Colon and Rectum Cancer : Surgery

by National Cancer Institute

(Page 3 of 5)

Treatment

Many people with colorectal cancer want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything they want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, people may take notes or ask whether they may use a tape recorder. When they talk to the doctor, some people also want to have a family member or friend with them to take part in the discussion, to take notes, or just to listen.

The doctor may refer a person with colorectal cancer to a specialist, or the patient may ask for a referral. Specialists who treat colorectal cancer include gastroenterologists (doctors who specialize in diseases of the digestive system), surgeons, medical oncologists, and radiation oncologists.

Getting a Second Opinion

Before starting treatment, people with colorectal cancer might want a second opinion about their diagnosis and treatment options. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. In general, taking several weeks to get a second opinion does not make treatment less effective. In some cases, however, people with colorectal cancer need immediate care.

There are a number of ways to find a doctor for a second opinion:

• The doctor may refer the patient to one or more specialists. At cancer centers, several specialists often work together as a team.
• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about nearby treatment centers.
• A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.
• The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background.

Preparing for Treatment

The doctor develops a treatment plan to fit each person's needs. Treatment for colorectal cancer depends mainly on the location of the tumor in the colon or rectum and the stage of the disease. The doctor can describe the treatment choices and the expected results.

People may want to ask the doctor these questions before treatment begins:

• What is the stage of the disease?
• What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment?
• What are the expected benefits of each kind of treatment?
• What are the risks and possible side effects of each treatment? How can the side effects be managed?
• How will treatment affect my normal activities? Am I likely to have urinary problems? What about bowel problems, such as diarrhea or rectal bleeding? Is treatment likely to affect my sex life?
• What will the treatment cost? Is this treatment covered by my insurance plan?
• Would a clinical trial (research study) be appropriate for me?

People do not need to ask all of their questions at once. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information.

Methods of Treatment

Treatment for colorectal cancer may involve surgery, radiation therapy, or chemotherapy. Some people have a combination of treatments.

Colon cancer sometimes is treated differently from rectal cancer. Treatments for colon and rectal cancer are described separately.

At any stage of colorectal cancer, treatments are available to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care.

People with colorectal cancer may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods.

Surgery

Surgery is the most common treatment for colorectal cancer. It is a type of local therapy. It treats the cancer in the colon or rectum and the area close to the tumor.

A small malignant polyp may be removed from the colon or upper rectum with a colonoscope. Some small tumors in the lower rectum can be removed through the anus without a colonoscope.

For a larger cancer, the surgeon makes an incision into the abdomen to remove the tumor and part of the healthy colon or rectum. Some nearby lymph nodes also may be removed. The surgeon checks the rest of the intestine and the liver to see if the cancer has spread.

When a section of the colon or rectum is removed, the surgeon can usually reconnect the healthy parts. However, sometimes reconnection is not possible. In this case, the surgeon creates a new path for waste to leave the body. The surgeon makes an opening (a stoma) in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. The operation to create the stoma is called a colostomy. A flat bag fits over the stoma to collect waste, and a special adhesive holds it in place.

For most people who have a colostomy, it is temporary. It is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the parts of the intestine and closes the stoma. Some people, especially those with a tumor in the lower rectum, need a permanent colostomy. People may want to ask the doctor these questions before having surgery:

• What kind of operation do you recommend for me?
• Do I need any lymph nodes removed? Will other tissues be removed? Why?
• What are the risks of surgery? Will I have any lasting side effects?
• Will I need a colostomy? If so, will it be permanent?
• How will I feel after the operation?
• If I have pain, how will it be controlled?
• How long will I be in the hospital?
• When can I get back to my normal activities?

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