5 things to know about colon cancer surgery
Colon Cancer Treatment
Treatment at UT MD Anderson¡¯s Colorectal Center combines the latest technology and research with a multidisciplinary team approach tailored to your unique needs.
Our team of surgeons use minimally invasive techniques, including advanced robotic surgery, that reduce recovery time and maximize quality of life. UT MD Anderson also offers clinical trials for patients at every disease stage, from newly diagnosed small tumors to patients with stage IV cancer.
Colon cancer treatment plans
Colon cancer that has not spread to distant parts of the body is usually treated with surgery. Some patients then receive chemotherapy or, less commonly, radiation therapy to kill any remaining cancer cells.
If colon cancer has spread, or metastasized, to distant parts of the body, some patients can still be cured. For others, the disease is managed like a chronic condition and care is meant to prolong and preserve quality of life. Treatments for all patients with metastatic colon cancer can include surgery, radiation therapy, and cancer drugs like chemotherapy and targeted therapy.
Surgery
Surgery is the most common treatment for colon cancer, especially if it has not spread. Like many cancers, surgery for colon cancer is most successful when done by a surgeon with a great deal of experience in the procedure. At UT MD Anderson, colon cancer surgery is performed by surgeons who are specialized in colon cancer surgery and are national and international leaders in the field. Surgeons around the country often refer their patients to UT MD Anderson surgeons for their expertise, especially for the most difficult cases.
Many colon cancer surgeries can be performed using minimally invasive techniques, such as robotic or laparoscopic surgery. These procedures require only a few small cuts. They offer less pain and faster recovery time compared to traditional open surgery. Surgeons at UT MD Anderson specialize in performing advanced robotic minimally invasive surgery.
Depending on the tumor¡¯s size and location, patients may not be able to have normal bowel movements after surgery. This can be either temporary or permanent. In these cases, waste in the colon is diverted through an opening in the abdomen and into an external bag. This procedure, called a colostomy, is performed at the same time as the surgery to remove the tumor.
The type of surgery colon cancer patients undergo depends on the stage and location of the tumor. They include:
Polypectomy:
A colonoscope, which is a long tube with a camera on the end, is inserted into the rectum and guided to the polyp. Tiny tools or a wire loop removes the polyp. A polypectomy is ideal for very early, low-risk cancers found within polyps and is usually performed during colonoscopy.
Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD):
If a polyp is too large to be removed by traditional polypectomy, an EMR or ESD may be performed. The doctor will use small instruments inserted through a colonoscope to perform detailed surgery from inside the rectum. The polyp and some surrounding tissue will be removed. With this type of advanced endoscopic procedure, major surgery can sometimes be avoided. Gastroenterologists at UT MD Anderson are experts at performing these specialized, advanced endoscopic procedures.
Colectomy:
In a colectomy, the section of the colon affected by cancer, some healthy surrounding tissue and all of the associated lymph nodes are removed. The lymph nodes are then analyzed under a microscope for the presence of cancer cells.
Determining what section of bowel and lymph nodes to take out, and successfully removing them, is the most important factor in the patient¡¯s outcome. Surgeons carefully evaluate the blood supply to the area to make these decisions. After removal, the surgeon connects the remaining sections of the colon back together. This surgery, also called a hemicolectomy or partial colectomy, can generally be performed with minimally invasive techniques.
Multiorgan resection for locally advanced cancers:
If a patient¡¯s cancer has spread to other nearby organs, they may be surgically removed along with the rectum. Organs that are commonly removed include the bladder, prostate, seminal vesical, ovaries and uterus.
Metastectomy:
If colon cancer has spread to other parts of the body such as the lung, liver, ovaries or distant lymph nodes, it may be possible to perform surgery to remove those tumors. At UT MD Anderson, a multidisciplinary team of doctors including surgeons, medical oncologists and radiation oncologists performs a detailed review to make the recommendation for the best option for treatment when metastasis is identified.
Peritoneal cytoreductive surgery and hyperthermic intraperitoneal chemotherapy:
Colon cancer can spread into the abdominal cavity. During peritoneal cytoreductive surgery, the surgeons remove all visible tumors from the lining of the abdomen. In some cases, this procedure is paired with Hyperthermic Intraperitoneal Chemotherapy, or HIPEC. HIPEC involves filling the abdominal cavity with chemotherapy drugs that have been heated. Also known as ¡°hot chemotherapy,¡± HIPEC is performed after the surgeon removes tumors or lesions from the abdominal area. Learn more about HIPEC.
Chemotherapy
Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing.
Targeted Therapy
Targeted therapy drugs are designed to stop or slow the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them.
Radiation therapy
Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.
Radiation therapy is used in select cases to ease colon cancer symptoms. It can also treat metastases when the disease has spread to just a few spots in the body.
