Surgical removal is the only acceptable curative therapy for colic cancer. If the lesion causes obstruction, it may be necessary to relieve the obstruction before a definitive operative procedure is performed.
Removal of the primary tumor is the best palliative procedure as it eliminates or diminishes the possibility of bleeding, perforation, fistula formation, infection and continuous discharge of foul material per rectum.
Extent of Resection and Choice of Operation
Cancers arising in the caecum, ascending colon or hepatic flexure.
- Right hemi-colectomy with ileo-transverse anastomosis performed in one stage is the operation of choice. Right hemi-colectomy involves removal of terminal 8inches of the ileum, the caecum, the ascending colon, that means the portion of the bowel supplied by the ileo-colic and right colic branches of the superior mesenteric artery.
- Unless the obstruction is advanced, resection with primary anastomosis on the right side is quite a safe procedure.
- In case of inoperable growth of the right half of colon, a palliative ileo-transverse colostomy should be performed to obviate the possibility of intestinal obstruction.
For growths in the transverse colon
- It is enough to remove the growth together with 3 inches of healthy bowel on each side with a wedge of mesocolon containing the middle colic artery.
- This is followed by end-to-end anastomosis of the two ends. Mostly the growths in the transverse colon occur in its middle 1/3rd and the affected lymph nodes lie by the side of the middle colic artery, so this simple colon resection with primary anastomosis is the operation of choice.
Growths in splenic flexure, descending colon and pelvic colon
- Though limited resection would have sufficed due to the fact that mostly the colonic glands are involved, yet a wide resection is advised to avoid any gland which may be missed lying along the course of inferior mesenteric artery.
- In case of inoperable growths in this region either a permanent colostomy or a transverse-pelvic colostomy may be performed.
For growth of the pelvic colon
- The growth along with 3 inches of healthy colon on both sides is removed and primary anastomosis is made.
- For inoperable growths, a permanent transverse colostomy should be performed.
- Carcinoma of colon with obstruction- although a few surgeons are doing emergency primary resection, majority would prefer to resect the lesion and bring cut ends of the colon out.
- In case of sigmoid colon cancer a Hartmann procedure is used.
Chemotherapy For Colon Cancer
- It is recommended for the patients who have inoperable, recurrent or metastatic colonic cancer. The most frequently used drug is 5-fluorouracil.
- Though chemotherapy has been used in conjunction with surgical therapy, yet no current evidence suggests that any benefit may result from this type of therapy.