Several diseases can interfere with the normal functioning of the colon. These diseases are classified as benign (noncancerous) or malignant (cancerous). They can cause symptoms including bleeding, infection, and perforation.
In some cases, doctors treat the disease by removing a segment of the colon. Given that the average person has 230 to 370cm of small bowel and 90 - 150cm of colon, removing a segment generally doesn't affect normal colon functioning.
In Crohn’s disease, inflammation causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can't absorb this excess fluid, you develop diarrhea. Altered intestinal contractions also can contribute to loose stools. Diarrhoea can range from mild to severe.
Diarrhoea can also be a symptom of ulcerative colitis. However, patients with ulcerative colitis tend to experience bloody diarrhea and also something called tenesmus. Tenesmus is the sensation of having to move one's bowels.
Food moving through your digestive tract can cause inflamed tissue to bleed, and your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. Should this occur, you must notify your physician.
The risks of any surgery must be weighed against the risks associated with disease state requiring the intervention.
In the case of ulcerative colitis, the risks of ongoing inflammation, infection and subsequent colon cancer are sometimes greater than the risks described below and surgery is thus indicated.
Major risks of laparoscopic proctocolectomy with ileo-anal J pouch for ulcerative colitis can include but are not limited to:
Diverticulitis is a common gastrointestinal disorder found mainly in the left side of the large intestine, primarily the sigmoid colon. Diverticulitis develops from a condition called diverticulosis, which involves the formation of outpouches of the colon wall. Diverticulitis results if one or more of these pouches (or diverticula) becomes inflamed. While left sided involvement is the rule, some patients may have diverticulosis and subsequent diverticulitis on the right side of the colon.
Risk factors believed to be important for developing diverticulosis includes: aging, low fiber diet and possibly lack of exercise. There are no known factors that cause diverticulosis to become diverticulitis.
Patients may also complain of nausea or diarrhoea; others may be constipated.
Other symptoms could include: vomiting, bloating, bleeding from your rectum, frequent urination, and difficulty or pain with urination.
Patients with the above symptoms are commonly studied with a computed tomography, or CT scan.
Your doctor may also choose to obtain a barium enema. In this test, x-ray dye (barium) is injected through the rectum and pictures are taken to study the inside of the colon. While this test is sensitive for the diagnosis, it does not give information about the overall extent of the disease.
Your doctor should discuss the reasons for choosing one of these tests versus another.
A first-time episode of diverticulitis is usually treated with conservative medical management, including bowel rest (i.e., ranging from nothing by mouth to liquids only), intravenous fluid, and antibiotics. Depending on the severity of your attack, this treatment plan may or may not require hospital admission.
Once your pain begins to resolve, most patients will be placed on a low residue diet. This low-fiber diet gives the colon adequate time to heal without needing to be overworked. Later, patients are typically placed on a high fiber diet as there is some evidence this lowers the risk for second and third attacks, known as recurrence.
Patient suffering one-time attacks typically do not require surgery so long as the attack resolved with medical therapy. Recurring attacks or more severe first-time cases may require surgery, either immediately or on an elective basis (see below). The decision to perform surgery for diverticulitis is always handled on a patient by patient basis so you should discuss your specific case with your doctor.
In some cases, surgery may be required to remove the area of the colon most affected by the disease. For example, if the involved segment is the sigmoid colon, the procedure is known as a sigmoid colectomy.
You should understand that segmental colectomy only involves removing the infected or thickened area. Surgeons routinely leave other areas of diverticulosis behind to avoid removing large amounts of your colon. Only a very small percentage of people who have surgery will have a repeat attack in the remaining bowel. However, repeat surgery is not usually warranted.
When is Surgery Indicated?
More typically, elective surgery for diverticulitis occurs. As discussed above, this is called segmental colectomy and can be performed either open or laparoscopically.
In open surgery, a large abdominal incision is made. Through this incision the surgeon is able to remove the diseased intestine. Once the diseased bowel is removed the remaining colon is reconnected. With this, the patient is able to have normal bowel movements, the same as before the surgery.
In laparoscopic surgery incisions are made in the abdominal wall through which instruments and a viewing tube (laparoscope) are inserted. A camera attached to the viewing tube sends images of the inside of the abdomen to a television screen. The surgeon looks at the screen to see what he or she is doing while using the instruments to perform the surgery.
In more emergent cases, when there has been perforation to the intestine from diverticulitis, two operations are usually involved.
