For stage 3 cancer, chemotherapy is often recommended after surgery to help reduce the risk of the cancer recurring. Surgery can also be used in more advanced cases, for example, to relieve symptoms such as bleeding or intestinal obstruction, or to remove tumors in other organs, which can help control the disease, adds Dr. Dozois. Rectal cancer, which is located in the last few centimeters of the large intestine, is often treated differently from colon cancer. Recovery can be faster, with patients starting to eat soon after surgery and returning home within a few days. In rectal cancer, minimally invasive techniques are also used, although the surgery can be more complex due to the reduced space in the pelvis and the need to preserve nerves. Because the rectum is located deep in the pelvis, next to other organs and structures, such as the nerves that control intestinal and bladder function, doctors often use a multidisciplinary approach. “In many cases of rectal cancer, especially when they are locally advanced or near critical structures, treatment often begins with chemotherapy and radiation therapy before surgery,” explains Dr. Dozois. It often improves treatment outcomes and, in some carefully selected patients, it may even allow for the preservation of intestinal function closer to normal. Treatment for rectal cancer may involve a team of specialists, including colorectal surgeons, medical oncologists, and radiation oncologists, who analyze each case together to define the best plan for each patient. “Both in colon and rectal cancer, the basic goal of surgery is the same: to completely remove the tumor, along with a margin of healthy tissue around it and the nearby lymph nodes,” states Dr. Dozois. “After surgery, the removed tissue is examined under a microscope to confirm the stage of the disease and decide if further treatment, such as chemotherapy, is necessary.” In early-stage colon cancer (stages 1 and 2), surgery alone can be curative. The approach is individualized based on: • Cancer stage: how deeply it has penetrated and whether it has spread. • Tumor location: rectal cancer usually requires a different therapeutic sequence than colon cancer. • Patient's overall health and preferences: the patient's goals, other illnesses, and expectations for recovery are also important factors. “Experience is key to optimizing outcomes in patients with colorectal cancer,” explains Dr. Dozois. These techniques use small incisions, as well as advanced instruments that allow surgeons to work with great precision, resulting in fewer complications, less pain, and a faster recovery than with traditional open surgery. In colon cancer, minimally invasive colectomies are common and, in many patients, can be performed through several very small incisions. However, whether it will be the first step, and what it entails, depends on several factors, especially where the cancer is located, how much it has invaded surrounding tissues, and whether it has spread, explains Eric Dozois, M.D., chair of Colon and Rectal Surgery at Mayo Clinic in Minnesota. “In colon cancer, surgery is usually the first and main step when the disease has not spread to distant organs. The goal is to shrink the tumor so it can be removed more completely and safely and to reduce the risk of it recurring.” This sequence, called neoadjuvant therapy, is less common in colon cancer but is standard in many cases of rectal cancer, which carry a higher risk of local recurrence. The goal is to remove the part of the colon affected by cancer along with the nearby lymph nodes, which are the first places to which cancer usually spreads,” states Dr. Dozois. Advances in surgery for colorectal cancer • The location and stage of the disease are determining factors in deciding whether surgery is the first step in patients with colorectal cancer. • Minimally invasive and robotic techniques allow for faster and more precise recovery in colorectal cancer surgeries. When a person is diagnosed with colorectal cancer — which includes both colon and rectal cancer — many people immediately think of “surgery.” These aspects are important and should be discussed with the medical team. Not all cases of colorectal cancer are the same. “That is why it is important to go to specialized centers that see a large volume of patients with colorectal cancer each year, use multidisciplinary teams to review each case, and recommend a therapeutic sequence that balances the possibility of a cure with quality of life.” Robotic surgery, in particular, offers 3D visualization and more precise control of the instruments, which can be especially useful. Rectal cancer surgery can sometimes affect bowel function. In some patients, a temporary or permanent stoma may be necessary, an opening in the abdomen through which waste is eliminated, depending on the location and extent of the tumor. “Subsequently, the surgeon reconnects the remaining intestine so it can function normally.” Many colorectal surgeries are performed using minimally invasive techniques, such as laparoscopy or robot-assisted surgery, he adds. Even when the surgery is technically successful, some patients may experience changes in bowel habits or control over defecation (a condition sometimes called low anterior resection syndrome), urinary difficulties, or sexual dysfunction. And it is true that surgery plays a central role in the treatment of most patients. Many patients will not need any further treatment beyond periodic check-ups.
