This year more than 100,000 Americans will be diagnosed with colon cancer, and about 40,000 will be told they have rectal cancer. Colorectal cancers kill more than 50,000 men and women annually, making them the second leading cause of cancer deaths in the United States (behind lung cancer).
The good news, however, is that deaths from the disease have been dropping for the past two decades because of improvements in early detection methods and treatment options. In fact, many people with colorectal cancer live long, full lives after undergoing surgery — the cornerstone of treatment for the disease. Most people whose colorectal cancer is found at an early stage, before it has spread through the intestinal wall and into nearby lymph nodes, can be cured.
The gold standard operation for colorectal cancer is “open” surgery, in which surgeons cut into the abdomen to open it entirely. This allows them to examine the whole area to tell whether a tumor has spread from the colon or rectum to nearby organs or to more distant sites, such as the liver or, in women, the ovaries and other reproductive organs. If possible, the surgeons remove all the cancer, as well as some of the normal tissue on either side of it to help prevent the cancer from returning. In addition, they take out all the blood vessels and lymph nodes in and around the affected intestine to eliminate the flow of malignant cells through this network and into other parts of the body.
Most early stages of colorectal cancer are treated with open surgery. The main exceptions are certain very early stage cancers, which have not penetrated very deeply into the intestinal wall. Superficial tumors in the rectum can sometimes be removed with instruments inserted through the anus — a technique known as transanal resection. Very early colon cancers can also be taken out with a colonoscope, a long, lighted instrument that can be used to view the entire colon and to remove polyps — benign or cancerous growths of tissue.
Although open surgery can often cure colorectal cancer, it is a major operation typically requiring a three-to-six-day hospital stay and six to eight weeks recovering at home before returning to work and other routine activities. A newer technique, known as laparoscopic-assisted colectomy, allows patients to leave the hospital sooner and to resume their normal daily activities much sooner. It is now an option for many patients whose cancer is at an early stage and confined to the colon.
Laparoscopy involves inflating the intestine with carbon dioxide and then feeding a tiny light and video camera, along with other surgical instruments, into the area through half-inch slits in the skin. The camera is attached to a monitor that gives the surgical team a good view inside the abdomen. The surgical tools are used to cut out the cancer and nearby surrounding tissues. Once the diseased part of the colon has been freed, one of the incisions is made larger so it can be removed.
Laparoscopic surgery allows surgeons to view the intestine, lymph nodes, liver, and other areas to look for cancer about as well as with open surgery.
An advantage of laparoscopic surgery is that it usually causes less postoperative pain than open surgery because the incision is smaller. People often recover sooner and are able to get back to normal activities sooner.
Studies have found that colorectal cancer is no more likely to come back in patients treated with laparoscopy than in people who have open surgery. Survival rates are also similar for both groups.
One theoretical concern is that unlike open surgery, in which a surgeon can look and feel for changes in tissue, the surgeon can't feel for tumors that might be hard to see. As a result, a physician may not notice, say, a thickening in the intestinal wall or an enlarged lymph node — changes that might indicate the presence of cancerous cells. But, as noted above, so far studies have not found that this affects recurrence or survival rates.
Another issue is that laparoscopic surgery is complicated and takes some time for surgeons to learn. People who are interested in undergoing laparoscopy should be sure they are in the hands of a skilled surgeon who has done many of these operations.