Surgery for colon cancer
Surgery is the most common treatment for colon cancer. The type of surgery you have will depend on the size of the cancer, where it is in the colon and whether it has spread.
Colon cancer surgery
Surgery is the most common treatment for colon cancer. The type of surgery you have will depend on:
- the size of the cancer
- where it is in the colon
- whether it has spread.
Your doctor will discuss this with you.
There are things you can do before and after surgery to help you prepare and recover.
Bowel cancer is a general term for cancer that starts in either the colon or rectum. It might sometimes be called colorectal cancer.
We have separate information about surgery to the rectum. The types of operation used for rectal cancer are different to the types of operation used for colon cancer.
In the video below, Oncologist Rebecca and Cancer Nurse Specialist Claire explain how bowel cancer may be treated. They talk about surgery, chemotherapy, radiotherapy, immunotherapy and targeted therapies.
We understand that having treatment can be a difficult time for people. We are here to support you. If you want to talk, you can:
- call the Macmillan Support Line for free on 0808 808 00 00
- chat to our specialists online
- visit our bowel (colon and rectal) cancer forum to talk to people who have been affected by bowel cancer, share your experience, and ask an expert your questions.
Before your operation
Before your operation, you go to a pre-assessment clinic to check you are fit for the operation. At the clinic, you may have blood tests, a blood pressure check and a recording of your heart (ECG).
For some types of colon cancer surgery, your bowel needs to be empty. A nurse may advise you about preparing for your operation. You may need to follow a special diet. You may need to take a laxative for a few days before the operation. You will also be asked not to eat or drink for a few hours before the operation.
Before the operation, you will usually be given antibiotics. These are to prevent infection. You may have them as an injection or tablets.
You will meet a member of the surgical team to discuss the operation. If you are going to have a stoma, you will also meet a stoma care nurse, who will explain what is involved.
During your clinic appointment, you can ask questions or share any concerns you have about the operation. If you live alone, or care for someone else, you may need help when you go home after surgery. Tell a nurse as soon as possible. They can help to make arrangements for you. We have more information about getting support at home after leaving hospital.
You will usually go into hospital on the morning of the operation. You will be given elastic stockings (TED stockings) to wear during the operation and for some time afterwards. This is to prevent blood clots in your legs.
Related pages
Removing very small, early-stage colon cancers
Some very small, early-stage colon cancers can be removed from the bowel lining using a colonoscope. This means the surgeon does not have to make a cut in your tummy (abdomen). The operation is sometimes called a local resection.
For a local resection, you may have a general anaesthetic. Or you will be given drugs called sedatives to make you sleepy. The surgeon passes a colonoscope into your back passage (rectum) and along the bowel until they reach the cancer. They use small cutting tools to remove the cancer and some healthy tissue (margins) from the affected area.
A doctor called a pathologist examines the cancer that has been removed to find out its grade.
Your surgeon may recommend a second operation to remove more of the colon if:
- the cancer cells look very abnormal (high-grade)
- the cancer has not been completely removed.
Removing part or all of the colon
Surgery to remove part or all of the colon is called a resection or colectomy. How much of the colon is removed depends on the size of the cancer and where the cancer is.
After the surgeon has removed the affected part of the colon, they join the 2 open ends of the bowel together. Sometimes they may need to create a stoma. The surgeon will usually remove the lymph nodes close to the colon. These are tested for cancer cells in a laboratory.
There are different types of colectomy:
- Total colectomy – the surgeon removes the whole colon. They bring the end of the small bowel (ileum) to the surface of the tummy to make a stoma. This is called an ileostomy. Sometimes the surgeon is able to join the small bowel to the rectum, so an ileostomy is not needed.
- Left hemi-colectomy – the surgeon removes the left half of the transverse colon and the descending colon.
- Right hemi-colectomy – the surgeon removes the right half of the transverse colon and the ascending colon.
These diagrams show the parts of the colon removed during these operations.