The risks of any surgery must be weighed against the risks associated with disease state requiring the intervention. In the case of recurrent complicated diverticulitis, the risks of ongoing inflammation and infection are greater than the risks described below and surgery is thus indicated.
Major risks of laparoscopic colectomy for diverticulitis can include but are not limited to:
Colorectal cancer is cancer of the large intestine (colon), the lower part of your digestive system. Rectal cancer is cancer of the last part of your colon.
In most cases of colon cancer, the process begins in the form of a polyp. These are benign (non-cancerous) clumps of cells that are often small, and produce few symptoms other than silent and slow bleeding (which may manifest as dark stool.)
It is not possible to distinguish adenomatous from hyperplastic polyps in the body so the current standard of care is to completely remove any colon polyps to permit complete analysis.
On occasion, it may be found that colon cancer has already developed in a removed polyp. In such cases, if the cancer has been completely removed, no further tissue removal is necessary. In cases where residual cancer is left, or if there is uncertainty if cancer cells remain, removal of the affected portion of the colon is indicated (see below.)
Screening tests, as well as simply lifestyle and diet changes, can greatly reduce your overall risk of developing colon cancer because most polyps can be found and removed before they turn into cancer.
Polyps rarely cause symptoms by themselves. On occasion, polyps may bleed and this will typically manifest as dark or tarry stool. Such a finding should prompt a phone call to your physician.
There are often no symptoms of colorectal cancer during its early stages. When symptoms do occur, they will vary according to the location and size of the cancer.
Symptoms may include:
Some factors that increase your risk of colon cancer include1:
Most colon cancers develop from adenomatous polyps, so early and routine screening is very important for detecting colon cancers. Common screen procedures include:
There are four main types of treatment for colorectal cancer:
The treatment or combination of treatments depends on the stage or extent of cancer present: location of the cancer, how far the cancer has penetrated the wall of the bowel, and whether the cancer has spread to the lymph nodes and other parts of your body.
Surgery is the main treatment option for early colon cancer. The most common surgery for cancer that begins in the colon is a colectomy. The type of colectomy performed will depend on whether all or part of the colon needs to be removed.1
Segmental Colectomy is a surgical procedure that removes the part of your colon that contains the cancer, plus a margin of healthy colon on either side to make sure no cancer is left behind. The two ends of colon are typically then reconnected.
In laparoscopic colectomy, surgeons utilise special instruments and cameras that are inserted inside the body through multiple small incisions, rather than one large incision. Patients usually recover faster after this technique and leave the hospital earlier on average than patients who choose open surgery. The cosmetic benefits also apply. Not everyone is a candidate for laparoscopic colectomy. People who have large tumors or those who have had many abdominal surgeries in the past, may not be candidates for this technique. This should be discussed with your surgeon as the decision is always dependent on your unique situation and your surgeon's level of comfort.
The risks of any surgery must be weighed against the risks associated with disease state requiring the intervention. In the case of polyps or cancer, the risks of developing or leaving known cancer in the body are greater than the risks described below and surgery is thus indicated.
Major risks of laparoscopic colectomy for colon polyps or cancer can include, but are not limited to:
Radiation is typically reserved for patients with rectal cancer only because it is dangerous to radiate the small bowel that comes in contact with the areas of the colon other than the rectum. Radiation therapy involves treatment with powerful energy rays that kill cancer cells.
If the cancer is large or if the cancer’s location makes surgical treatment difficult, radiation therapy may shrink the tumor before surgery.
There are two main types of radiation therapy, depending on the source of the high energy rays:
This allows high energy rays to focus directly onto the tumor. This technique is more frequently used with rectal cancer, prostate cancer, and in older or ill patients who would not be able to withstand surgery.
Radiation therapy causes several side effects: nausea, skin irritation, diarrhea, rectal or bladder irritation, or fatigue
Also known as “chemo” and is the use of drugs that kill cancer cells. They may be given intravenously or taken by mouth. The drugs penetrate through the bloodstream, making them effective for cancers that have spread throughout the body.
Chemotherapy after surgery can increase the survival rate for some patients with invasive colorectal cancer. However, there are negative aspects to chemotherapy as well. While killing cancer cells, chemotherapy drugs can also damage normal, healthy cells too. This leads to side effects such as:
Most side effects (such a hair loss) will resolve when chemotherapy is completed.
When caught early colorectal cancer is one of the most preventable and curable cancers. Because so many polyps are left untreated, colorectal cancer is now the second most common cancer in men and women in Australia. The risk of being diagnosed by age 85 is 1 in 11 for men and 1 in 16 for women.1
www.cancer.gov (National Cancer Institute)