Colorectal Surgery
Why would I be referred for colorectal surgery?
There are many different gastrointestinal conditions that can result in the need for surgery. These can either be benign (non-cancerous) disease or malignant (cancerous) disease
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Inflammatory bowel disease such as Crohn’s and Ulcerative Colitis
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Diverticulitis
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Large colon/rectal polyps
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Colon or rectal cancer
What should I expect prior to coming to my appointment?
Prior to booking surgery you may have had several test or procedures done as required:
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Colonoscopy: a diagnostic test in which a long thin camera is inserted through the rectum into the colon.
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CT of the chest, abdomen and/or pelvis
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MRI of abdomen and/or pelvis
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CEA bloodwork: colon cancer marker that can be detected in bloodwork
What should I expect at my appointment?
On the day of your appointment please bring your health card and a list of any medications that you are taking. You also may want to bring a list of questions and a loved one who can act as a second set of ears.
Your surgeon will discuss any results from your colonoscopy, diagnostic tests and bloodwork, do a physical exam and come up with a treatment plan. Your treatment will depend on the results and if your disease is benign (non-cancerous) or malignant (cancerous).
Benign Colorectal Disease
What is benign colorectal disease?
Several non-cancerous diseases of the colon that may require surgery. These include:
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Inflammatory Bowel Disease:
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Diverticulitis
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Benign colon and rectal polyps
Inflammatory bowel disease
Inflammatory bowel disease (IBD) is a term used to describe disorders that involve chronic inflammation of your digestive tract. Types of IBD include:
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Crohn’s: A type of Inflammatory Bowel Disease that is characterized by inflammation of the lining of your digestive tract. Crohn’s can affect multiple areas of the GI tract
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Ulcerative Colitis: Long-lasting inflammation and sores (ulcers) in the innermost lining of your colon and rectum
What causes Inflammatory Bowel Disease?
The exact cause of IBD remains unknown. Although previous it was thought that diet and stress caused the disease, doctors now believe it only aggravates the condition. Family history and genetics plays a role, as it is more common in people who have family members with the disease. Other possible causes are immune system malfunction.
What are the symptoms of Inflammatory Bowel Disease?
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Diarrhea
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Fever and fatigue
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Abdominal pain and cramping
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Blood in your stool
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Reduced appetite and weight loss
How is Inflammatory Bowel Disease diagnosed?
IBD is diagnosed by undergoing a colonoscopy. During this procedure biopsies of the affected area can be taken, which will then be examined to diagnose Crohn’s or Ulcerative Colitis.
What is the treatment for Inflammatory Bowel Disease?
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Medication: There are various types of medications to treat IBD. You will be referred to a gastroenterologist to help manage medication.
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Surgery: Surgery is considered to treat IBD only if complications have occurred or if medication therapy has failed. For information about specific surgeries see the section about different types of colorectal surgery.
Diverticulitis
Diverticulitis is inflammation of small pouches called diverticula that develop along the walls of the intestines.
What causes Diverticulitis?
Diverticula occurs when naturally weak places in your colon give way under pressure causing little pouches. Diverticulitis occurs when the diverticula tear, resulting in inflammation and/or infection.
What are the symptoms of Diverticulitis?
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Pain, which may be constant and persist for sever days
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Nausea and vomiting
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Fever
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Constipation, or less commonly diarrhea
How is Diverticulitis diagnosed?
Diverticulitis is diagnosed usually when a person is undergoing an acute attack. A doctor will take into account the symptoms the patient is having, and a CT test will be ordered, that can identify the inflamed or infected pouches.
What is the treatment for Diverticulitis?
Treatment for diverticulitis depends on the severity of your symptoms and include:
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Medication: Antibiotics and pain medications may be given
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Diet: You may be instructed to go on a liquid or soft food diet until your symptoms have resolved. You will also be given instructions on how to change your diet to prevent recurrence.
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Surgery: Surgery is only performed if complications occur or if medication therapy has failed. For information about specific surgeries see the section about different types of colorectal surgery.
Large Benign Colon or Rectal Polyps
Benign polyps are non-cancerous growths on the lining of your colon or rectum. Most of them are not harmful and do not cause any symptom but have the potential to evolve into colon cancer over time. These polyps are found on colonoscopy and can usually be removed at this time. If they are too large to be safely removed during colonoscopy then they may need to be surgically removed. For information about specific surgeries see the section about different types of colorectal surgery.
Colorectal Cancer
What is Colorectal Cancer?
