Surgery for metastatic bowel cancer

Metastatic 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. It is also called advanced cancer.

In some circumstances your doctor might describe your cancer as advanced if it has not spread but it can not be removed with a standard operation.

Your cancer might have spread when you are first diagnosed. Or the cancer might come back after you were first treated. 

You might have surgery if your 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. 

Locally advanced cancer

Locally advanced cancer means that the cancer has spread into the tissues around the bowel or nearby lymph nodes. It hasn’t spread to other organs. This is different to a metastatic cancer. A team of doctors and other professionals recommend the best treatment and care for you in this situation. 

Deciding about treatment for metastatic bowel cancer

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 either:

• gives your surgeon time to plan surgery to remove the blocked part of the bowel

• will be only treatment you need, which means you don’t need to have a large operation

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 cancer that has spread to the liver or lungs

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

You might have surgery to remove the cancer that has spread. Surgery to the liver or lungs is not a suitable treatment for everyone.

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.

Some people might have their bowel cancer and liver secondary cancer removed at the same time. Two teams of surgeons work together for this treatment. But it’s more common to have each operation separately.

Removing liver secondaries can be very successful for some people. About 45 out of 100 people treated (45%) 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 more commonly, combined with other treatments such as chemotherapy.

Liver transplant

A liver transplant is an operation to remove your liver and replace it with a healthy one from a donor. It is a big operation and is only suitable for a very small number of people. You doctor will let you know if this kind of operation is possible for you.

Coping with cancer that has spread

You might find it difficult to cope when you are diagnosed with metastatic or advanced cancer.

It is common to feel this way. Talk to your specialist nurse about how you are feeling. They can arrange for more support if you need it.