February 27, 2003 at 11:03 PM CST - Updated June 17 at 6:35 AM
Colorectal cancer is the third most commonly diagnosed cancer in the U.S. and the third leading cause of cancer death. According to the American Cancer Society, this year, about 147,500 new cases will be diagnosed in the U.S.
(105,500 cases of colon cancer and 42,000 rectal cancers). About 57,100 will die from the disease.
The risk for developing colorectal cancer increases with age – about 90 percent of cases are diagnosed in patients over 50. Having a parent or sibling with the cancer doubles the risk of developing the disease. Some other risk factors include: history of polyps, presence of chronic inflammatory bowel disease, a diet consisting mainly of foods from animal sources, physical inactivity, obesity, and smoking.
The main treatment for colorectal cancer is surgery. In addition, patients may receive radiation therapy and/or chemotherapy. When possible, doctors will remove the section of cancerous tissue and small margins of healthy tissue along with nearby lymph nodes. For patients with colon cancer, doctors can often connect the two remaining sections of the colon, preserving normal digestive function.
Reconstruction: Avoiding Permanent Colostomy
Patients with rectal cancer may or may not need a permanent colostomy. If the cancer is located near the upper section of the rectum, the doctor may be able to remove the cancer and still have enough tissue to connect the remaining segment to the anus. If the cancer is extensive or located at the lower end of the rectum, the anus may need to be removed. The end of the colon is surgically attached to a newly created opening in the wall of the abdomen
(a procedure called a colostomy). Waste products (digested food) then pass from the colon into an outside collection pouch attached to the opening.
Surgeons have developed a technique to prevent the need for a permanent colostomy. The diseased portion of the colon and rectum is removed. Next, a new rectum, or reservoir is constructed out of the remaining colon. A temporary colostomy is performed to allow the colon to heal. After several weeks, the colostomy is reversed and the new rectum is connected to the colon. The surgery is extensive and generally requires a large incision from the ribs to the pubic bone. Patients often have significant pain and a recovery time of about two months.
Now, some surgeons are performing the procedure laparoscopically. It’s called a Transanal Abdominal Transanal Proctosigmoidectomy with descending coloanal anastomosis, or TATA. The incisions are smaller and there’s less disruption of tissue, so patients have less pain and a faster recovery time.
Prior to surgery, patients receive radiation and/or chemotherapy. The treatment shrinks the tumor, and hopefully, reduces the amount of tissue that needs to be removed. Then, the patient has surgery. The first part of the surgery is done through the anal canal. Using a lighted scope and special surgical instruments, the cancer is cut away. The second part of the surgery is done through the abdomen. The belly is inflated with carbon dioxide, which pushes the organs out of the way and gives the surgeon more room and a better view inside the body. Next, three to four small incisions are made in the abdominal wall. Using staples and a device called a harmonic scalpel to control bleeding, the diseased area of the rectum and colon are completely cut. The tissue is then removed through the anal canal. A new rectum is constructed from the lower end of the colon and a temporary colostomy is created. Healing time takes about four to eight weeks. Later, the colostomy is reversed in another minimally invasive procedure. Within about a week, normal bowel function returns.
For general information on colorectal cancer:
American Cancer Society, contact your local chapter or visit their website at www.cancer.org
The American Society of Colon and Rectal Surgeons, 85 W. Algonquin Rd., Suite 550, Arlington Heights, IL 60005, www.fascrs.org