Intestinal Cancer Surgery

Listed below is the step by step procedure of intestinal cancer surgery:
  1. What is Intestinal Cancer Surgery?
  2. Why is Intestinal Cancer Surgery Required?
  3. Pre-operative Preparation
  4. Day Before Surgery
  5. Procedure Day
  6. Methods/Techniques of Intestinal Cancer Surgery
  7. Post Procedure
  8. Risks and Complications

What is Intestinal Cancer Surgery?

Different surgical procedures employed for eliminating cancer of the intestines completely from the patient's body comprise intestinal cancer surgery. Intestinal cancer can refer to the cancerous affection of any part of the small or large intestine. The resultant symptoms are dependent on the affected part. It is a fairly common occurrence now a days. Awareness is increasing among people and hence its diagnosis and treatment are not very complicated.

Surgery for intestinal cancer includes removal of the tumor, removal of affected lymph nodes, at times removal of the cancerous portion of the intestines and in very advanced cases removal of a substantial part of the healthy intestine too. In some cases, the removal of entire small or large intestine may be needed.

Why is Intestinal Cancer Surgery Required?

Intestinal cancer may affect the small or large intestine. The oncologist (cancer surgery specialist) starts treatment depending on the affected part and the symptoms experienced. Treatment modality is also dependent on the stage of intestinal cancer. Staging is a process which determines the intensity of cancer by assessing the tumor size, number of lymph nodes and the area of its spread. Staging becomes important when the decision to opt for surgery has to be taken. Following are the indications that surgery is indeed needed for intestinal cancer.

  • Very early stage of cancer: This stage usually comprises of a single tumor on the internal lining of the intestine. Surgery offers a quick and almost permanent solution in this stage. Once the tumor is removed, the cancer is as good as completely eliminated.
  • Very advanced stages of cancer: Similar to the first point, very advanced stages of intestinal cancer also call for surgery. In such cases, many treatment methods have to be employed simultaneously; surgery being one of them. Cancer which has affected a substantial area of the intestine, can be dealt with by surgical removal of the unhealthy part of intestine or the entire intestine (small or large). This might prevent further spread of the cancer.
  • Palliation: Some cases may be treated with methods other than surgery. However, during the treatment, there may be certain symptoms which need surgical intervention to provide relief to the patient. A growing tumor may obstruct the intestines leading to symptoms like abdominal pain, poor digestion, constipation, nausea and vomiting. The tumor may even threaten to spread beyond the intestine, rupturing them in the process. This could lead to excessive bleeding. To provide relief from these conditions, surgery might be performed to remove the tumor. The surgery does not rid the patient of cancer completely, but forms part of palliative treatment.
  • When other treatment methods cannot be used: Medication and radiation therapy are also used to treat cancers. Sometimes the oncologist may begin treatment with either or both these methods. If cancer fails to respond to these methods, then surgery might be needed. At times the cancer may be so advanced that only surgery can save the patient. Medicines and radiation therapy will not be effective. Another instance when surgery is the only option of treatment is when medicines and radiation therapy are contraindicated (reason to withhold some medical treatment) in a case of intestinal cancer. They might be harmful to the patient or cannot be used due to some other health conditions the patient may be having. Once it is established that surgery is indeed necessary, the surgeon needs to prepare and plan the procedure carefully. This will ensure proper and error free execution of the surgery. The preparation needed for surgery is described in the next section.

Pre-operative Preparation

The following are pre-requisites to be fulfilled before proceeding with intestinal cancer surgery:

  • Examination:
    Before the surgery, a complete physical check up is essential to assess the general physical condition of the patient. A detailed report is sent to the surgeon.
  • Laboratory investigations:
    Blood group determination is essential. It is necessary to arrange the correct type of blood if transfusion is required due to excessive bleeding during surgery. Blood sugar levels are determined. If they are high, surgery needs to be postponed till the levels are normalized. An ECG is done to determine the functioning of the heart. Chest X-Ray will help to observe the lungs for spread of cancer and to assess respiratory function.

Day Before Surgery

Patients are generally advised to get admitted to the hospital one day prior to the surgery. They are asked not to consume any food one night prior to the surgery. The blood pressure, pulse rate, respiratory rate, body temperature are monitored at regular intervals. The patient is given laxatives to clear the bowels. Antacids are administered to curb acidity.

