Surgery is usually the main form of treatment for bowel (colorectal) cancer.
There are several types of surgery for colorectal cancer, depending on where the cancer is, and these may be combined with other treatments such as chemotherapy, radiotherapy or biological therapies to increase the effectiveness of the surgery:
- Total colectomy: removal of the whole colon
- Hemi-colectomy: only part of the colon needs to be removed.
- Sigmoid-colectomy: removal of the sigmoid colon (bottom of the colon)
- Transverse colectomy: removal of the transverse colon (middle of the colon)
- Laparoscopic colectomy: keyhole surgery to remove early stage bowel tumours
- Local resection: removing the cancer from the lining of the bowel for early-stage cancer
- Colostomy: part of the colon is removed and the cut end diverted to an opening in the abdominal wall (tummy) so that bowel movements can be collected in a bag worn over the opening (stoma)
- Ileostomy: part of the small bowel is removed and the cut end diverted to an opening in the abdominal wall (tummy) so that bowel movements can be collected in a bag worn over the opening (stoma)
- Debulking surgery: to remove cancer from inside of the your bowel before having you have chemotherapy or radiotherapy to make it more effective.
- Surgery for bowel obstruction: sometimes the cancer completely blocks the bowel, in this situation an operation is needed straight away to open the bowel.
Several people had been invited to share in decision-making about their surgery but felt that this was an unrealistic expectation since they had no expertise in the area. One man, who actually had a background in medicine, describes such an encounter with his surgeon. Other people had been encouraged to ask questions but pointed out that without being offered information they didn’t know what questions to ask.
He wished his surgeon had told him what he wanted to do rather than expecting him to choose.
A number of people had sought second opinions because they, or a member of their family, were not satisfied with the scenario that had been presented. Two of these people had been told they would definitely need a permanent colostomy when this turned out not to be the case. The other two lacked confidence in the first surgeon they saw and were much happier with the second. One woman explains why she wanted a second opinion and the contrast between her two consultations.
She wanted a second opinion because she lacked confidence in the first surgeon she consulted.
The level and quality of information offered to patients before their surgery was extremely variable. Overall, people who were well briefed before their operations seemed to find the experience less frightening. A few people were too ill to take in much information or preferred not to know too much about what was going to happen.
Some people were extremely satisfied with the information they received before surgery and were thoroughly reassured by it. One man describes such a meeting with his consultant. Another man had a satisfying consultation because he had researched his condition in advance and knew what questions he wanted to ask.
He felt he received excellent information before surgery.
He went to his consultation well-prepared with questions.
Others had been offered information but felt that the surgeon’s choice of language was unhelpful. One man explains how his surgeon’s light-hearted explanation of his surgery left him confused.
He was confused by his surgeon’s explanation of his coming surgery.
People who had emergency surgery were sometimes given minimal information about what was happening to them. One man did not know what had happened until 5 or 6 days after his surgery.
Before his diagnosis of bowel cancer Stephen had emergency surgery to remove a blockage in his bowel. He had a Hemi- colectomy.
He was admitted as an emergency case and was offered no explanation of what had happened for days.
A woman who has had 6 major cancer operations recalls her fears before her first surgery and how every subsequent operation brought new concerns. She stressed the importance of anticipating people’s information needs before major surgery.
She remembers her fears before the first of many cancer operations.
She stresses the need for people to be offered detailed information before surgery.
Stephen was only 15 when he had his first surgery. He went on to have many more surgeries to remove tumours that had spread from his original bowel cancer and although he felt he was included in the discussion about his treatment and surgeries there were not always many options medically suitable for him.