases where the cancers have spread beyond
the rectal wall. The patients undergo radial resection in which the lower rectum along with the

surrounding structures (including the sphincter muscles that control bowel movements) are often removed.

Total Mesorectal Resection: It involves the removal of the entire cancerous region of the
rectum alongwith the surrounding lymph nodes (located in the mesorectum); it, however, preserves the sphincters reducing the need for a permanent colostomy.

MANAGING SIDE EFFECTS:

Some side effects ofcolon cancer surgery include: sexual dysfunction, irregular bowel movements, gas and flatulence, diarrhea, bladder complications, fecal incontinence, complications regarding the stoma, etc. The potential side effects of sexual and bowel dysfunction can be very difficult, many patients, however, manage normal reproductive lives. The surgery doesnt ask for any dietary restrictions, but patients should take plenty of fluids and a good amount of fiber to avoid any complications.