Procedure Day

One the day of surgery, the patient is wheeled to the operating room. Sterile clothing is used to drape the patient. The anesthetist is already present in the operating room. For intestinal surgeries, general anesthesia is administered. It is given by a trained anesthetist in the form of respiratory fumes or injected into the veins. General anesthesia acts on the brain and the patient remains unconscious through out the surgery.

The skin over the area where the surgical incision is going to be made is shaved to remove any hair. It is cleaned with Betadine or a similar antiseptic solution before surgery begins. Blood pressure, respiratory rate, pulse and body temperature are monitored through the surgery and even afterwards. Surgery begins only after the patient is completely under the influence of anesthesia.

Methods / Techniques of Intestinal Cancer Surgery

As described above, surgery for intestinal cancer can include removal of either the cancerous tumor, a segment of the intestine, the whole of the intestine or surrounding lymph nodes. Following are the types of intestinal cancer surgery:

  • Polypectomy
  • Local Excision
  • Resection
  • Colectomy
  • Sigmodectomy
  • Lymph Node Removal

Each of these procedures has been described in detail below:

  • Polypectomy

    This surgery is performed in the early stages of cancer when the tumor is small and restricted to the intestinal lining. Only the tumor is removed. The rest of the intestine is left untouched. This procedure can be performed by inserting a long narrow tube fit with a camera, known as an endoscope, into the intestine. The intestine can be viewed and the tumor removed. This procedure does not involve any surgical incision over the skin and can be done without general anesthesia. Some other form of anesthesia can be used. If tumor is present in the large intestine, the endoscope is inserted via the rectum and this procedure is known as colonoscopy. If the small intestine is involved, the endoscope enters via the mouth.

  • Local Excision

    This surgery can be done laparoscopically or by open method. Laparoscopic surgery involves making multiple small cuts over the skin. Through one cut, an instrument known as a laparoscope is inserted. This is a camera which helps visualize the interior of the abdomen. Through other incisions, surgical devices are inserted and the operation is performed.

    Open surgery includes making a single big incision and performing the surgery by visualizing the abdominal cavity directly. At times, more than one incision may be needed. But this doesn't happen often. Blood loss is far less and wound healing much faster in the laparoscopic type.

    Local excision involves removal of the cancerous tumor and a portion of the intestine where the tumor has formed. Incision is made on the skin over the abdomen, the underlying layer of fat and muscles is carefully separated. The tumor and the portion of intestine are removed. The separated tissue is rearranged to its former position and the skin is sutured (stitched with a medically designed thread). Care is taken to avoid damage to adjacent healthy organs, blood vessels and nerves.

  • Resection

    Resection is usually done for small intestinal cancer. The procedure can be done by open or laparoscopic method. After the surgical incision has been made and the upper layer of fat and muscles is dissected, the cancerous part of the small intestine is excised. The remaining healthy ends of the small intestine are sutured together to maintain continuity of the digestive tract. Rest of the procedure remains the same as for local excision surgery which has been described above.

  • Colectomy

    This surgery is done for large intestinal cancer and involves surgical removal of the colon. The affected part of the colon or the entire colon is surgically removed. If only right half or left half of the colon is removed, it is known as hemi-colectomy. If only some portion of the colon is removed, it is known as partial colectomy. If the entire colon is removed, it is known as total colectomy. The procedure can be done by open method or laparoscopically.

    If only a part of the colon is removed, the remaining part of the healthy colon is connected to each other to keep the digestive tract intact. Sometimes, if one end of the colon is excised, the remaining colon is either connected to the caecum above or the rectum below. If the entire colon is removed, then the terminal part of the small intestine is connected to a bag known as a colostomy bag. This bag lies outside of the body. The fecal matter gets collected into the bag and has to be discarded periodically.

  • Sigmoidectomy

    Sigmoidectomy is the name of the surgery done to treat cancer of sigmoid colon. It involves total removal of the sigmoid colon. It can be done by open method or laparoscopically. The skin over the abdomen is incised and underlying layer of fat is separated. The muscles are cut carefully to avoid damaging them. After the sigmoid is visualized, it is cut and the terminal part of the colon is connected to the rectum to keep the digestive tract intact. The separated muscle tissue and the skin are sutured to complete the procedure.

  • Lymph Node Removal

    This surgery is usually done along with the surgeries described above. It involves removal of lymph nodes adjacent to the affected part of intestine. The cancer may or may not have reached the lymph nodes yet. They are the easiest way for cancer to spread. Their removal ensures that the caner won't spread rapidly to other organs or other lymph nodes.

