Treatment - Bowel cancer

If colon cancer is at a very early stage, your surgeon may be able to remove the cancer from the colon wall with a small bit of healthy tissue around it. This is called a local excision.

If the cancer spreads into muscles surrounding the colon, your surgeon may need to remove a whole section of your colon. This is a colectomy.

There are 3 ways your surgeon can perform a colectomy:

Open colectomy

This is where the surgeon makes a large cut (incision) in your tummy (abdomen) and removes a section of your colon.

Laparoscopic (keyhole) colectomy

This is where the surgeon makes some small incisions in your tummy (abdomen). The surgeon is guided by a camera and removes a section of your colon.

During surgery, nearby lymph nodes are also removed.

It's usual to join the ends of the bowel together after bowel cancer surgery. If this is not possible, you may need a stoma (bag). This is usually temporary.

Both types of surgery are thought to be equally effective at removing cancer. They have similar risks of complications.

You will have a faster recovery time and less pain after a laparoscopic or robotic colectomy. It is has become the normal way of doing most of these surgeries.

Robot-assisted surgery (robotic colectomy)

This is a type of laparoscopic surgery that uses robots and a computer to help to remove the tumour.

There are many different types of surgery to treat rectal cancer. But it depends on how far the cancer has spread and where the tumour is.

Some types of surgery are through your bottom only and some are through your tummy.

The main types of surgery are:

• local resection
• total mesenteric excision
• anterior resection
• abdominoperineal resection
• stoma surgery

Bowel cancer surgeons always do their best to avoid giving people permanent stomas if possible.

A stoma is another way for your poo to leave your body. You have an opening on your tummy that is connected to a bag. When you poo it goes into the bag.

You may have stoma long-term. You may have it short-term. For example, if your surgeon wants to help your body heal after surgery they might away from where they have done some surgery to

Your surgeon will bring a loop of bowel out through your abdomen (tummy) wall and attach it to the skin. This is called a stoma. A bag is worn over the stoma to collect your poo.

When the stoma is made from the small bowel (ileum) it's called an ileostomy. When it's made from the large bowel (colon) it's called a colostomy.

Stoma care

Before surgery a stoma care nurse can talk to you about the best place for a stoma. The nurse will take into account your body shape and lifestyle. But this may not be possible if your surgery takes place in an emergency.

The stoma care nurse will tell you about what you need to do to look after the stoma and the type of bag suitable.

Recovery

It can take a few weeks for the join in the bowel to be healed. After it has healed you will have another operation to close the stoma.

In some people rejoining the bowel may not be possible. It may lead to problems controlling bowel function. In this case you may have the stoma for the rest of your life. This is a permanent stoma.

Before having surgery, the care team will tell you if they may need to make an ileostomy or colostomy. They'll tell you if it's likely to be temporary or permanent.
There are support groups that are there to support patients who have had or are about to have a stoma. You can get details from your stoma care nurse.

Caring for your stoma - cancer.ie

Bowel cancer surgery has many of the same risks as other major surgery, including:

• bleeding
• infection
• blood clots
• heart or breathing problems

Different types of surgery also have different risks.

One risk is that the joined up section of bowel may not heal properly and leak inside your abdomen. This is usually only a risk in the first few days after the operation.

The nerves that control peeing and sexual function are very close to the rectum. Sometimes surgery to remove a rectal cancer can damage these nerves.

After rectal cancer surgery, most people need to poo more often than before. Your hospital team can advise you on food, medicine and lifestyle changes that will help.

Sometimes, some people - particularly men - have other distressing symptoms. If you have low anterior rectal syndrome (LARS) pelvic floor physiotherapy or colonic irrigation may help.

Support and advice is offered on how to cope with these symptoms until your bowel adapts.

Most hospitals use an enhanced recovery programme to help patients recover quicker after bowel cancer surgery.

It involves giving you more information about what to expect before surgery.

Before surgery

The programme avoids giving you strong laxatives to clean your bowel before surgery. In some cases you may be given a sugary drink two hours before the operation to give you energy.

After surgery

During and after the operation, the anaesthetist controls the amount of IV fluid you need.

After the operation, you'll be given painkillers so you can get up and out of bed by the next day.

Most people will be able to eat a light diet the day after their operation.

You may be given special compression stockings to reduce the risk of blood clots in the legs (deep vein thrombosis).

These will help prevent blood clots. You may also be given a regular injection with a blood-thinning medicine called heparin until you're fully mobile.

A nurse or physiotherapist will guide you in the correct way to get in and out of bed. This is so you do not injury yourself after tummy surgery.

Going home after surgery

With the enhanced recovery programme, most people are well enough to go home within a week of their operation.

The timing depends on when you and the doctors and nurses looking after you agree you're well enough to go home.

You will get written advice from a dietitian before you leave hospital.

Follow-up tests

We'll ask you to return to hospital a few weeks after your treatment. This is so we can do tests to check for any remaining signs of cancer.

You may also need routine check-ups for the next few years to look out for signs of the cancer recurring. It's becoming increasingly possible to cure cancers that come back after surgery.

Diarrhoea after bowel surgery

If you've had part of your colon removed, it's likely you'll have some diarrhoea or poo often.

Your poo can be more frequent and looser after surgery. This is because you have had part of your bowel or rectum removed.

One of the things the colon does is absorb water from poo and empty when going to the toilet.

After surgery, the bowel does not empty as well at first. This can happen if part of the rectum has been removed.

Tell your care team if this becomes a problem. There are medicines you can take to help these problems.

You may have trouble tolerating certain foods, some foods may cause constipation and some may cause diarrhoea. You will find out what suits you or doesn’t suit you.

It is unlikely how often you poo will return completely to how it was before surgery but it should settle down in time.