Surgery for Colorectal Cancer

This content has been reviewed and approved by

Howard Burris, MD
Director, Drug Development
Sarah Cannon Cancer Center
Tennessee Oncology

Surgery is the main type of treatment for colorectal cancer.

• Local excision - Some early colorectal cancers, especially stage 0 and some stage I tumors, can be removed without cutting into the patient’s abdomen. Instead, the doctor uses a long, flexible tube that is attached to a camera and is called a colonoscope. The doctor inserts the tube through the rectum into the colon. The camera projects an image of the internal lining of the colon onto a monitor. When your doctor sees a polyp, a small bulging piece of tissue, he or she surgically removes it with a wire snare, a surgical laser beam, or ultrasound. Polyps can also be removed by burning them.
• Resection - The most common surgery is resection, or removal, of the primary (original) cancer and regional lymph nodes (the ones near the colon and rectum). During resection, your surgeon will also remove normal sections of the bowel on both sides of the tumor. Depending on the cancer’s stage, resection can sometimes cure colorectal cancer.
  
  If the tumor is large and has created a hole in your colon, you might need a temporary colostomy. In a colostomy, an opening is made in the abdomen and one end of the large intestine is attached to this opening. Stool comes through the intestine, out the opening, and into a replaceable plastic bag. You will wear this bag outside your body. Often, you will only need the colostomy for a short time. As soon as your colon heals, the doctor can sew the two ends of the colon back together. In very rare cases, when the cancer cannot be completely removed, the two ends of the colon are not sewn back together and the colostomy becomes permanent.
• Laparoscopic surgery - In laparoscopic surgery (also known as keyhole surgery), the surgeon inserts a laparoscope, or tiny telescope connected to a video camera, into a narrow tubelike instrument called a cannula that has been inserted into your abdomen. The laparoscope displays a magnified view of the colon on a monitor. The surgeon inserts several other cannulas to work inside and take out part of your colon. The cuts needed to insert the cannulas are usually small and heal quickly.
• Radiofrequency ablation - In some cases, the physician uses a special probe with tiny electrodes that kill cancer cells. This probe is sometimes inserted directly through the skin. In other cases, the doctor cuts into the abdomen to insert the probe.
• Cryosurgery - In cryosurgery, the surgeon uses an instrument to freeze and destroy the tumor. This is especially useful for stage 0 colorectal cancer and for metastases, or cancer cells that have spread to other organs, in the liver.