Intestinal Cancer
Tumors in the colon are common. Although the majority
are not malignant, cancers of the colon are the
most frequent in the intestinal tract. If a tumor of the
colon is suspected, the methods for diagnosing it are
readily available and highly accurate. Unlike cancer of
the stomach, cancers of the colon can usually be effectively
removed and the long term outlook is much better. Because these are growths in the wall and passageway for
stool, they cause blockage of the stool passage and they
bleed.
Any change in bowel habit, cramps or bleeding in the
stool requires investigation for the possibility of a colon
tumor. Certain innocent tumors of the colon appear to
have the potential for becoming cancerous. The surgical
techniques and methods for managing these tumors are
well established.
How can you know that there is a tumor in the colon?
Sometimes the tumor can be felt by a digital examination
of the rectum. At other times the physician can see
the tumor through an instrument called a sigmoidoscope,
which is inserted into the rectum for a distance of ten or
more inches. Another procedure is to put barium into the
rectum by an enema method and take X rays of the
barium filled intestine. This is called a barium enema
examination.
What does it mean to be "sigmoidoscoped" and how is
the tumor seen through the rectum?
This procedure can be done in the doctor's office. It is
completely painless and does not require an anesthetic.
You must take a laxative the night before and have a
cleansing enema early on the morning of the examination.
A hollow tube with a light attached is advanced to the
colon through the rectum. This is easily done. If any
abnormal growths are seen, a part of them can be removed
(biopsied) for microscopic examination. All activities
can be immediately resumed. Bleeding soon afterward is
usualy insignificant and comes from the biopsy wound.
This examination is a routine part of every adequate
cancer detection study.
What is the barium enema X ray?
The examination is done in the hospital or in the office
of an X-ray specialist (a radiologist). As far as the
patient is concerned, he will be getting an enema, but
instead of water it contains a barium compound, which
molds with the colon and can be photographed. The patient
lies on a table during the examination and is moved about
so that he can be photographed in various positions.
Then the barium is passed just as if he were having a
bowel movement. X-ray photographs are also taken
in this evacuated state. The films are developed immediately
and the diagnosis usually is readily made.
Where the study reveals a small tumor that can be
confused with a piece of stool or where the findings are otherwise uncertain, the examination is repeated in a few
days. The procedure is painless, with only a mild sense
of abdominal pressure and a desire to move the bowels.
A properly performed examination allows for an accurate
diagnosis in most instances.
What surgery is done?
Essentially the operation consists of removing the involved
bowel containing the tumor and a generous segment
on each side, together with its suspending membrane
(mesentery). This membrane contains the vascular system
of the colon and the lymph glands. The two remaining
ends of the colon are sutured together so that the
intestinal contents can pass. The creation of this new
opening is called an anastomosis.
Will I move my bowels normally afterward?
Yes, in surgery on these tumors the rectum is left
intact.
Will I have an abdominal opening?
Usually not. Sometimes we make a temporary abdominal
opening, a colostomy, and close it before you leave
the hospital. This often makes it possible to carry a patient
through a difficult operation by avoiding serious complications.
What happens if nothing is done for this cancer? Is there
such a thing as being too old for this operation?
These cancers do not stay stationary; they continue to
grow, and in so doing they cause bleeding and blockage
of the bowel. In other words, they always cause trouble.
Virtually all individuals with cancer of the colon should
be operated on to avoid these problems. No patient is too
old. One can adjust the kind of operation to the patient's
condition.
What is the risk of this operation?
Certain statistics for cancer have been likened to a bikini.
What they reveal can be less interesting or vital than
what they conceal. The risk of this operation lies not
only in the fact that it is a cancer but also in the age
and general condition of the patient. The entire past and
present status of the patient's health is challenged by an
operation. Thus a long term smoker runs the risk of pneumonia,
a poorly nourished patient may not heal well, a
cardiac may get an acute heart attack, an elderly man
may have a stroke. Also a serious postoperative infection
may occur. There is a wide range of risks; generally considered,
3 to 5 percent of the patients may not survive.
What does the operation accomplish?
The aim is to remove the cancer so that it won't spread
or recur. Even in a situation where cure cannot be
achieved, it is usually possible to relieve the cramps and
severe difficulty in moving the bowels and to eliminate
the bleeding that causes anemic weakness and lethargy.
How often is it possible to get a real cure?
In early colon tumors we can completely cure about
75 percent of those who survive the operation.
Is it possible to get another cancer in the part of the colon
that is left behind?
This happens in about 5 percent of the cases. It is a
problem to which we have to be alert.
Why then isn't the entire colon removed?
That can be done and is one of the standard operative
techniques for this disease. Complete removal is a procedure
of greater magnitude; it may be attended by
significant postoperative diarrhea, but it may remove the
cancer potential. When the colon has more than one tumor or when a second tumor appears, this is often
the operation of choice.
If the operation is on Monday, why do I have to come to
the hospital on the Tuesday before?
It takes this amount of time to get the intestine cleaned
out so that it is in the best condition for suturing. Certain
blood tests and X rays have to be brought up to date. The
time is also used to sterilize the bowel with various drugs
and to get the patient stabilized. The time taken to get
everything properly prepared and evaluated pays big
dividends in terms of reducing postoperative problems.
Does this cancer come from hemorrhoids or the fact that
I always delayed moving my bowels when I had the initial
urge? I was always too busy.
There is no connection as far as is known.
If the operation is successful, is there any specific advice
for the future?
Not really. After things are healed, the diet can be what
you wish. Laxatives and even enemas are allowed, and
there is no restriction of activity.
How can I know if it comes back that is, if the tumor
regrows?
That can be determined only by the patient's symptoms,
the doctor's findings on abdominal and rectal examination,
and subsequent X-ray studies.
Is there anything that my brothers or sisters or children
should do to prevent this from happening to them?
This disease of the colon is not inherited. The best
precaution is early diagnosis for bleeding in the bowels
or any change in bowel habits. There is value in having a
sigmoidoscopy as part of a general annual checkup.
