How are cancers of the colon and rectum treated?

Once tests have confirmed that the cancer has not spread anywhere else, most colon cancers are treated by surgery. This will usually involve removing the cancer together with the lymph glands along the blood vessels supplying that section of the bowel.

In most cases, the two ends of the bowel are joined together again (anastomosis) but if the cancer has led to an emergency, it may not be possible to join the bowel together right away. Once the colorectal cancer and surrounding tissue have been removed they will be examined under the microscope and only then will it be possible to fully determine the stage of the cancer.

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If the cancer is confined to the bowel wall, then surgical removal alone may be all that is needed. If there is any sign of spread to the local lymph glands a course of chemotherapy post-operatively may well be advised.

Unless they are very small and can be removed by a local operation, most cancers of the rectum need to be checked very carefully pre-operatively by various scans. This will help decide whether or not the cancer should be treated by radiation therapy.

Cancers in the lower part of the rectum will be removed together with the immediately surrounding tissue called the mesorectum. This operation which aims to cure the cancer is called total mesorectal excision (often abbreviated to TME).

Will a colostomy be necessary?

Fortunately, modern surgical techniques have made the need for a stoma to be much less likely than it was in the past.

What happens after surgery?

While you are recovering, the specialist team will meet to consider whether further treatment is advisable. Such decisions are based largely on the information we have about how advanced the primary cancer was. After the operation, the treatment options will be explained and if there is a need for further treatment—such as chemotherapy—this will be arranged.

The specialist team will wish to see you again in the months and years after surgery to check on how you are doing. Very often, you will be offered blood tests, scans or a follow-up colonoscopy to detect whether the cancer has come back. If it does recur, that is obviously bad news, but there are still options for cure even if the tumor has come back.