Colorectal cancer occurs when some cells in the colon (colon cancer) or the rectum (rectal cancer) start to grow out of control and invade the cells surrounding them or spread into other tissues (metastasize).
What is my risk of having colon or rectal cancer?
Colorectal cancer is the 2nd most commonly diagnosed cancer in Canada, and the 2nd leading cause of death from cancer in men and the 3rd leading cause of death from cancer in women. Risk factors for colorectal cancer include:
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Age: more than 90% of cases occur in people over 50 years old
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Family history of colorectal cancer
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Personal history of colorectal cancer or polyps
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A genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch Syndrome)
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History of inflammatory bowel disease (Crohn’s or ulcerative colitis)
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Low fiber, high fat diet
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Obesity
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Alcohol and tobacco use
What are the symptoms of colorectal cancer?
Seven out of ten people diagnosed with colorectal cancer will have no symptoms as during its early growth stage the cancer is very small. Symptoms often appear once the tumor grows larger and can mimic the same symptoms of many other health conditions.
Symptoms include:
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Changes in bowel habit, including diarrhea or constipation or a change in the consistency of your stool
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Rectal bleeding or blood in your stool
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Persistent abdominal discomfort such as cramps, gas, or pain
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A feeling that your bowel doesn’t empty completely
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Weakness or fatigue
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Unexplained weight loss
How do I prevent colorectal cancer?
The most effective way to reduce your risk of colorectal cancer is by having regular colorectal cancer screening. Almost all colorectal cancers begin as precancerous polyps (abnormal growths) in the colon or rectum. These growths can be present in the colon for years before invasive cancer develops. Colorectal screening can find these polyps and remove them before they turn into cancer or can find colorectal cancer in its early stages making it easier to cure.
You can also modify your lifestyle to reduce risks:
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Eat a diet that has a variety of fruit, vegetables and whole grains
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Drink alcohol in moderation
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Stop smoking
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Exercise regularly and maintain a healthy weight
What is colorectal screening and when should I be screened?
Colorectal screening is used to identify colorectal cancer or precancerous polyps when a person has no symptoms. Screening is done based on your age and risk factors and can include a stool test (fecal immunochemical blood test) or colonoscopy.
To determine when and how you will be screened your physician will determine if you are average risk or increased risk.
Average risk:
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People age 50-74 with no first-degree relative who has been diagnosed with colorectal cancer
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No personal history of polyps
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No inflammatory bowel disease
Increased risk:
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People with a family history of colorectal cancer
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Personal or family history polyps
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Personal history of inflammatory bowel disease (Crohn’s or Ulcerative Colitis)
Screening Recommendations
For people at average risk of colorectal cancer:
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Screening with fecal immunochemical test (FIT) every two years for asymptomatic people ages 50-74 without a family history of colorectal cancer, screening may continue after age 74 for individuals in excellent health.
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Abnormal FIT results should be followed up with a colonoscopy within eight weeks.
For people at increased risk of colorectal cancer:
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Recommendations are that asymptomatic people get screening with colonoscopy if they have a family history of colorectal cancer. Screening should begin at 50 years of age, or 10 years earlier than the age their relative was diagnosed, whichever comes first.
If you are interested in colorectal screening please speak to your family doctor.
What is the treatment for colorectal cancer?
Treatment for colorectal cancer depends on many factors, including the size, location, and stage of the cancer, whether it is recurrent and the overall state of health of the patient.
Treatment options include:
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Colorectal Surgery: This is the most common treatment. The tumor and any nearby lymph nodes will be removed, to reduce the cancer from spreading and determine staging. Depending on the extend of disease, and location, will determine the type of surgery done.
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Chemotherapy: Chemotherapy is a method to destroy cancer cells using medication. It is a systemic therapy, meaning that it affects your entire body and is administered either through pills or an intravenous device. If chemotherapy is necessary, you will be referred to the North East Cancer Center, in Sudbury, to speak to a Medical Oncologist.
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Radiation: Radiation uses a high energy beam to destroy cancer cells. This works by damaging the DNA of cancer cells so that they can’t continue to grow. Radiation is a local treatment because it is applied and takes effect in a specific area of the body (where the tumor is located). Your surgeon will refer you to the North East Cancer Center located in Sudbury to speak with a Radiation Oncologist if indicated.
Different types of Colorectal Surgery:
There are many different types of surgery and which one is done is dependent on where your disease is located, the severity, and overall patient health status.
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Colectomy or bowel resection: an operation to remove part of the intestine that is diseased. The name of the surgery depends on the part of the intestine that is removed.
