Colo-rectal Cancer

Surgery for Colorectal Cancer

By 22/01/2020 May 20th, 2020 No Comments

Treatment

What is the treatment of colon cancer?

Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer.

You will be advised on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread and your general health.

The most common treatment options for colon cancer are surgery, and chemotherapy.

If your cancer hasn’t spread, you will almost certainly be offered surgery to remove the colon. Unlike other cancers of gastrointestinal system, cases where in colon cancer has spread to other areas, surgery is performed and is of proven benefit. This is very unique to colon cancers treatment.

What is the treatment of rectum cancer?

Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer.You will be advised on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread and your general health.

The most common treatment options for rectal cancer are surgery, and chemotherapy.

You may have radiotherapy or chemo-radiotherapy to shrink a tumour before surgery and make it easier to remove. It also reduces the chance of the cancer coming back in the rectum after surgery. Your surgeon will be the best judge to decide this for you.

If your rectal cancer isn’t bulky and hasn’t spread, you will almost certainly be offered surgery to remove the rectum. Unlike other cancers of gastrointestinal system, cases where in rectal cancer has spread to other areas; surgery is performed and is of proven benefit. This is very unique to rectal cancers treatment.

Surgery

Surgery for Colon Cancer:

Though cancer surgeries are extensive and take longer hours; with advanced medical care, surgeries have become safer and better equipments are now available to perform surgeries. Improved techniques of anaesthesia and post-operative monitoring have significantly contributed to overall safety of surgical procedures for cancers.

Surgery for Rectum Cancer:

Though cancer surgeries are extensive and take longer hours; with advanced medical care, surgeries have become safer and better equipments are now available to perform surgeries. Improved techniques of anaesthesia and post-operative monitoring have significantly contributed to overall safety of surgical procedures for cancers

If you are found suitable for the surgery, you will be usually admitted one or two days prior to the proposed date of surgery. There may be dietary restrictions and you may be given laxatives to evacuate your bowels prior to surgery.

Your blood group will be checked and blood is usually reserved for all major abdominal surgeries. It is always a good idea to start with deep breathing exercises once you are admitted to the hospital.

Your doctor may summon a physiotherapist to assist you with the same. You will have most of your body parts shaved for the surgery. You will be given a consent form for your signature.

The form would have details of the procedure to be performed on you by your treating surgeon. In case you have any doubts you should feel free to ask them to the surgical team.

The position of the tumour in the colon will determine how much of colon is removed. If the left side of the colon is removed, it is called a left hemi colectomy.

If the middle part of the bowel is removed (the transverse colon) it is called a transverse colectomy

If the right side of the colon is removed, it is called a right hemi colectomy.

If the sigmoid colon is removed it is called a sigmoid colectomy.

After your surgeon removes the part of the bowel containing the tumour, they join the ends of the colon back together. The place where they join is called an anastomosis.

Sometimes, to give the area time to heal, the surgeon makes a temporary colostomy or ileostomy (diversion of stools) higher up the bowel. You have the temporary stoma repaired in another operation a few months later. This is called a stoma reversal. In the meantime, you have a colostomy bag over the opening of the bowel.

Removal Lymph nodes close to colon

During the surgery all the lymph nodes around the colon will be taken out. This is called Lymphadenectomy. The surgeon takes out lymph nodes because they may contain cancer cells that have broken away from the main cancer.

Taking them out reduces the risk of your cancer coming back in the future. The lymph nodes will be sent to the laboratory and checked. This will help your doctor work out the stage of your cancer. And the stage helps to decide which treatment is best for you.

Bypass surgery

Sometimes the cancer may be very large and may be attached to some vital organs within the abdomen that prevents its removal. If this happens, the surgeon may make a connection between the intestine before and after the blocked site so as to allow digestive matter to bypass the blockage.

This is known as bypass surgery and will not cure the cancer, but can relieve symptoms.

You will be transferred to the Intensive care unit after the surgery. Your recovery will depend on the magnitude of surgery performed. After the operation, the patient is usually monitored in the ICU for 48 to 72 hrs and the overall hospital stay (if no complications) is usually between 10–14 days. Your pain and discomfort will be taken care of by the anaesthetic team.

You will be given pain-killers and an intravenous infusion (drip) to replace your body’s fluids until you are able to drink and eat again after a few days. You will also have a naso-gastric (NG) tube in place. This is a thin tube that passes down your nose into your stomach or small intestine and allows any fluids to be removed so that you don’t feel sick. It is usually taken out within 48 hours. Sometimes a small tube (catheter) is put into the bladder to drain your urine into a collecting bag.

After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery. If you have to stay in bed the nurses will encourage you to do regular leg movements and deep breathing exercises. You will be seen by a physiotherapist who can help you to do the exercises.

Drinking and eating after surgery

After an anaesthetic, the movement of the bowel slows down and usually takes about 72 hours to get back to normal. After about 48-72 hours you will probably be ready to start taking small sips of water, however your doctors will tell you when it is appropriate for you to start drinking some fluids.

This will be gradually increased after a couple of days until you are able to eat a light diet, usually four or five days after your operation.

Going home

You will probably be ready to go home in about two weeks after your operation and once your stitches have been removed. If deemed appropriate your doctor may send you home with stitches and call you later to remove the stitches.

By and large you should be able to climb several flights of stairs after your discharge from the hospital and you will be given diet instructions.

Before you leave hospital you will be given an appointment for a post-operative check-up at the outpatient clinic.

Diet after colon surgery

There is no restriction on the type of food you eat after a colon surgery and you should be able to eat all that you did before surgery.

At first you may notice that certain foods upset the normal action of your intestine or your colostomy if you have one. Foods such as fruit and vegetables may give you loose stools and make your colostomy act more often than normal. This is often temporary and after a while you may find that the same foods do not have any effect.

There are no set rules about the types of food to avoid and each person needs to experiment. Some foods that disagree with one person may be fine for another. If you continue to have problems, it may help to talk to a dietician at the hospital.

Depending on the type and extent of the surgery you have had, you may have more frequent motions. Tell your doctor if this happens as they can give you medicine to help control it

Try keeping a food diary if you are having problems you think are related to your diet. Take a small notebook and draw a line down the centre of each page. Write down what you eat and when on the left of the page. Write down any symptoms you get and when on the other side of the page. After a few days, you may be able to spot which foods cause which symptoms.

Dr. Deepak Chhabra

Dr. Deepak Chhabra

Dr. Deepak Chhabra is a consultant Surgical Oncologist with an extensive experience in cancer surgeries. After completing his Masters in Surgery (from the prestigious T.N.Medical College and B.Y.L Nair Hospital in Mumbai) and Diplomat from the National Board of Examinations, he subsequently received his specialist oncosurgical training at Mumbai.

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