Rectal Cancer

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Surgery

Most people who have rectal cancer have surgery to remove their cancer. Often they have several weeks of radiation therapy to the pelvis and chemotherapy first. Having these treatments before surgery has been shown to improve control of the cancer and improve the chance of cure in patients with more advanced rectal cancers.

Rectal cancer surgery for Seattle Cancer Care Alliance (SCCA) patients is performed by surgeons at University of Washington Medical Center (UWMC). If you need surgery, it will be done by a surgeon who is specially trained to do this operation. Your surgeon will work closely with the other members of your health care team.

The exact procedure you have will depend on many factors, such as the stage and exact location of your cancer as well as your health, weight, height, and preferences. You and your team will discuss your options and decide together what is best for you.

Local Excision

If your cancer is limited to one or more polyps and was found at a very early stage, the cancer may have been removed at the time of your colonoscopy. This procedure is called a polypectomy. Sometimes, a polypectomy is all the surgery a patient needs. But some people still need a deeper local excision of the rectal wall or even a larger operation. These decisions are individualized and often very complex. Your surgeon will talk with you about what he or she recommends for you and why.

Mesorectal Excision

For most patients, rectal cancer cannot be removed with a simple polypectomy. Instead, your surgeon will remove (resect) the segment of your rectum that contains the cancer. The surgeon also takes out fatty tissue and lymph nodes near the rectum. These are checked under a microscope to see if they contain cancer. The operation is called a proctectomy (removal of the rectum) with total mesorectal excision. In some cases, this operation can be performed with robotic or laparoscopic assistance.  

“Mesorectal excision is one of the most exciting surgical, technical developments of the 20th century,” says Karen D. Horvath, MD, professor of surgery at UWMC and associate chair of surgery for education. “Together with chemotherapy and radiation therapy, it has significantly reduced the rate of recurrence of rectal cancer in the pelvis.”

The procedure is an important advancement in surgical treatment to cure rectal cancer, and it is available to SCCA patients.

Anastomosis

After taking out the cancerous segment of your rectum, the surgeon may be able to connect the healthy parts of your intestine together (a procedure called anastomosis) so that stool can move through your bowel and out of your body along the normal pathway. If some of your rectum remains, then your colon will be sewn to this. If your entire rectum has been removed, then your colon will be sewn to your anus. It may take several operations to achieve this end result.

During the process, you may temporarily need an ileostomy. This means the surgeon creates an opening (stoma) in your abdomen and attaches the open end of your small intestine (ileum) to it on the inside. A bag is attached to the skin on the outside to collect waste. Having an ileostomy allows the new anastomosis (where the healthy parts of your intestine were connected) to heal. A few months after the rectal surgery, the ileostomy can usually be reversed with a much smaller operation but only after testing to ensure the intestine is healed from the earlier operation.

The ability to save the muscles of the anus (anal sphincters) and eliminate the need for a stoma requires highly specialized surgical care, which the surgeons at UWMC and SCCA are able to offer.

Colostomy

In some patients, in order to completely remove the cancer the anal sphincters cannot be saved. Instead of an anastomosis between the colon and the rectum or anus, some people need a permanent colostomy. The surgeon creates a stoma in your abdomen and attaches the open end of your colon to it on the inside. A bag is attached to the skin on the outside to collect waste. While this is clearly a change from what patients were used to before having cancer, you can lead a full, satisfying life with a colostomy.