Colorectal Cancer Treatment: Surgery, Guidelines & Stage-wise Options

Colorectal Cancer Treatment Plans: Is Surgery Necessary?

If you or someone you care about has just been told they have colorectal cancer, one of the first things that often comes up is, “Will I need surgery?” It’s completely understandable since surgery is seen as the standard treatment response, and in many cases, it is.

But here’s the truth: not everyone with colorectal cancer (CRC) needs surgery, and even when it is part of the plan, it doesn’t always mean a difficult recovery or long hospital stays.

Today, there are multiple surgical options available, ranging from minimally invasive procedures to organ-preserving techniques that have fewer complications, better outcomes, and faster recoveries.

Read on to understand how treatment decisions are made for CRC, when surgery is needed, and what to expect if it's part of the care plan.

Understanding the standard CRC treatment paths

Regular screening is essential since it does not show any noticeable symptoms until the later stages, particularly for high-risk individuals. These include men, especially those over 50, and those with a family history of colorectal cancer.

This course of treatment is often decided by a team of specialists, including a colorectal surgeon, a medical oncologist, and a radiologist. They review test results and develop personalized plans based on an individual's condition.

Most colorectal cancer treatment options involve one or more of the following procedures:

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  Surgery to remove the tumour
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  Chemotherapy to kill cancer cells that have spread
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  Radiation therapy to target tumours in specific areas
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  Immunotherapy in select cases where the cancer shows certain markers

Each treatment has its benefits and side effects and can be used as a stand-alone option or in combination. These approaches are aligned with current colorectal cancer treatment guidelines that aim to personalize care and improve patient outcomes.

When is surgery recommended for colorectal cancer treatment?

Surgery is the primary and most effective step for colorectal cancer treatment.

But it only works if the cancer is detected early and is limited to the colon or rectum. In stage 1 colorectal cancer treatment, surgery alone is enough to remove the cancerous tissue, including tumours and affected lymph nodes.

For more advanced stages, particularly stage 4 colorectal cancer treatment, when the disease has spread to other organs like the liver, surgery is not used as the first step but the second or last.

Instead, treatments like chemotherapy or targeted therapy are used to control the disease. Surgery is considered later in these stages to relieve symptoms or remove isolated tumours that have separated because of these therapies and medications.

With that said, colorectal cancer surgery is not just one type but includes different procedures. Let’s take a look:

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  Polypectomy
  It is done when the cancer is in the early stage, often Stage 0 and Stage 1, and limited to the inner lining of the colon or rectum using colonoscopy.
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  Local excision
  The surgery involves removing a small tumour along with a margin of surrounding tissue when rectal cancer is detected at an early stage and has not spread beyond the surface layer.
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  Colectomy
  This colon cancer surgery involves removing part or all of the colon along with nearby lymph nodes and is done in Stage 1 to Stage 3.
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  Proctectomy
  It refers to the surgical removal of part or all of the rectum and is performed when rectal cancer is too large or deep to be treated with local excision alone.
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  Low anterior resection (LAR)
  This procedure is used for mid-to-upper rectal cancer. It removes the upper part of the rectum while preserving the anal sphincter, allowing for normal bowel function.
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  Abdominoperineal resection (APR)
  APR is done when the tumour is located very low in the rectum and removes both the rectum and the anus, creating a permanent colostomy.

How is treatment decided? Key factors that influence a surgical recommendation

No doubt surgery is the most essential part of colorectal cancer treatment, but it’s not a suitable option for every patient. Healthcare providers consider different clinical and health factors before making a decision.

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  Location
  Colon cancers are more likely to be treated with surgical procedures. But rectal cancers, especially those located close to the anal, often need chemotherapy before surgery.
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  Diagnostic insights
  Cancer tests such as colonoscopy, biopsy, CT scans, and more help evaluate the size of the tumour and how far it has spread to decide on the best treatment.
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  Overall health and age
  A healthcare provider assesses the patient’s age, physical condition, and any existing medical issues. If a person has serious health concerns, surgery may carry too much risk, and alternative treatments are considered.
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  Patient preference
  In some cases, patients don't want surgery if it could lead to permanent changes such as a colostomy bag or sexual dysfunction. These concerns are discussed beforehand with the patients to ensure that the treatment aligns with their needs.

What to expect with colorectal cancer surgery?

If surgery is part of your or your loved one's colorectal cancer treatment plan, there is nothing to worry about. With the way surgical techniques have advanced in recent years, many patients go through treatment with fewer complications and better outcomes than ever before.

Moreover, the healthcare team is with you every step to prepare you for the surgery and ensure a faster recovery. Depending on the procedure, they may adjust your diet, stop certain medications, and prep your bowels before the surgery.

Once the colon cancer surgery is done, it's also normal to experience a range of side effects:

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  Pain at the incision site
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  Bloating
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  Fatigue
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  Changes in bowel habits, such as constipation

However, most side effects can be managed with medication and a few lifestyle adjustments. In some cases, patients may experience long-term changes, such as needing a stoma bag, but this is relatively uncommon and depends on the specific cancer stage.

Finally, as with all treatments, the healthcare provider will schedule follow-ups to monitor healing, check for cancer recurrence, and ensure timely recovery.

Parting thoughts

Not every individual diagnosed with colorectal cancer will need surgery. The decision depends on several factors, including the stage of the cancer, its location, overall health, and personal preferences.

Moreover, the healthcare team works closely with each patient to develop a personalized treatment plan that fits their specific needs and medical conditions.

So, try not to worry about the healthcare provider's treatment plan. Remember, it is designed with your or your loved one's condition in mind to give the best chance of recovery.