Left hemi-colectomy
Right hemi-colectomy
Some people have an operation to remove the sigmoid colon (the S-shaped bend that joins the colon to the rectum). This is called a sigmoid colectomy or high anterior resection. The surgeon may join the 2 open ends of bowel together. Or they may need to create a type of stoma called a colostomy.
Sigmoid colectomy
Some people have an operation to remove the transverse colon (the top part of the colon). This is called a transverse colectomy.
Transverse colectomy
Open or laparoscopic surgery
Your operation may be done as open surgery or keyhole surgery. This is called laparoscopic surgery.
Open surgery means the surgeon makes 1 large cut, usually near the tummy button. The length of the cut depends on the size of the cancer and where it is.
Laparoscopic surgery means the surgeon makes 4 or 5 small cuts in the tummy. They pass a thin tube through 1 of the cuts. The tube is called a laparoscope. It has a small camera on the end. The surgeon then passes specially designed surgical tools through the other cuts. The surgeon uses these tools to remove the cancer.
Laparoscopic surgery is also sometimes called minimally invasive surgery. You usually recover more quickly from it than from open surgery.
Robotic surgery
Robotic surgery is when laparoscopic surgery is helped by a machine. The laparoscope and the surgical equipment are attached to robotic arms. The surgeon controls the robotic arms, which can move very precisely. This is very specialised surgery and only available in some hospitals in the UK.
Your surgeon will talk to you about which type of surgery is likely to be best in your situation.
Stomas (colostomy or ileostomy)
Sometimes during surgery the surgeon needs to create a stoma. This is an opening the surgeon makes through the tummy (abdominal) wall. It connects the bowel to the surface of the tummy. The stoma is round or oval-shaped, and it looks pink and moist. It has no nerve supply, so it does not hurt.
Having a stoma means stools (poo) and wind will not pass out of the rectum and anus in the usual way. Instead, they will pass out of the stoma, into a disposable bag you wear over the stoma.
If the stoma is made from an opening in the colon, it is called a colostomy. If it is made from an opening in the small bowel (ileum), it is called an ileostomy.
Stomas may be temporary or permanent. Only a small number of people with colon cancer need a permanent stoma.
The surgeon may make a temporary stoma to allow the bowel to heal after surgery. If you have a temporary stoma, you will usually have an operation to close the stoma and rejoin the bowel after you have finished your treatment. This operation is called a stoma reversal.
Your surgeon will tell you whether you are likely to have a stoma, and whether it will be temporary or permanent. If you need to have a stoma, you will be referred to a nurse who specialises in stoma care. They can talk to you about what to expect.
We have more information about stomas.
Surgery for advanced colon cancer
If the cancer has spread to other parts of the body, you may be able to have surgery to remove it. It can sometimes lead to a cure.
Surgery is only suitable for some people with secondary liver cancer or secondary lung cancer. You can talk to your cancer doctor about whether this surgery may be helpful for you. Some people might need surgery if the cancer is causing a blockage in the bowel.
We have more information about treatment for colon cancer that has spread to other parts of the body.
After your operation
Your nurse will explain what to expect after your operation. They will help you to get out of bed or sit up for a short time as soon as you are able to.
You are likely to have a drip in your arm to give you fluids until you are eating and drinking again. You may have a tube in your tummy, close to the wound, to drain fluid into a drainage bag or bottle. You nurse will explain any other tubes.
We have more information on recovering after bowel cancer surgery.
Booklets and resources
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our colon cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
National Institute for Health and Care Excellent (NICE). Colorectal cancer: diagnosis and management clinical guidelines. Updated December 2021. Available from: www.nice.org.uk/guidance/NG151 [accessed November 2023].
KJ Monahan, MM Davies et al. Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG). Gut. 2022; 71:1939-1962. Available from: https://gut.bmj.com/content/71/10/1939 [accessed December 2022].
Cervantes A, Adam R, Rosello S, et al. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology. 2023 Jan; 34(1):10-32. doi: 10.1016/j.annonc.2022.10.003. Epub 2022 Oct 25. Available from: www.annalsofoncology.org/article/S0923-7534(22)04192-8/fulltext [accessed February 2023].
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