All You Need To Know About Colon Cancer Surgery in Singapore

Do I Really Need Surgery to Treat Colon Cancer?

Indeed, colon cancer surgery is the only treatment that a colon surgeon can offer for the definitive cure of colon cancer. While there are other treatment options such as chemotherapy, they are best used as supporting treatments, not as standalone treatments, as they merely reduce the risk of occurrence but do not always offer a cure.

In the treatment of colon cancer, the main point is to remove the part of the colon affected by cancer, along with surrounding areas containing the lymph nodes where the cancer would typically spread to. After the affected part of the colon is removed, the remaining part of the colon will be joined back together so bowel movements are not affected.

Types of Colon Cancer Surgery

  • Open Surgery
  • Laparoscopic Surgery
  • Single Port Incision Surgery
  • Robotic Surgery

1. Open Surgery

This is the traditional method of colon cancer surgery where a long incision (10 to 30cm long) is made through the center of the abdomen. This was preferred due to the easy access it provides to all areas of the colon.

However, this results in a large incision that cuts through the entire core muscle in the center, giving rise to longer recovery periods and greater pain.

2. Laparoscopic Surgery

This is the preferred method of colon resection surgery today. Laparoscopic surgery is more complex than traditional open surgery as the colon surgeon will have to skillfully maneuver his way around as there are only three to five small incisions around the abdomen to work with.

3. Single Port Incision Surgery

This is one of the latest advancements in laparoscopic surgery in the past few years. One incision (2 to 5cm) will be made at the navel. A camera and two instruments are inserted through this single “port” and the surgery is performed. The tumor and the affected part of the colon are then removed through this incision.

4. Robotic Surgery

A very advanced and modern type of minimally invasive surgery. Like a laparoscopy, it requires only small incisions to insert instruments. The difference is the robotic system provides a 3D view and greater magnification and clarity to the colon surgeon. This provides an accurate depth perception and increased level of precision not found in other forms of laparoscopic techniques.

Comparing the 4 Surgery Types

Laparoscopic surgery, single port incision surgery and robotic surgery are all considered minimally invasive surgery (keyhole surgery). The actual amount of cutting done in all forms of surgery, be it minimally invasive or open, is the same. The only difference is in the approach (large versus small incisions on the abdominal wall, and the instruments used to do the cutting).

The advantage of minimally invasive (keyhole) surgery compared to open surgery is well proven in patients’ lower level of pain and faster recovery.

What is unclear is the relative advantage of the various forms of minimally invasive surgery. Studies have shown that the results of robotic surgery and laparoscopic surgery are comparable with no advantage favouring one over the other. What is clear, though, is that robotic surgery is more expensive than laparoscopic surgery.

Do I Need a Stoma?

  • What is a Stoma?
    A stoma is an artificial opening created in the abdomen to allow the small or large intestines to come through and discharge the feces into a bag. Many patients who have to undergo surgery for colon cancer are concerned that they might need a stoma.
  • Who Needs a Permanent Stoma?
    It is not common to require a permanent stoma. This usually happens only if the cancer involves the anal muscles, and the muscles need to be removed to clear the cancer. If the anal muscles are removed, putting the intestines back there would lead to the loss of control of stools, hence these patients are offered a permanent stoma so that stools can be collected into a bag without any leakage or smell.
  • Who Needs a Temporary Stoma?
    In some patients with rectal cancer, the position of the cancer is low, hence after removing the colon/rectum, the joint (anastomosis) is very close to the anus. It is known that the closer the anastomosis is to the anus, the higher the risks of it not healing well, opening up and causing severe infection. In such cases, the surgeon may opt to bring out a temporary stoma. This diverts the faeces away from the anastomosis and avoids major spillage and infection if the anastomosis does not heal properly. The stoma is then closed up in 6-12 weeks’ time when the anastomosis has healed.
 

Non-surgical treatment

There are numerous treatment options that do not require surgery. However, most of these are used together to enhance cure rates of surgery, or used for control of the cancer in situations where it cannot be cured.

These includes:

  • Chemotherapy

    This may be an oral drug or injection that acts to kill the cancer cells.

  • Targeted therapy

    We know understand more about the genetic and protein changes in the cancer cells.

    Targeted therapy are drugs that affect these changes. This includes drugs that affect new blood vessel formation (Vascular Endothelia Growth Factor or VEGF protein) as cancer cells needs new blood vessels to supply blood for it to grow, or EGFR (Epidermal Growth Factor Receptor protein) which is a protein that helps cancer cells grow. There are also other drugs that act on other genes or proteins.

    Targeted therapy is typically used for stage 4 cancer

  • Immunotherapy

    These are drugs that help the body’s own immune system to destroy cancer cells.

    The immune system normally can destroy cancer cells, but cancer cells may produce proteins that turn off the immune response. Immunotherapy drugs act to turn off these proteins so that the immune system can destroy the cancer cells. Immunotherapy is used for cancers which show certain type of genetic changes.

Radiotherapy

This is to use radiation to kill cancer cells. It is most commonly used on rectal cancer, and not suitable for use elsewhere in the colon. Radiotherapy in itself is usually not a cure.

It may be used before surgery to shrink the tumour to make surgery easier and / or reduce recurrence rate, or use after rectal cancer surgery to reduce recurrence.

 

Post-Colon Cancer Surgery Care

This usually involves regular follow-ups for physical examinations, colonoscopies and other imaging tests to ensure that the wound is healing as expected and the cancer does not recur.

At each follow-up, your colon surgeon may also conduct a CEA blood test as a rising CEA may suggest a recurrence of colon cancer.

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