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Right hemicolectomy: the removal of the ascending (right) colon
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Left hemicolectomy: the removal of the descending (left) colon
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Sigmoidectomy: the removal of the lower part of the colon which is connected to the rectum
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Hartmans: Sigmoidectomy without joining the ends of the bowel together and instead creating an ostomy (when the bowel is brought up to the skin)
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Anterior resection: the removal of the upper part of the rectum
2. Colostomy reversal: Procedure in which the large intestine and rectum are reconnected after a previous colostomy.
3. Loop Ileostomy reversal: Procedure in which the two ends of bowel are reconnected after a previous ileostomy.
These procedures may be done laparoscopically, open or a combination of both. The type of operation depends on the severity of your disease, location, and overall health status.
For further information about Colorectal Surgery, please see attached handout
Click on image to download
Colostomy / Ileostomy
Sometimes during bowel surgery, it is necessary to create a colostomy or ileostomy. An ostomy is a surgically created opening in the abdomen for the removal of stool. You may have to receive a colostomy or ileostomy, either temporarily or permanently, depending on surgery performed, your health status, and extend of the disease found during surgery. Your surgeon will discuss the risk of this occurring with you during your consultation appointment.
What is an ostomy?
An ostomy is a surgically created opening in the abdomen in which a piece of the colon (colostomy) or end of the ileum (ileostomy) is brought outside the abdominal wall to create a stoma through which digested food passes into an external pouching system. An ostomy is created when a portion of the colon or rectum is removed due to a disease process or damaged area of the colon. Some diseases which would cause this surgery are cancers, inflammatory bowel disease, trauma, diverticulitis.
Ostomies can either be:
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Temporary: Your surgeon may be required to create an ostomy to give a portion of the bowel a chance to rest and heal. When healing has occurred, the ostomy can be reversed, and normal bowel function restored.
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Permanent: When part of the colon or the rectum becomes diseased, a long-term (permanent) ostomy must be made. The diseased part of the bowel is removed or permanently rested. In this case, the ostomy is not expected to be closed in the future.
Care of your ostomy
A pouching system is usually worn. Pouches are odor free and different manufacturers have disposable or reusable varieties to fit one’s lifestyle. While in hospital you will be seen by an ostomy nurse who will help you to determine which ostomy supplies best suit you and they will teach you how to care for your ostomy.
The Government of Ontario has a Funding for Ostomy Grant. It is available to any Ontario citizen who will have an ostomy for longer than 6 months. The North Bay General Surgery office has all the paperwork and can assist you filling out the forms.
Living with an ostomy
Work: With the possible exception of jobs requiring very heavy lifting, an ostomy should not interfere with work. People with ostomies are successful business people, teachers, carpenters, welders, etc.
Sex and social life: Physically, the creation of an ostomy usually does not affect sexual function. If there is a problem, it is almost always related to the removal of the rectum. The ostomy itself should not interfere with normal sexual activity or pregnancy. It should not prevent one from dating and continuing relationships and friendships.
Clothing: Depending on stoma location usually you are able to wear similar clothing as before surgery including swimwear.
Sports and activities: With a securely attached pouch one can swim and participate in practically all types of sports. Caution is advised in heavy body contact sports and a guard or belt can be worn for protection. Travel is not restricted in any way. Bathing and showering may be done with or without the pouch in place.
Diet: For guidance, follow your nurse or doctor’s orders at each stage of your post-op adjustment. Individual sensitivity to certain foods varies greatly but many people eat as they did before surgery. You must determine, by trial, what is best for you. A good practice for all is chew thoroughly and hydrate properly. If you have an ileostomy, you may have to be careful with fresh fruit and vegetables as these can cause blockages. Ileostomies produce liquid stool, sometimes these ileostomies can produce large amounts of stool. This can be concerning and if your ostomy is producing greater than 1.5 – 2L per day and you need to contact your surgeon.
Hernias: A parastomal hernia is a protrusion of the intestines through the weakened area around the stoma. This will present as a bulge or lump around the ostomy site. Please contact your surgeon if you are experiencing significant pain from your ostomy site or if your ostomy is no longer working properly. Hernias are very common and don’t always require repair.
Ostomy Canada Society: non-profit volunteer organization dedicated to all people with an ostomy, and their families, helping them to live life to the fullest through support, education, collaboration and advocacy. https://www.ostomycanada.ca/
Canadian Cancer Society: Has information and resources about living with a colostomy. www.cancer.ca