Mar 07, 2016 1:00 AM

Author: Bartley Pickron, MD

An estimated 136,000 people will be diagnosed with colorectal cancer in the United States this year. Those patients will have a lot of questions. Here are the answers to the five I hear most.

1. Will I Need to Have a Colostomy Bag?

Most patients with colorectal cancer have surgery where a section of the colon is removed and then the two ends are put back together so there is no need for bag. Certain circumstances may require the use of an ostomy bag such as if the tumor is close to the anal opening, if radiation has been used as part of the treatment, if there is associated infection, or if the patient is is generally poor health at the time of surgery. Overall, few patients with colorectal cancer require a bag.

2. Will I need chemotherapy?

The use of chemotherapy depends on the final staging of the tumor which is generally not known until after surgery. The important determination for chemotherapy use in colorectal cancer is determining whether the tumor has spread outside the colon. The general rule of thumb for colorectal cancer is that if the tumor has spread outside the colon to the adjacent lymph nodes then chemotherapy is recommended. If there is no spread of the tumor then surgery is usually adequate treatment.

3. Do I Have to Have a Big, Painful Incision for Surgery?

No. Most colorectal cancer tumors can be removed with minimally invasive surgery using tools such as laparoscopy or robot assisted surgery. In these cases, instead of a single, long incision multiple small incisions about a quarter to a half inch in size are used to do the internal work of removing the colon. An incision of two to three inches is then required to remove the cancerous part of the colon. In these minimally invasive surgical procedures, recovery is generally quick with a hospital stay of two to four days and a quicker overall recovery compared to traditional open surgery.

4. How Do We Know That the Tumor Isn’t Going to Come Back?

The short answer is that we don’t know. We do keep a close watch on colorectal cancer patients through a surveillance program with the surgeons and the medical oncologists. Typical follow up in to be seen every three months for the first two years after surgery followed by every six months for the next two years and then annually after that. Bloodwork and CT scans are performed at regular intervals to look for any evidence of tumor recurrence so that if the tumor comes back then it can be caught early and treated aggressively.

5. Will My Bowel Movements Be Different After Surgery?

Usually yes, but it depends on the surgery. Most patients experience stools that are softer and more frequent than usual for the first 3–6 months after surgery as the body adjusts to missing the segment of colon that was removed. Generally speaking, the closer the tumor is to the anal opening, the more changes patients experience.

colon cancer colorectal surgery

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