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Radiation before surgery to "shrink the tumor" and avoid a colostomy

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Richard Whittington, MD
Last Modified: February 24, 2004

Dear OncoLink "Ask The Experts,"
My doctor said I could have radiation before surgery to "shrink the tumor" and avoid a colostomy. Can you tell me more about this?  

Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:

When surgeons operate they go above and below the tumor by a couple inches to be certain they get an adequate margin around the tumor. If the lower margin is too close to the anus (the opening of the rectum to the outside) then it is necessary to put in a colostomy. If the radiation and chemotherapy shrink the tumor and it is not as close to the anus, it may be possible to avoid a colostomy. When radiation is used preoperatively less of a margin of safety is needed around the tumor and the patient may be spared a colostomy. The pre-operative treatment is similar to the radiation and chemotherapy that is recommended in the post-operative setting. However, the patient generally receives additional chemotherapy after the surgery has been completed. Sometimes surgeons will put in a temporary colostomy to allow the bowel that has been connected time to heal. This colostomy can be removed after adequate healing time (usually a few months).