To understand how the most effective treatment for colon cancer works, you have to know a little something about the organ itself, says FarhaadGolkar, MD, a surgeon at AdventHealth Palm Coast, formerly Florida Hospital Flagler.
It’s basically a five-foot-long pipe that has one major job: Absorb the water from the food you eat. As it passes through the colon, stool starts out very watery and, ideally, ends up dry.
The best way to treat colon cancer is to remove the entire section of the colon that the tumor is located in. To the colon, that’s no big deal.
“You can remove about two-thirds of the colon with minimal effect on a patient’s lifestyle,” Dr. Golkar said.
March is National Colorectal Cancer Awareness Month. Surgical treatments can be curative when colon cancer is caught early. In these cases, more than 9 in 10 patients survive their cancer.
Learning that colon cancer surgery is curative may give you that final motivation you need to get a colonoscopy. The American Cancer Society recommends that adults at normal risk — meaning they have no family history of colon cancer or other risk factors — should get their first colonoscopy at age 45.
There are three general ways new patients find themselves in Dr. Golkar’s office. All three involve a colonoscopy.
A Path to the Operating Room
While there is no “good” way to be diagnosed with colon cancer, the best way to spot it early is during a “screening” colonoscopy. This means the test was performed while the patient was healthy, before symptoms came up.
At other times, routine blood tests discover anemia, which means a low blood cell count. Colon cancer can cause long-term bleeding, so a finding of anemia without an obvious cause may result in a colonoscopy.
Finally, patients can experience symptoms of colon cancer itself, like belly pain or blood in the stool, which can also trigger a colonoscopy.
In any case, the colonoscopy is important to Dr. Golkar because it tells him how large the tumor is and where it’s located. That determines which part of the colon he’ll remove.
Afterward, a computed tomography, or CT, scan will confirm the tumor hasn’t spread to the lungs, liver or elsewhere. If it has, surgery likely won’t be an effective treatment up front.
How It Works
Remember how Dr. Golkar removes the entire section a tumor is in, and not just the tumor itself? This is because the colon is divided into five sections based on their connections to blood vessels and lymph nodes. Just as each of these sections share blood and lymph, an immune system fluid, they may also share cancer cells. Taking the whole section out is the best way to conduct surgery.
Dr. Golkar is proficient in minimally invasive, or laparoscopic, techniques, meaning he can use small cuts to insert tools to see inside the abdomen and conduct the procedure.
“I use minimally invasive techniques every day,” he says. “Depending on the location, I offer a variety of either open or laparoscopic procedures.”
To picture how the surgery begins, think of the colon like a pipe and the section with cancer like a piece to be removed.
“You make a cut on either side of the cancer, remove it along with the surrounding lymph nodes, and put the two ends of the colon back together with staples,” Dr. Golkar said. Before that can happen, he has to loosen the remaining ends of the colon so they can connect without tension.
Common Questions About Surgery
Dr. Golkar says some of his patients’ anxieties stem from their questions about what the surgery and recovery will be like. Here are four of the most common ones:
1. How long will I be in surgery? In the hospital? In recovery?
The surgery itself lasts about two to three hours, Dr. Golkar says. A typical hospital stay afterward is about five days. Why so long?
After the surgery, the body’s digestive tract shuts down for a time. As that happens, the patient can’t eat or drink. So they get their nutrition, fluids and pain medicine intravenously.
After the intestines “wake up” and the patient can eat solid food, they’re ready to go home. They typically receive three days of oral opioid pain medication after they go home. In addition to their addiction risks, these drugs have the unwelcome side effect of causing constipation.
It generally takes about four to six weeks to get back to normal or nearly so, Dr. Golkar says.
2. Will I need a colostomy bag?
A colostomy bag is a small pouch that is affixed on the outside of someone’s body that collects waste. Patients worry about whether they’ll need one after colon cancer surgery, but usually they do not, Dr. Golkar says.
“The only incidences where patients end up with colostomies is when they undergo emergency surgery” when their colon is completely blocked or when the colon has ruptured or perforated, he said.
3. Will I need chemotherapy?
Dr. Golkar says he can’t answer this question until after the surgery, when the tumor and lymph nodes are analyzed under a microscope. There are a few situations in which chemotherapy after surgery is used:
- If the tumor is especially large
- If the tumor had features that made it aggressive
- If cancer cells were detected in nearby lymph nodes
In all three cases, the role of chemotherapy is to eradicate microscopic cancer cells that could be anywhere else in the body. But many patients don’t need chemotherapy at all.
4. What are the possible complications?
Dr. Golkar says there are two different classes of complications, or risks, of surgery.
First, there are the potential problems that come with every surgery, like heart problems due to anesthesia or infection from a cut.
Second, there are problems unique to colon cancer surgery. The biggest is a leakage at the site of the new connection of the colon formed by the staples.
“We go to great lengths to avoid leakage when we do the surgery,” Dr. Golkar said. He said leakage occurs in about 3 percent to 5 percent of surgeries.
Part of the goal of learning all you can about colon cancer surgery is to help calm your anxiety. Stress can harm the body, too, and optimism is important in cancer therapy.