Immunotherapy
The immune system finds and defends the body from infection and disease.?Cancer is a complex disease that can evade and outsmart the immune system. Immunotherapy improves the immune system¡¯s ability to eliminate cancer.
There are two types of immunotherapy currently used to treat colon cancer:
- Immune checkpoint inhibitors stop the immune system from turning off before cancer is completely eliminated.
- Monoclonal antibodies attach to specific proteins on the surface of cancer cells or immune cells. They either mark the cancer as a target for the immune system or boost the ability of immune cells to fight the cancer.
Angiogenesis inhibitors
Angiogenesis is the process of creating new blood vessels. Some cancerous tumors are very efficient at this process. New blood vessels increase blood supply to a tumor, allowing it to grow rapidly. Angiogenesis inhibitors, or anti-angiogenic therapy, disrupt the creation of these blood vessels.
Clinical trials
Clinical trials are a key component of UT MD Anderson's mission to end cancer. Patients may volunteer to participate in these research studies, which help doctors improve cancer prevention, diagnosis and treatment.
Some clinical trials allow patients to receive experimental medications or treatments, though not all patients are eligible.
If you're interested, ask your doctor if you might be a candidate for a clinical trial.
Learn more about colon cancer:
What is a total pelvic exenteration?
¡°Exenteration¡± refers to a complex surgery in which organs, bones and other structures are removed from the pelvis in order to treat cancer. A pelvic exenteration might involve the bladder, rectum, anus and/or sacrum (tailbone), as well as the prostate gland in men and the vagina and/or uterus in women.??
While this procedure may sound fairly extreme, it is often the best ¡ª and only potentially curative ¡ª option for some types of cancer. It also provides the best possible chance of long-term cancer control.?
But which cancers does a pelvic exenteration typically treat? What makes you a good candidate for one? How will it affect your sex life and bathroom habits? And, what else should you know about this life-changing operation? Read on for answers.?
Which cancers is a total pelvic exenteration used most frequently to treat?
A total pelvic exenteration (TPE) is most commonly used for locally advanced rectal cancer?or another type of cancer that involves the rectum. This is because of the way cancer grows and spreads in the rectum. But TPE is also used to treat:?
In fact, pelvic exenteration was originally designed to treat recurrent cervical cancer. It originated as an operation for this gynecologic cancer because the cervix is located in the center of the pelvis. In the days before HPV vaccinations prevented most cervical cancers and radiation therapy was used to treat it, cervical cancer often grew into the structures around it. This procedure was seen as a way of clearing it out.?
Are there different types of exenterations?
An exenteration used to treat rectal cancer usually involves the removal of the rectum, plus something else. That could be the bladder, the bone behind the rectum (the sacrum), or any of the other structures surrounding it that are not normally removed during rectal surgery. Generally speaking, though, there are three types of exenterations:
Anterior exenteration
In a male, this entails removing the bladder and the prostate, but leaving the rectum intact. In a female, this involves removing the bladder, uterus and possibly the vagina, but leaving the rectum intact.??
Posterior exenteration
This involves the removal of the rectum and sacrum, as well as the uterus (if present) and possibly part of the vagina in a female.?
Total pelvic exenteration
In a male, this involves removal of the rectum, bladder and prostate. In a female, this normally entails the removal of the rectum, bladder and uterus (if present) and can also include the vagina.?
Which patients make the best candidates for an exenteration?
Ideally, we want you to be at your very fittest before an exenteration. That way, you¡¯ll have some strength in reserve if any complications arise. So, any therapies we might recommend before that are all part of a plan to get your body prepared for surgery, not to help you avoid it.??
Your best chance for a cure is when we can do a TPE early as a planned part of your treatment, rather than waiting to do it as a last resort when systemic treatments are no longer working. But a TPE is a long and very complex operation, and the recovery can be prolonged. Not all patients will be able to undergo it. So, the first thing we ask is, ¡°Do you have a cancer that¡¯s resectable?¡± That is: ¡°Can your tumor be removed with surgery? Then, your surgeon will determine if you are fit enough to undergo it.??
Unfortunately, a lot of patients are told elsewhere that this type of surgery is impossible, even when their cancer is not metastatic and is still potentially curable. They only come to MD Anderson after other treatments have failed. Other patients are so leery of the procedure itself that they¡¯ll try almost anything to avoid it.?
The trouble is that while chemotherapy and radiation therapy can sometimes slow a cancer¡¯s growth, the problems caused by a locally advanced tumor in the pelvis often become worse. These can include severe pain, obstructions, infections, blood supply problems, and nerve damage. All of those may end up becoming much bigger issues than they would¡¯ve been if someone had gotten the surgery earlier.?