Colon Cancer

About Colon Cancer

Laparoscopic colonic cancer surgery is the standard of care today. Extensive evidence exists to prove that laparoscopic colon cancer surgery is safe and effective. In the hands of expert laparoscopic cancer surgeons the disease clearance is proven to be better than conventional open surgery. Laparoscopic colon cancer surgery is less traumatic to the patients and is better accepted by patients. Most of our patients are discharged within 4 days of surgery.


MBBS, MRCSEd, DNB (Gen Surg),
MNAMS (Gen Surg), DNB (Surgical Oncology),

Fellowship in Laparoscopic and Robotic Onco-Surgery.
Dr Nayak is one of the leading senior Surgical Oncologists (cancer surgeon) of Bangalore. He is one of the pioneers of Laproscopic (laparoscopic) cancer treatment (surgery). He is the Director of Surgical Oncology at Fortis Hospital, Bangalore.

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    MBBS from KIMS, Bangalore
    MS from NHLMMC, Ahmedabad
    M.Ch Surgical oncology from Tata Memorial hospital,Mumbai


    Assistant Professor in RRMCH, Bangalore

The Advantages of laparoscopic cancer surgery include

What Is Colon Cancer (Large Bowel)?

Large bowel is made of colon and rectum. This part of the digestive tract carries the remains of digested food from the small bowel and gets rid of it as waste through the opening to the back passage (anus). Cells that line the colon and rectum may begin to grow out of control, forming a tumour (a growth of cancer cells). Rectum (back passage) has been addressed in a separate page.

The large bowel has four sections: the ascending colon, the transverse colon, the descending colon and the sigmoid colon. Tumors can start in any of these areas or in the back passage. Most common type of cancer is adenocarcinoma. Tumours start in the innermost layer and can grow through some or all of the other layers.

Symptoms And Diagnosis

Colonic cancers can come with anemia due to slow loss of blood or with obstruction to bowel. However, these symptoms occur only when the disease is infiltrated locally. Screening methods are available that can detect colonic and rectal cancer before symptoms appear (stage 0). When detected early, these cases can be cured with much simpler surgery.

Symptom of colon cancer depends on the location of the tumor in the colon (ascending colon, transverse colon, descending colon and sigmoid colon).

  • Change in bowel habits like diarrhea, constipation, or feeling that the bowel does not empty completely
  • Bright red or very dark blood in the stool
  • Narrow stools
  • Vomiting, gas pains, bloating, fullness, and cramps
  • Unexplained weight loss
  • Chronic fatigue
  • Anemia

People with any of the above symptoms should seek medical help. Stool occult blood test detects small amounts of blood in stool which may indicate colonic cancer. Colonic cancer is diagnosed by colonoscopy. A biopsy is performed during these procedures to prove the diagnosis.

Staging & Treatment

Surgery is the main treatment for colonic cancer. The stage of colon cancer can only be confirmed after surgical removal of tumor. However, imaging studies like CT scan or MRI scan give good idea about the operability of the disease in many cases and to some extent about the stage of the disease.

Stage 0

Stage 0 colon cancer is when the disease is limited to the innermost lining (mucosa). While performing endoscopy, an endoscopist can exise it completely (polypectomy). When performed properly, this would serve as complete treatment. However, often more extensive surgery (resection) to remove rectal cancers is required (discribed in next session). Surgery can cure cancer at this stage.

Stage I

Stage I tumors have spread beyond the inner lining (mucosa) of the colon into the muscle layer. However, the cancer has not spread to the outer wall of the colon or outside the colon. The curative treatment involves surgery to remove the cancer along with a normal segment of colon to clear lymph nodes (small nodular structures that are present throughout the body that clear the tissue fluids). Additional treatments are not usually needed. Aggressive surgery to remove all of the cancer offers a great potential for cure. The five-year survival rate for stage I cases is more than 90%

Stage II

Stage II colon cancers are larger and extend through the muscular wall of the colon, but there is no cancer in the lymph nodes (small nodular structures that are present throughout the body that clear the tissue fluids). The curative treatment is surgical removal of the affected area along with surrounding normal colon to clear the lymph nodes. Chemotherapy may also be given to selected patients precaution against cancer recurrence. The five-year survival rate for stage II colon cancer is more than 70%

Stage III

Stage III rectal cancers have spread outside the rectal wall to the lymph nodes (small nodular structures that are present throughout the body that clear the tissue fluids). Lymph nodes are one of the first to get affected by spreading cancer. The treatment involves multiple modalities:

  • Surgery to remove the tumor and all involved lymph nodes (described in next session).
  • After surgery, the patient has to undergo chemotherapy inorder to reduce the risk of cancer recurrence.

The five-year survival rate for stage III colon cancer is about 60%.

Stage IV

Stage IV colon cancers are the ones that have spread to far away organs. Usually these include liver or lung. The mainstay of treatment is chemotherapy, but surgery to remove the tumor may also be recommended. Surgery, when performed, is often used to relieve or prevent blockage of the colon or to prevent bleeding. A curative surgery may be considered in selected cases where all the tumor tissue can be surgically removed (limited number of liver & lung spread). When surgery is possible, the five-year survival rate can be upto 50%. If surgery is not feasible the survival is poor.

When surgery is not possible, other options include destroying them with microwaves or heat (radiofrequency ablation) or giving chemotherapy directly into the liver used with embolization (chemoembolization), etc.

Surgeries For Colon Cancer

The only curative treatment for colon cancer is surgery. All other forms of treatment like chemotherapy and radiotherapy can only reduce risk of recurrence of cancer, but cannot cure the cancer. The type of surgery depends on the location of the tumor in the colon (ascending colon, transverse colon, descending colon and sigmoid colon).
  • Right Hemicolectomy : Removal of the last part of the small bowel, the caecum, ascending colon and a small part of the transverse colon. The cut part of the small bowel is connected to the remainder of the large bowel.
  • Transverse Collectomy:Removal of the transverse colon. The ascending and descending colons are joined to each other.
  • Left Hemicolectomy: Removal of the descending colon and sigmoid colon. The cut part of the transverse colon is connected to the rectum.
  • Sigmoid Colectomy:Removal of the sigmoid colon. The descending colon is connected to the rectum.
  • Total abdominal colectomy: Removal of entire colon. The terminal part of small bowel is attached to the rectum.


The idea of these surgeries is that the affected portion of the bowel along with its lymph nodes should be removed. This reduces the risk of recurrence of cancer in the future.