If colorectal cancer has not spread beyond the colon, rectum, or lymph nodes, surgical removal of the cancer is the most common treatment. The goal is to remove as much of the cancer as possible and preserve as much colon and/or rectal function as possible. It is common to combine surgery with radiation therapy and/or chemotherapy to attempt to remove all of the cancer.

Surgery may need to be done on the colon, rectum, or both.

Colon Surgery

Polypectomy and Local Excision

A colonoscope is placed through the anus and rectum, up into the colon. The scope allows the doctor to see inside the colon. Instruments are inserted through the colonoscopy tube to remove polyps and/or early stage cancer if it has not invaded into the deeper layers of the colon wall. Tissue samples of the colon will also be taken for biopsy.

Partial Colectomy

If the cancer is larger, both the tumor and a small amount of healthy tissue and nearby lymph nodes will be removed. This is called a partial colectomy. In many cases, the healthy portions of the colon (and rectum) can be reconnected. This procedure is called anastomosis. This is generally the preferred procedure because it preserves anal function and avoids the need for a permanent colostomy.

Laparoscopic-assisted Colectomy

In some cases, it is possible to remove part of the colon and nearby lymph nodes through several small incisions in the abdomen. Laparoscopes are equipped with cameras that allow the surgeon to see inside the abdomen. Special instruments are inserted through tubes to remove tumor. Healing time and recovery are somewhat faster than with an open colectomy.

Total Colectomy

A total colectomy is the removal of the entire colon. The last part of the small intestine, called the ileum, is then connected to the rectum. In some cases, a small pouch is made from the ileum to store stool. This pouch mimics the function of the rectum. This surgery preserves anal function and eliminates the need for a permanent colostomy.

Surgical Resection of a Colorectal Tumor Mass

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If it is not possible to reconnect the colon and rectum, a colostomy is necessary. A colostomy is a surgical opening (stoma) through the wall of the abdomen into the colon. This creates a path for stool to leave the body. After a colostomy, a special bag will be worn outside of the body to collect body waste. The colostomy may be either temporary or permanent. In cases where the entire colon is removed, the small bowel will be used to create the stoma.

Rectal Surgery

Rectal surgery is more complex because more non-colon tissues and muscles are involved, such as those related to urinary function.

Surgery for Metastatic Colorectal Cancer

Metastatic colorectal cancer cannot be cured with surgery, but some procedures may help prolong life by treating tumors in other parts of the body. These methods are most often used for cancer that spreads to the liver, but it can also be used on other tumor sites. Options include:


Ablation is the destruction of cancer cells without removing the tumor from the body.

  • Radiofrequency ablation—A CT-guided probe is inserted through the skin and into the abdomen. The probe emits high energy radio waves which kill cancer cells with high heat.
  • Ethanol ablation—Concentrated alcohol is injected directly into the tumor with a needle that is guided with an imaging test. This may also be called a percutaneous ethanol injection (PEI).
  • Cryosurgery—An ultrasound-guided probe is inserted through the skin into the abdomen. Cancer cells are killed by freezing them.
  • Embolization

    Tumors grow and spread using the body's blood supply. During embolization, substances are injected to slow or stop blood flow to the tumor.

  • Arterial embolization—A catheter is threaded through an artery in the thigh to the liver's main artery. A substance is injected into the hepatic artery to block blood flow.
  • Chemoembolization—Tiny beads with chemotherapy drugs are threaded through the catheter and into the hepatic artery. The drugs will eventually block blood flow.
  • Radioembolization—Tiny beads with radiation are placed near the tumor. Over a period of time, the beads release radiation and kill the tumor.