    Completion of surgery does not essentially mean completion of treatment. During the recovery period, certain restrictions are advised to be followed by the patient. If surgery is performed for removal of whole or part of the intestine, the patient needs to follow some precautions for a long time. These precautionary measures have been described in detail in the following section of the article.

Post Procedure

Following listed are the recovery tips to be followed in the weeks after discharge from hospital:
  • Monitoring the patient's health

    Immediately after surgery, the patient is transferred out of the operating room and kept under observation. The vitals (blood pressure, pulse, respiratory rate, body temperature) are monitored. An intravenous needle has been inserted into the patient's arm before the surgery. It is retained to provide nutritional support to the patient as consumption of food is restricted for some hours. After the surgeon gives permission, liquid diet may be started for the patient. If this is tolerated well, the patient may be given soft solid food to eat which is easy to digest.

  • Bowel habits

    After the surgery, it may take longer time that usual for bowel habits to return to normal. Diarrhea or constipation may be experienced. Doctors provide medication or some alternative therapy to treat these conditions.

    If the person is wearing a colostomy bag, it needs to be emptied at regular intervals. The part of the skin through which it is inserted may be examined routinely for signs of infection or other complications.

  • Medication

    Pain medication as prescribed are to be taken. Antibiotics are administered for some days or weeks after the surgery.

  • Follow up

    The patient is advised to do a general follow up for health check up as well removal of the stitches over the skin. Even after surgery or the entire medical treatment is complete, the patient is expected to follow up with the doctor regularly. This is a precaution undertaken to avoid recurrence of cancer.

  • Long term care

    It is wise to be aware of one's own health. Cancer of intestines can recur in the same location or in another organ. It is always useful to watch out for any indications of recurrence. The earlier they are detected, the earlier they can be treated.

  • Diet post surgery

    Once the intestine has been removed - whole or a part of it, normal digestion gets slightly disturbed. People who undergo cancer surgery are advised to consume soft and easily digestible food for first few weeks after surgery. Complete abstinence from alcohol and tobacco consumption is advised. A strict watch is advised to be kept on spicy, salty and pickled food. Large quantities of food should not be consumed as they may be difficult to digest.

These precautionary measures ensure quick and easy recovery after intestinal cancer surgery. However, the surgical procedure itself is responsible for complications. They may not occur in every case. But if they do, separate treatment is usually administered.

Risks and Complications

Intestinal cancer surgery is associated with some complications. These have been discussed in detail below. They do not essentially occur in every case. But if they do, treatment is available to successfully treat all of them

  • Anesthetic complications

    The patient may develop allergic reaction to the anesthetic medicines used. These could be in the form of breathing troubles, feeling light headed, nausea. These can be treated with medication. The anesthetic medicine is usually changed and the patient is monitored more carefully during the surgery.

  • Accidental injury to healthy organs

    During surgery, the healthy tissue adjacent to intestines could get damaged by the surgical instruments. Minor cuts can be left to heal for themselves. If the damage is severe, it is repaired during surgery. In case a blood vessel gets cut accidentally, there could be excessive bleeding. Blood transfusion may be required in some cases

  • Digestive troubles

    Surgical removal of intestines will reduce the normal length of intestines; thus altering the normal time taken for digestion. This may lead to improper digestion of food, constipation, diarrhea. These can be treated with proper diet and medication.

  • Intestinal strictures

    After removal of a part of the intestine, the remaining ends are sutured together. The sutured portion may get deposited with excess of fiber when it heals and it could lead to a stricture. A stricture indicates narrowing of the intestinal lumen. This could lead to intestinal obstruction and digestive troubles like constipation. It can be reversed with further surgery or introduction of a stent. A stent is a collapsible device which will keep the intestinal lumen patent.

A lot of study and research has been put in to discover newer methods of intestinal cancer surgery. These new methods have brought about many developments in the way surgery is performed. Also, they do not occur essentially in every case. Every case of intestinal cancer surgery is different. Hence the same protocol for surgery cannot be applied for all patients. The approach will differ in every case.

The complications and risks of intestinal cancer surgery mentioned above are not for discouraging the patients. These are completely treatable. With proper care and precautions on part of doctor and patient both, intestinal cancer surgery offers a great scope of improvement in the patient's health.

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