Screening Saves Lives		Surgical Spotlight		What’s New
Patient Perspective		Healthy Fast Foods

Surgical Spotlight
Continence – Preserving Surgery and Stomas
Tracy Hull, M.D., CCF Colorectal Surgeon

Many patients facing surgery to remove cancer from their colon and/or rectum share a common fear. They worry that so much of their colon or rectum will have to be removed that they’ll no longer be able to have bowel movements normally and will, therefore, need to wear a “bag” on the abdomen that collects stool. Fortunately, advances in surgical techniques to remove colorectal cancer are so significant that less that 10 percent of people with rectal cancer and less than 1 percent of people with colon cancer need a permanent stoma.

A stoma is an opening of an internal organ onto the skin. When the opening is into the colon, or large bowel, it is called a colostomy; when it is into the ileum, or small bowel, it’s called an ileostomy. A stool-collecting bag is attached to the skin around the stoma. Some patients need a temporary colostomy to let the rectum and/or colon heal after especially complex surgery. They then undergo a second operation about eight to 12 weeks later to have the stoma closed.

Reconstruction Almost Always Possible
To remove colorectal cancer, surgeons must cut away the cancerous portion of the bowel with a generous margin of normal tissue around it. It’s necessary to remove some normal surrounding tissue to be sure all the cancer is taken out. In cancers of the lower part of the rectum, this margin may include the anal sphincter, making a permanent colostomy necessary. This happens in about 10 percent of patients with rectal cancer. Surgeons at the Cleveland Clinic use techniques and skill to preserve the sphincter muscles, avoiding a permanent colostomy, while still maintaining one of the highest cure rates in the world. Colostomy is almost never needed in patients with colon cancer.

Stomas: No Lifestyle Change
Many times, people who must have a permanent stoma and wear an external pouch feel as though their life, as it was before cancer, is over. There’s no doubt that it’s a big adjustment at first, but most people with a stoma say that it really doesn’t alter their lifestyle in any significant way. Dr. Hull has had patients who have engaged in all types of sports; even contact sports such as football. No one has to know you have a stoma unless you want to share that information. The pouch can be concealed under clothing, and it is odor free. Stoma therapy nurses and patient support groups are valuable aids in the adjustment process.

In Patient Perspective, we share the story of Janice Retzer, who describes what it’s like to live with a permanent stoma.