Bowel cancer surgery

Information about surgery for bowel (colorectal) cancer.

About bowel cancer surgery

Surgery for colon cancer

Surgery is a common treatment for colon cancer. You may need other treatments before or after surgery for colon cancer.

Surgery for rectal cancer

For rectal cancer a combination of radiotherapy and chemotherapy (chemoradiation) and sometimes additional chemotherapy can be given before surgery. For very early rectal cancers, surgery may be the main treatment.

About bowel surgery

Surgery aims to remove the part of the bowel that contains the tumour.
If the cancer is found early, surgery can often cure it.
If the cancer is very small you may only need a small surgical procedure to remove it (local resection).
After your surgery you may have a stoma − an opening on your tummy that lets poo leave your bowel into a bag.
Lymph nodes will also be removed as part of your surgery, to help
prevent the cancer spreading.
Your hospital stay will depend on the type of surgery. Some people are ready to go home 3-7 days after surgery. For bigger surgeries the length of stay may be 10-14 days.

Types of surgery for bowel cancer

The type of surgery you have will depend on:

Where in the bowel the tumour is found and how big it is
The type of tumour
If the cancer has spread to other tissues/organs

Which part of your bowel will be removed depends on where the cancer is.

Once the part of your bowel with the tumour is removed (bowel resection), the two ends of your bowel are joined together, if possible.

Your surgery may involve a stoma, which allows your bowel motions (poo) to pass through an opening on your tummy instead of through your back passage. There's more about stomas below.

Ask your surgeon to explain your surgery

How the surgery will be done
Which part of the bowel will be removed
What will happen afterwards

Ways of doing bowel surgery

Keyhole surgery (laparoscopic surgery)

With keyhole surgery, a small cut is made in your abdomen. Your surgeon will put a tube with a tiny telescope and light inside your body through a very small cut. Special instruments can then be used to remove the tumour.

There is usually a quicker recovery with keyhole surgery than with open surgery and you may spend less time in hospital. Although the scar on your tummy will be smaller, your bowel will still need the same amount of healing – it’s important you give yourself time to recover.

Keyhole surgery can be used for some types of bowel cancer. Your surgeon will discuss if you’re suitable and if this type of surgery is available in your hospital.

Robotic surgery

This is similar to laparoscopic keyhole surgery. The surgeon uses
robotic arms to help remove the tumour through a small incision. As
with all keyhole surgery, the aim is to provide quicker recovery with
less post-operative pain.

Open surgery

A long cut is made in your abdomen. This means your wound may go from below your breastbone down towards your pelvis in a straight line. The length will depend on where the cancer is.

Stomas / colostomy

Your surgery may involve a stoma, which allows your bowel motions (poo) to pass through an opening on your tummy instead of through your back passage. A bag will collect the bowel motions.

You may have a temporary stoma to allow the join in your bowel to heal. Or you may have a stoma because it’s not possible to join up the ends of your bowel again. Read more about how to care for your stoma and stoma reversal.

Image courtesy of Cancer Research UK/Wikimedia Commons

Possible side-effects from bowel surgery

General side-effects

With all surgeries there is a small risk of bleeding and infection. Read more about general side-effects of surgery.

Caring for your stoma

Keep the stoma clean and free from tissue or crusts. This is to prevent it getting blocked, which could interfere with your breathing. It will also stop the skin around the stoma getting sore and help to prevent infection.

You may have a lot of secretions or phlegm initially after the surgery but this will reduce by the time you go home.

Using a small freestanding, table-top mirror can make it easier to see what you are doing. It might be helpful to have a relative or close friend with you when learning to look after the stoma.

Diarrhoea

Depending on your surgery, you may have diarrhoea for a short while. Drink plenty of clear fluids and let your doctor and nurse know. They can give you medication to control it. If you have an ileostomy, contact your stoma nurse for advice on treating diarrhoea and drinking fluids.

Change in bowel habits

Some people find their bowels are more active after surgery. As a result, you may have to control what you eat for a while. If you have a stoma, your bowels may move at certain times of the day. You may notice that your stoma is more active after a meal or that it works a little bit all day.

Wind (flatulence)

Sometimes wind can be a problem. It can build up and give you pain and discomfort. Talk to your nurse about taking peppermint water. Your doctor can prescribe medication to relieve it as well.

Sexual side-effects of bowel surgery

Most people have no problem resuming their sex life after bowel surgery. It may be a few weeks before you feel ready.

Others may find it harder, especially if their rectum has been removed (proctectomy). For example, surgery to the rectum can affect the nerves and blood supply to the sexual organs. This may result in problems such as:

Erection and ejaculation problems. This usually clears up over time.
Narrowing and shortening of the vagina. This can make sex painful. For some, it can also lead to a loss of sensation or less vaginal secretions. Usually simple solutions, such as lubricants, can help these problems.

Getting support

If you have any sexual problems after your treatment, talk to your doctor and specialist nurse. They are used to dealing with these type of problems, so there’s no need to feel embarrassed. They can advise you on treatments, give you tips and also refer you for counselling – for you or for you and your partner – if you feel it would help.

Stomas and sex

Body image: If you have a stoma it may change the way you feel about your body. You may also have concerns about how your partner will react. Try to talk to your partner about the way you are feeling. Talking can help to ease your anxiety. If you need more advice, talk to your doctor. He or she can refer you for special counselling if you feel it would help.
Food and drink: Try not to eat too much before sex. You could plan times for sex when a bowel movement is less likely.
Managing the pouch: Empty the pouch before sexual intimacy. An empty and flat bag will not become loose from the stoma. It can be rolled up or taped down so it will not get in the way. It is possible to wear decorative covers as well. Smells can also be controlled. .
Intimacy: You may be afraid that the bag will interfere with sex, become dislodged or cause damage to the stoma. These are all normal fears. But an empty and flat bag will not become loose from the stoma. It can be rolled up or taped down so it will not get in the way.
Decorative covers: It is possible to wear decorative covers as well. There are also a variety of pouches to suit your needs. There are bands you can wear on your tummy for support and discretion. Your stoma care nurse can give you advice about this.

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