Bowel Cancer Surgery

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Bowel Cancer Surgery

Bowel cancer develops when abnormal cells in a polyp grow beyond the inner layer of the colon. The established treatment is surgical removal of a section of bowel and surrounding tissue but radiotherapy and chemotherapy can sometimes lower the risk of recurrence.

The treatment you receive for bowel cancer depends on how early on you are diagnosed, whether the cancer has spread, the type and size of the cancer, how aggressive it is, your general health and which part of your bowel is affected.

The earlier you are diagnosed, the greater your chances of making a complete recovery.

The different treatments for bowel cancer include:

Read our answers to Frequently Asked Questions by other patients of Windsor Bowel Clinic

Bowel resection (colectomy)

This is an operation – called a colectomy – to remove all or part of your bowel. This is usually done as a laparoscopic (keyhole) procedure with the creation of a join (anastomosis) to maintain continuity.

  • Total colectomy removes the large bowel (colon)
  • Proctocolectomy removes the large bowel and rectum
  • Hemicolectomy removes the left/right side of the large bowel
  • Sigmoid colectomy removes the part of the bowel closest to the rectum
  • Anterior resection removes all or part of the rectum
  • Abdominoperineal excision removes the rectum and anus.

Prior to surgery you will undergo routine tests. If you smoke you will be asked to stop as smoking increases the risk of infection and can delay recovery.

You may need to follow a special carbohydrate-rich diet before surgery, particularly if you have lost weight as a result of your condition. The day before surgery you may be asked to take a laxative or have an enema to clear out your bowel.

You won’t be able to eat for at least six hours before surgery although you can usually drink water up until two hours beforehand.

The surgery will be performed under general anaesthetic. You may be given a spinal anaesthetic in addition, which is pain-relieving medication injected into the space surrounding your spinal cord.

Depending on the size of the tumour, surgery will usually be performed laparoscopically (keyhole surgery) or sometimes as an open procedure. People tend to recover more quickly from laparoscopic surgery and have less pain as it involves making smaller cuts in your abdomen. The surgeon will remove the diseased section of bowel and then join the two healthy ends together using stitches or staples. This is called a bowel anastomosis, or join.

If the end of your bowel has to be removed and cannot be rejoined or used straight away, the surgeon will bring a health end of your bowel through the abdomen and onto the surface of your skin, creating an artificial opening called a stoma. After surgery,stool will exit your body via the stoma and be collected in a special bag.

Stomas may be temporary or permanent, depending on how much of your bowel is removed. If your large bowel is used to create the stoma it is called a colostomy. If your small bowel is used it is called an ileostomy.

If you have ulcerative colitis and are generally healthy you may be able to have an ileoanal pouch which collects stool inside your bottom. There is some risk of complications, however, and this type of surgery is not suitable for everybody.

anatomy-of-anal-canal

Enhanced recovery

Enhanced recovery is an internationally recognised approach to caring for people who have had bowel surgery.

The aim is to help you recover quickly so you can get back to normal life as soon as possible. It focuses on getting you eating, drinking and moving around as soon as possible. Alongside good pain control, this has been shown to speed up your recovery.

Nutritional supplement drinks – You will be given these to aid your recovery. You should stop drinking them two hours before surgery.

Bowel cleansing – The day before your operation, you may be given medication or an enema to clean out your bowel thoroughly.

Stoma care nurse – If you are due to have a stoma (a colostomy or ileostomy) you will meet a specialist stoma care nurse before and after your operation who will talk to you about how to care for your stoma.

Surgical stockings – You will need to wear these during and after surgery to prevent blood clots from forming in your legs while you are less mobile than normal.

Urinary catheter – A fine tube located in your urethra draining urine from your bladder. This is usually removed 24 to 48 hours after the operation.

Anti-sickness medication – This helps to reduce any sickness from the anaesthetic so you can start eating and drinking normally, which will help you recover quicker.

Breathing exercises – You will be shown how to do these to lower your risk of developing a chest infection, which can sometimes happen after surgery. You will also be given feet and ankle exercises to reduce the risk of developing blood clots.

Mobilisation – You will be helped to get out of bed six hours after your operation and you will spend the next two hours out of bed, either sitting or walking around. This helps your lungs to start functioning normally again and helps to get more oxygen into your body which will speed your recovery. You should aim to spend eight hours out of bed each day after this, unless advised otherwise by your doctor.

Eating and drinking: You will be encouraged to eat and drink again as soon as possible. Your body needs nutrients to heal and to help your gut to start moving again.

Pain control – Preventing a build up of pain allows you to move around, eat, drink and sleep comfortably. You may be given patient controlled analgesia, which allows you to administer your own dose of painkiller intravenously via a drip in your hand.

Colon

Oncology

Oncology is the specialist medical treatment of cancer patients. You may be offered:

This includes:

Chemotherapy, which uses drugs to destroy cancer cells. However, it also causes damage to healthy cells and you may experience a range of side effects including fatigue, nausea and vomiting, blood disorders, pain and hair loss.
Targeted therapy, which targets specific genes or proteins found in cancer cells, blocking the signals that tell cells to grow and divide.
Immunotherapy, which boosts the body’s own natural defenses, helping it to become more effective at destroying cancer cells.

This involves surgery to remove tumours and surrounding tissue and also biopsies to diagnose cancer.

This uses X-rays or other particles to destroy cancer cells. It may be given as the first cancer treatment or after surgery or chemotherapy to target any cancer cells remaining.

If it is not possible to destroy all of the cancer, radiation therapy may be used to shrink tumours and relieve symptoms. This is called palliative radiation therapy.

Find out about the consultants that will be looking after you

Early diagnosis of colon and rectal cancer

The earlier rectal cancer is diagnosed, the greater the chances of making a complete recovery. Regular screening helps to detect bowel cancer before it has spread and while it is easier to treat.

Polyps can take 10 to 15 years to develop. Detecting and removing polyps can prevent them from developing into cancer.

Ninety percent of people survive for five years or more when colorectal cancer is found at an early stage. Once it spreads outside the rectum or colon, however, survival rates are lower.

Treating stage 0 rectal cancer that has not grown beyond the inner lining of the rectum involves removing or destroying the cancer. Removing the polyp, local excision or transanal resection can normally do this.

Learn more about Bowel Cancer Screening

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