Cancer occurs when something goes wrong with this system,
causing uncontrolled cell division and growth. The cells lump
together and form a mass of extra tissue, also known as a
tumor, which continues to grow. As it grows, it may damage
and invade nearby tissue.
Cancer that spreads from the place where it started to somewhere
else in the body is called metastatic (MEH-tuh-STA-tic).
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Q: Once it has been determined that
I have a growth in my colon or rectum, will I need additional
diagnostic studies?
A: If your problem was diagnosed
using a digital rectal exam, or through fecal occult blood
testing (Hemoccult® test), you will need additional
evaluation, most likely by colonoscopy, which examines the
entire colon and rectum, or, at least, by sigmoidoscopy,
which examines the final two feet of the colon and the rectum.
These examinations are important not only to determine the
extent of the current problem, but also to look for other
abnormalities, which might also be present and could influence
your best course of treatment. Your physician will determine
which test is best for you.
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Q: Prior to having surgery on my colon
or rectum, will I need any additional preoperative evaluation?
A: A variety of laboratory
examinations, including chest X-ray, EKG, CBC (complete
blood count), chemistries, coagulation parameters, are routinely
required. If you are anemic or there is risk for significant
blood loss, a sample of your blood will be held at the blood
bank to expedite replacement blood in your type if transfusion
becomes necessary. A CT or CAT scan of the abdomen and pelvis
may be ordered by your physician. This study can help to
evaluate the local or metastatic (spread) of any cancer.
For rectal cancers, a transrectal ultrasound, which determines
the depth of a tumor and possible lymph node involvement,
can also help in determining the best treatment options.
Other special studies may be dictate by your general state
of health. For example, if you have emphysema, a pulmonologist
may be consulted and perform pulmonary function tests or
an arterial blood gas. Your surgeon will evaluate the necessity
of such studies.
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Q: Prior to my sigmoidoscopy or colonoscopy,
or colorectal surgery, will I require any special bowel
preparation?
A: So that the lining of the
colon can well-visualized during colonoscopy, it is necessary
to remove the stool using laxatives taken by mouth. Popular
choices include GoLytely®, Nulytely®, Fleet®
Phosphosoda, and Magnesium Citrate. Preparation for sigmoidoscopy,
a test that views only the lower portion of the colon, is
routinely done with enemas (often, Fleet® enemas). Your
physician will choose a regimen which will allow the most
comfort while appropriately cleansing your colon. Preparation
for an abdominal colon resection or rectal excision requires
that your colon be cleansed of stool and bacteria. This
cleansing allows for a safer anastomosis (joining of two
pieces of bowel), and decreases the incidence of wound infection.
Your physician will choose the appropriate regimen for you,
which may include oral antibiotics such as erythromycin,
neomycin, or ciprofloxacin. It is very important that, whichever
plan is established, you follow the prescription completely.
If you are unable to complete the plan, your surgery may
need to be cancelled or rescheduled. Please call your physician’s
office with any problems.
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Q: What is a stoma, and will I need a one?
A: A stoma, commonly referred
to as a colostomy or ileostomy, is an artificial opening
in the abdomen created during surgery that allows elimination
of stool after the operation. It is necessary if passage
to the anus is interrupted after the operation. The colostomy
may be temporary, to give the colon a chance to heal, or
permanent (in 10 to 15 percent of cases) if the lower part
of the rectum has been removed. In most cases, if a stoma
will be permanent, your surgeon will be able to tell you
this prior to the procedure. However, if your anastomosis
(rejoining of the bowel) is low, or there are other factors
encountered during the operation that cause your surgeon
to be concerned about your safety, a temporary stoma may
be required. This "protecting" or "diverting"
stoma may be in the form of a colostomy or ileostomy brought
to the skin’s surface before the anastomosis, thus
allowing time for healing without being bathed by stool
and bacteria. The stoma may be closed or reconnected at
a later date, after healing of your anastomosis has taken
place. This healing is confirmed by a radiologic study,
such as a gastrograffin enema, and/or by direct visualization,
which will view the lining and may offer an opportunity
to dilate a narrowed ("strictured") area. Caring
for a stoma is enhanced by specially-trained nurses called
"enterostomal" therapists. They help teach you
about stoma care, skin care, and appliance management. They
can also introduce you to other patients with stomas ("stomates")
so that you can learn from their experiences.
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Q: How will my pain be managed after the
surgery?
A: In the immediate postoperative
period, you will receive some form of analgesia which you
can control, termed Patient Controlled Anesthesia ("PCA").
This may be a device with a button you push to deliver intravenous
medication to yourself, or in the form of an epidural catheter,
with the same opportunity to self-administer additional
pain medication. The epidural catheter is similar to that
placed in women who are in labor and is very safe. It seems
to block the input of pain sensation, and therefore, if
effective, will block the response to pain. Once you are
able to take pain medicine by mouth, these other methods
will be removed. Interim forms of pain management include
intravenous or intramuscular injections given by the nursing
staff.
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Q: How long will I need to stay in the
hospital after my surgery?
A: The length of hospital
stay varies depending on the individual and the type of
surgery. In general, the length of stay ranges from 4 to
10 days. Most surgeons will keep their patients in the hospital
until they can take food and pain medicine by mouth, are
urinating, and having bowel movements. Individual practices
may vary, so this issue should be discussed with your surgeon
prior to your surgery. Special needs or concerns (for example,
in the elderly who require assisted living) may require
that special arrangements be made prior to the surgery.
These concerns should be discussed with your physician,
family and friends well in advance so that proper arrangements
can be made.
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Q: How will the diagnosis of colon or rectal
cancer affect my family?
A: It is common that a diagnosis
of cancer may both frighten and upset your family. However,
there are now several therapeutic options available to patients,
and these should be discussed at length with your surgeon
and with your family prior to making final decisions. Letting
your family know will give them time to adjust, and help
you make decisions in a time when your own decision-making
processes may be more difficult. Additionally, if it appears
that you have a family history of colon, ovarian, endometrial,
gastric, or pancreatic cancer, it is important for your
family members to be screened as well. Colon cancer, as
mentioned above, may be preventable in its early stages.
