New Directions		Question & Answer		Surgical Spotlight
Mother & Son		Importance of Registries		Helping Others
Research Update		Code of Silence		Patient Advocacy
Patient Perspective

Mother & Son: The Big and Small of Colorectal Surgery
Angela Goodrich-Looman doesn’t have to look far to see how much surgical techniques to rid the body of colorectal cancer have improved. She can observe it in her son, Matthew Goodrich.

Both have undergone surgery to eliminate the threat of cancer due to familial adenomatous polyposis (FAP), an inherited disease in which hundreds of polyps develop in the colon and rectum, eventually turning cancerous. Both Angela (a Mingo Junction, Ohio, mother of two boys) and Matthew, her 13-year-old son, had some 2,000 polyps, making their cases among the most serious examples of the disease treated by Cleveland Clinic physicians.

FAP runs in Angela’s family, also affecting her father, paternal grandmother, several paternal aunts, uncles and cousins. Fortunately, Angela’s second son, Tyler, 4, isn’t showing the same signs for the disease that surfaced in Matthew before that age.

While they share a common experience with FAP, the two have diverging stories when it comes to treatment. Like her son, diagnosed at a young age, Angela had multiple surgeries to her son’s one operation to take care of the same procedures.

Her Story
The late Dr. David G. Jagelman removed Goodrich-Looman’s large intestine when she was 12 years old, using conventional surgery or colectomy. (She learned of the famed Cleveland Clinic colorectal surgeon through a Woman’s Day article after doctors in Steubenville, Ohio, diagnosed the disease.) Working through a major incision from her breastbone downward, he removed the large intestine but was able to save her rectum. Angela was hospitalized for more than a week and recuperated over many more weeks.

Several years later when her doctors discovered multiple rectal polyps, Angela needed more major surgery to remove her rectum. Fortunately, she was spared having a permanent colostomy (sack worn outside the body to collect waste) by a new surgery at the time called restorative proctocolectomy or “J-pouch” surgery.

With this technique, a fecal reservoir is created inside the body using a portion of the small intestine to create a new rectum, referred to as the ileal reservoir or J-pouch. The procedure, which joins the pouch to existing sphincter or anal muscles, allows normal bowel movements and good bowel control.

His Story
Matthew benefited from laparoscopic bowel surgery, a far less invasive technique that allows surgeons to pass surgical instruments into the abdomen through four or five small holes, rather than a large surgical incision. Diagnosed at age 8 with FAP, doctors waited until Matthew was 11 to remove his colon. His rectum was also removed and replaced with a J-pouch.

With high-tech procedures that positioned a tiny video telescope inside the abdomen through an incision near the belly button, Dr. Peter W. Marcello, staff colorectal surgeon, was able to peer inside Matthew’s body while he removed the colon through another inch and one-half incision. Dr. James Church created the J-pouch.

Laparoscopy Advantages
While it’s still too early to judge laparoscopy’s suitability for colon cancer, Matthew’s experience shows that it’s definitely a procedure of choice in removing the entire colon when a patient’s condition is still precancerous. The laparoscope also has been implemented successfully to excise polyps that are too large or dangerous to remove during a colonoscopy, the initial viewing that both Angela and her son had of their colons with a flexible and lit tube called a colonoscope.

Because it’s less invasive, laparoscopic surgery dramatically reduces both hospitalization and recovery time as well as any scarring to the body. Other than a little soreness the first few times he got up, Matthew was well on his way to recuperation over the next five or six days. As for Angela, she’d choose the same laparoscopic procedure in a heartbeat over conventional surgery.

“Compared with mine, his (recovery) was wonderful,” she said. “He was rollerblading the next week.”

Angela says that a temporary ileostomy for a year while she was pregnant has left lingering effects in occasional unexpected trips to the bathroom. Despite this, it has not really slowed her down. Angela runs a daycare in her home, and her son Matthew enjoys a healthy, athletic lifestyle, playing in a hockey league. Most importantly, they’ve rid themselves of any fear that those 2,000 polyps would turn into colorectal cancer.