Does bowel cancer always result in surgery?
What happens during surgery?
Will you need a colostomy bag?
Open surgery or keyhole surgery?

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Does bowel cancer always result in surgery?
Unlike some other cancers where many treatment choices are available, surgery is the main treatment for removing the cancer from your bowel as soon as possible. Of course, no operation will ever be performed without your prior consent.

However, some people will also require chemotherapy and radiotherapy to reduce the size of the tumour and prevent progression of the disease. If surgery is not an option, then chemotherapy and radiotherapy are offered to halt progression of the disease and to help control the symptoms.
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What happens during surgery?
During the operation the piece of bowel that contains the cancer is removed and the two open ends are joined together. The lymph nodes near the bowel may also be removed because this is the first place to which the cancer may spread.

You will usually stay in hospital for about 10 days after surgery, and will be given antibiotics to prevent any infection.
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Will you need a colostomy bag?
Most people diagnosed with bowel cancer do not need a colostomy bag. However, in some cases, the bowel cannot be rejoined straight away, and one end is brought out onto the skin of the abdominal wall. This is called a colostomy, and the opening of the bowel is known as a stoma. Bowel motions pass through the stoma into a colostomy bag, which is worn over the stoma.

Many stomas are just temporary and can be reversed after a few months. Only a very small number of people with bowel cancer cannot have a stoma reversal.

If you do need a bag after surgery, you will be given support and advice from specialist stoma care nurses. Life can carry on as normal with a stoma, including sporting activities. For more information contact the British Colostomy Association [top]

Open surgery or keyhole surgery?
Open surgery is currently the most common form of surgery for bowel cancer patients, and specialist surgeons are based in the majority of centres in the UK. In the majority of cases, open surgery to remove bowel cancer is highly successful and can be completely curative if the cancer is caught at an early enough stage.

After open surgery you will have a wound (incision) that goes in a straight line from just below the breastbone for a variable length down to the pelvis. However, this scar will heal and fade over time. As you have had a major operation, you will not be able to get up and rush home immediately! You can expect to be in hospital for an average of 8-10 days.

As of September 2006, NICE recommends a new technique called laparoscopic, or keyhole, surgery that should be discussed as an option for all patients. The decision about whether to use open or laparoscopic surgery should be made after informed discussion between the patient and the surgeon. In particular, they should talk about whether the patient's condition is suitable for laparoscopic surgery, the risks and benefits of the two procedures, and the surgeon's experience.

Laparoscopic surgery involves carrying out an operation through small cuts in the abdomen. This type of procedure is often called keyhole surgery. The surgeon inserts a narrow telescope attached to a camera and other special instruments through the cuts to remove the part of the bowel with the tumour. Most of the operation is performed through these small cuts, but a slightly larger opening is needed to remove the section of bowel from the body. Laparoscopically assisted surgery is similar, but involves using the larger opening to carry out part of the surgery as well as to remove the section of bowel. Both procedures need smaller cuts than open surgery.

When NICE recommends a treatment, the NHS must ensure it is available to those people it could help, normally within 3 months of the guidance being issued. However, at the moment there is a shortage of surgeons skilled in carrying out laparoscopic surgery for colorectal cancer, so it will not be possible to make the procedure available throughout the NHS within this period. If you have bowel cancer, and your doctor thinks that laparoscopic surgery may be the right treatment for you, you should discuss its availability and, if appropriate, the other options with him or her. Please see http://guidance.nice.org.uk/ if you appear to be eligible for the treatment but it is not available.