ENThe diagnosis usually comes after a colonoscopy prompted by blood in the stool, alternating constipation and diarrhoea or a falling haemoglobin: the report mentions the unfamiliar word «sigmoid», surgery has been scheduled, and questions outnumber answers.
Sigmoid colon cancer treatment in Germany starts not with surgery but with a second look at the diagnosis. Below: where the sigmoid colon lies, what that changes for the surgeon, how the operation works, when chemotherapy is added and what follows discharge.
Where the sigmoid colon is, and why that matters
The sigmoid colon is the last, S-shaped stretch of the large bowel before the rectum. Only the rectum is a more frequent site of large-bowel tumours, so «sigmoid cancer» and «bowel cancer» often appear side by side in reports; for the general rules, see colorectal cancer treatment in Germany.
Unlike rectal cancer, a sigmoid tumour lies higher, outside the narrow pelvis and away from the sphincter, the muscle that holds back stool. The surgeon need not trade the sphincter for a safety margin, so the question «will the stoma be permanent» means something different; for tumours lower down, see rectal cancer treatment.
A sigmoid tumour is often found late: it does not hurt for a long time, and the first signs resemble ordinary bowel trouble — changed bowel habits, bloating, blood in the stool. Slow bleeding can cause anaemia, noticed only as weakness and tiredness. The Krebsinformationsdienst of the German Cancer Research Center lists the signs (in German).
How the diagnosis is rechecked in Germany
First, a German pathologist reviews the slides and paraffin blocks brought from home, and this is no formality: tumour type and grade decide the extent of surgery and whether chemotherapy is needed.
A complete colonoscopy checks for a second tumour or polyps further up; if the instrument cannot pass a narrowing, it is completed after surgery. CT of the chest and abdomen looks for spread, the blood marker CEA gives a baseline for follow-up, and MRI is added if the liver findings are unclear.
Molecular tests for microsatellite instability (MSI) and RAS and BRAF mutations are not done for science: they show which modern drugs would work if the disease spreads beyond the bowel. In a certified centre every case is decided by a tumour board (Tumorkonferenz) where surgeon, gastroenterologist, oncologist, pathologist, radiologist and radiation oncologist sit together.
Surgery: sigmoid resection
A sigmoid resection removes the tumour-bearing segment with its feeding vessels and the fatty tissue holding the lymph nodes, then joins the bowel ends. The cleaner this lymphatic basin is removed, the more accurate the stage and the lower the risk of recurrence; German guidelines call for at least 12 lymph nodes to be examined.
It is done open, laparoscopically through small incisions, or robotically. Keyhole surgery means less wound pain, a bowel that wakes up sooner and earlier discharge, but it does not suit every tumour; the surgeon decides from the images. Only some patients need a temporary stoma to protect the join, mainly when the tumour has blocked the bowel or the wall has torn.
Such operations are routine at bowel cancer centres certified by the German Cancer Society (Darmkrebszentrum), the first filter when choosing a hospital. Colorectal surgeons include Prof. Mia Kim, chief physician for visceral surgery and coloproctology at München Klinik Harlaching (keyhole bowel surgery, including sigmoid diverticular disease), and Prof. Ayman Agha, chief of surgery at München Klinik Bogenhausen. In Hamburg, Dr. Thies Daniels heads general, visceral and tumour surgery at Albertinen Hospital (laparoscopic and robotic colon surgery); in Berlin, Prof. Matthias Pross heads the bowel centre of the DRK Kliniken; in Tübingen, Prof. André Mihaljevic is medical director of general, visceral and transplant surgery at Tübingen University Hospital (surgical oncology, robotic surgery).
Chemotherapy and follow-up
Whether chemotherapy follows depends on the histology of the removed segment, the key document after surgery, which sets the stage. With involved lymph nodes, preventive chemotherapy lowers the risk of recurrence and is usually advised; with clear nodes but deeper growth, risk factors decide; at the earliest stage it is unnecessary. The stage also sets its length.
Spread to the liver or lungs does not automatically rule out surgery: some deposits are removed or destroyed with heat (radiofrequency or microwave ablation), with chemotherapy built around this, and the tumour board decides what is removable. For microsatellite-unstable tumours that have spread, immunotherapy for bowel cancer is discussed.
Follow-up matters because a recurrence found early is treated differently from one found late. For stage II and III, check-ups with CEA and abdominal ultrasound come every six months for two years, then yearly up to five years; colonoscopy follows after one year, then every five years if clear. Routine CT is not part of the German schedule set by the S3 guideline on colorectal cancer.
Frequently asked questions
Can sigmoid colon cancer be treated without surgery?
Usually not: surgery is the main treatment. The exception is a very early cancer in a polyp: if the pathologist confirms low aggressiveness, that the tumour does not fill the whole polyp and has not grown deeper, removal at colonoscopy may suffice. Radiotherapy plays no role in colon cancer, including the sigmoid.
Is a stoma always needed after sigmoid surgery?
No: only some patients need a temporary stoma, mainly when the tumour has blocked the bowel or the wall has torn, so that the join can heal. Once it has healed and the patient has recovered, the stoma is usually reversed in a further operation.
How long is the hospital stay after surgery?
After sigmoid surgery patients stay in hospital for several days to a few weeks, depending on the extent of the operation, the approach (keyhole surgery shortens the stay) and wound healing. Histology review, work-up and any chemotherapy are separate stages, planned once the hospital has seen the records.
How AlenMed arranges treatment
The hospital is chosen by its volume of bowel operations and certification as a bowel cancer centre, not by the loudness of its name. AlenMed has 86 partner hospitals in 38 cities, 345 doctors and an office in Munich; the reports, CT disc and slides sent in become a request to the right department.
The company translates records, books the appointment and histology review, arranges the visa invitation, meets the patient and provides a medical interpreter for consultations and on the ward. Estimate and invoice come from the hospital itself; for the costs, see cost of bowel cancer treatment in Germany.
This material is for information only and is not an offer. The extent of surgery and drug treatment is decided by the doctor after an in-person examination.
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