Surgery for advanced cancer

Advanced bowel cancer is cancer that started in either the back passage (rectum) or large bowel (colon) and has spread to another part of the body.

Your cancer might be advanced when it is first diagnosed. Or the cancer might come back after you were first treated. 

You might have surgery if advanced bowel cancer blocks your bowel and causes symptoms. And sometimes you can have surgery to remove cancer that has spread to your liver or lungs. 

The choice of treatment depends on:

• the type of cancer
• the number of secondary (metastatic) cancers
• where the secondary cancers are
• treatment you have already had
• your general health

Surgery for a blocked bowel

Sometimes cancer can grow so that it completely blocks the bowel. This is called a bowel obstruction. The waste from the food you have digested can't get past the blockage. 

To relieve symptoms, it is sometimes possible to:

• unblock the bowel by putting in a tube called a stent
• remove the blocked section of bowel

A stent

The surgeon puts a tube with a light at the end (colonoscope) into your bowel through the back passage (rectum). This is called a colonoscopy.

The surgeon uses the colonoscope to see where the blockage is and pushes a stent through it. The stent expands and holds the bowel open so poo can pass through again. The stent stays in place to keep the bowel open. It relieves symptoms and gives your surgeon time to plan surgery to remove the blocked part of the bowel. 

Removing the blockage

Your surgeon might be able to remove the blocked section of bowel and attach the two ends of the bowel together. Or they might need to bring the upper end of the bowel out into an opening in the skin of your tummy (abdomen). This is called a stoma.

If the opening is from your large bowel (colon) it is called a colostomy. If the opening is from your small bowel (ileum) it is called an ileostomy. You wear a small bag over the stoma to collect your poo. 

Surgery to remove small secondary cancers

If bowel cancer spreads, it often goes to your liver or lungs. The bloodstream or lymphatic system can carry it there. 

Sometimes, if there are only 1 or 2 small areas of cancer spread (secondaries) in the liver or lungs you can have surgery to remove them. Surgery to remove cancer that has spread is sometimes called a metastasectomy. This is not suitable treatment for everyone. 

You can only have this type of surgery if you have just a few areas of secondary cancer in either your liver or your lungs. To decide if this treatment is suitable for you, your doctor will look at:

• your general health 
• how advanced your cancer was when diagnosed
• how quickly your cancer has come back 
• how many secondary cancers you have
• the size and position of the secondary cancers
• how close they are to major blood vessels 

About having liver surgery

You will have scans such as a CT scan, or an MRI scan. You might also have a test to look at the blood supply to the area (an angiogram) to make sure the operation is possible. 

Removing secondary cancers from the liver is specialised surgery and is carried out in major liver cancer centres. There are centres throughout the UK, so talk to your own specialist about this if you think it might help you. If this treatment is right for you, your specialist can refer to your nearest surgery centre. 

Removing liver secondaries can be very successful for some people. About 40 out of 100 people treated (40%) are alive 5 years later. You might be able to have treatment again if the cancer comes back in the liver. You can have more than half of your liver removed if necessary because liver tissue can grow back after surgery.

Treatment is less likely to be successful if:

• you have cancer in the lymph nodes near the liver 
• you have cancer that has spread to another body organ 
• your surgeon cannot completely remove all of the liver secondaries 

You might have surgery on its own, or combined with other treatments such as chemotherapy.