Jackson Surgical Associates

What Is Colorectal Cancer?

The colon, which is the large intestine, is a muscular tube that forms the last part of the digestive tract. It absorbs water and stores food waste.

The colon is about four to six feet long, while the rectum is the last six inches on the colon.

The colon and the rectum have a smooth lining composed of millions of cells. Changes in these cells can lead to growths in the colon that can become cancerous and should be removed.

Changes that occur in the cells that line the colon or rectum can lead to growths called polyps. Over a period of years, polyps can turn cancerous. Removing polyps early may prevent cancer from ever forming.

How Colorectal Cancer Is Diagnosed

Your doctor likely detected a suspicious growth during a test called a colonoscopy. You may have been tested because you had symptoms such as rectal bleeding or a change in bowel habits.

Or your colon may have been checked as part of a routine screening for cancer. You may also have certain other tests. These give your doctor more information and help plan your surgery:

• CT or PET scan. A CT scan uses X-rays to create images of your body. In a PET scan, a mildly radioactive substance helps detect cancer cells. With either test, the results are displayed on a computer screen.
• Endoscopic ultrasound. In this test, a small ultrasound probe is placed in your rectum. The probe creates images of your rectum and anus.

During Colorectal Surgery

During colorectal surgery, the affected parts of the colon or rectum are surgically removed. You will be given instructions on how to prepare for your surgery. Follow these instructions carefully. By doing your part, you can help make your surgery a success.

You will likely be admitted to the hospital on the day of your surgery. In certain cases, admission to the hospital the day before is needed.

You will be told how to prepare your bowel for surgery. Follow these instructions carefully and ask questions if you have them:

• Have only clear liquids. For 12 to 24 hours before your colorectal surgery, you will be told not to eat any solid foods and to drink only clear liquids. These liquids include broth, plain coffee, gelatin, and clear fruit juice
• Do your bowel prep to clear your colon of stool. This involves drinking a liquid laxative, using enemas, or both.
• Make sure your stomach is empty. Do not have anything to eat or drink, including water or chewing gum, after midnight the night before surgery. (Your bowel prep liquid is OK to drink at this time.) If you are asked to take antibiotic pills before surgery, take them with small sips of water.

At the hospital, an IV (intravenous) line will be inserted into your arm to provide fluids and medications. You will meet with your anesthesiologist or nurse anesthetist to discuss the medication that helps you sleep during surgery. A soft tube called a catheter may be placed into your bladder to drain urine.

The idea of having part of your colon removed may sound scary. But the fact is that part or all of the colon can be removed without causing serious problems.

During surgery, the surgeon removes the affected part of the colon or rectum through a process called resection. Some normal tissue and nearby lymph nodes may also be removed. In most cases, the healthy sections of the bowel are reconnected.

To reach the colon, your surgeon will make one incision in your abdomen if he or she is doing open surgery or through several small incisions if he or she is doing laparoscopic surgery.

With open surgery, the incision may be several inches long and may run vertically around your navel. Laparoscopic surgery is done with long, lighted instruments through several small incisions in the abdomen. Your surgeon can tell you about the incision you will have.

If You Need an Ostomy Following Colorectal Surgery

After certain types of surgery, the colon and rectum may need to be kept clear of stool while they heal. In other cases, the rectum has been removed or can’t be reconnected to the rest of the colon. In either case, an ostomy is needed.

This creates a new opening in the abdomen so waste can leave the body. You may need the new opening for a short time or permanently. If you had an ostomy during colorectal surgery, your healthcare providers will help you learn how to care for it.

Two kinds of ostomies can be done during colorectal surgery. During a colostomy, part of the colon is connected to an opening in the abdomen wall. During an ileostomy, the small intestine is connected to an opening in the abdomen wall.

For both types, the new opening is called a stoma. This is where stool now leaves the body. Stool passes through the stoma into a special bag or appliance. Your healthcare team will tell you whether the stoma is needed for only a short time, or whether it will be permanent.

Recovering After Colorectal Surgery

When the surgery is done, you will be taken to the recovery room for a while. Your blood pressure, pulse, and breathing will be monitored, and you will receive pain medication to keep you comfortable. Your hospital stay may last from a few days to a week or longer.

If you have a urinary catheter, it will probably be removed shortly after surgery. Your IV line will remain in place for a few days to give you fluids.

You will continue to receive medication for pain. Soon after surgery, you will be up and walking around. This helps improve blood flow and prevent blood clots, and it also helps your bowels return to normal. You will be given breathing exercises to keep your lungs clear.

• You won’t eat or drink anything until your colon begins working again. When this happens, you will begin with a liquid diet. After that, you will be given solid foods according to your doctor’s instructions.
• In most cases, you will visit your doctor seven to 10 days after leaving the hospital. You can get back to your normal routine about a month or two after surgery. Full recovery may take four to six weeks or longer. While your body heals, you may tire more easily. You also are likely to have some bloating. Loose stools and more frequent bowel movements are common after surgery. This may get better over time, but may never disappear completely.
• Being active helps your body heal. Walk as much as you feel up to.
  Protect your healing incisions by avoiding heavy lifting or vigorous exercise until your doctor says it is OK. Follow your doctor’s advice about climbing stairs and bathing.
  You can drive when you are no longer taking pain medications—usually within a week.

Call you doctor if you have any of the following after colorectal surgery:

• Fever over 101
• Persistent nausea or vomiting
• Severe constipation or diarrhea
• Unusual redness, swelling, or pain around your incision.
• Worsening pain