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Colorectal Cancer

The colon and rectum are continuous and cancers affecting them are referred to as colorectal cancers. Rectal cancer causes nearly 50,000 deaths a year in the U.S alone. Nearly 2/3 of colorectal cancers occur in the colon while about 1/2 occur in the rectum. In fact, colorectal cancers are the third-leading cause for cancer deaths in the U.S. after lung cancer and breast cancer. Typically colon cancer starts as small adenomatous polyps that later turn cancerous. Incidence of colorectal cancer is higher in Western nations as compared to Asian and African countries. More men tend to get affected by this form of cancer than women. Often hereditary syndromes cause multiple polyps in the digestive tract. Environmental and genetic factors play a large role in the occurrence of colorectal cancers. Those suffering from inflammatory bowel disease or ulcerative colitis have an increased risk of developing colorectal cancers.


Rectal cancers do not produce symptoms in the initial stages. They can be detected only by digital or proctoscopic screening tests. If you notice blood in your stools or change in the shape of the stools or cramping pain in the lower abdomen, visit a doctor to check for signs of colorectal cancer. Patients may notice change in bowel habits and urinary symptoms. Stools may be narrower and often black and tarry. A feeling of bloating or colic pain may be experienced on account of obstruction due to tumor. Sometimes there is bowel perforation accompanied by fever and pain. Weight loss, fatigue and anemia may result.


A digital rectal examination helps in detecting abnormal lesions. Any tumor can be assessed for size and ulceration. Laboratory tests and screening procedures such as x-rays and Endoscopy aid in visualizing the lining of the colon. Since the risk of colorectal cancer increases with age, the American Cancer Society recommends yearly digital examination of the rectum for those above 50 years. Any abnormal lesions in the rectum are examined and a biopsy is performed. If a diagnosis of rectal cancer is established, staging has to be established to determine the depth of tumor penetration. Staging aids the physician in determining the treatment options. Rectal cancers are divided into 4 stages. In the first 2 stages and suspected stage 3 state, surgery is used to remove the affected part of the rectum along with its vascular and lymph. Radiation and chemotherapy are also resorted to. Radiation therapy helps in shrinking the tumor prior to surgery. Rectal cancer is often linked to diets rich in fat and calories and low in fiber. Colon cancers can be prevented with the right diet and lifestyle. Diets rich in unsaturated animal fats and highly saturated vegetable oils are known to cause colorectal cancers. High-fiber food helps in the formation of soft and bulky stools, diluting carcinogens and decreasing colonic transit time. This allows lesser chance for polyps to develop. Other dietary elements such as calcium, selenium, carotenoids and vitamins A, C and E help in destroying dangerous free radicals in the colon.

Rectoplasty

Reconstructive surgery of the anus / rectum or the terminal part of the intestine is termed Rectoplasty. Rectoplasty is a surgery concerned with therapeutic and cosmetic reformation of tissue. The goal of Rectoplasty is to restore the form and function in deformed body structures which may be damaged due to various factors including disease, congenital anomaly, tumor, trauma or infection. Rectoplasty is employed not just for aesthetic problems and corrections, but also for anatomical and physiological irregularities. Vertical reduction rectoplasty has been devised specifically to correct physiological abnormalities which are present in the rectum of patients with idiopathic megarectum. Posterior sagittal ano-rectoplasty is adopted to rectify the malformations in infants, especially in females where the vestibular fistulae is frequently underestimated.


Hemorrhoidectomy

Hemorrhoidectomy is a surgery to remove hemorrhoids - enlarged veins that is found in and around the rectum and anus. Hemorrhoids may result from straining frequently due to constipation or child birth. Hemorrhoids can be classified into two types namely - external and internal. While external hemorrhoids occur below the anal sphincter and protrude at the anus, internal hemorrhoids occur above the anal sphincter and may be classified as first, second, third or fourth degree. External thrombosed hemorrhoids cause pain and they contain clotted blood. Normally the thrombosed external hemorrhoids are incised and the clot evacuated.


Hemorrhoidectomy becomes necessary when conservative measures fail to alleviate the severe burning, itching, swelling, protrusion, bleeding and pain in the anal area. Hemorrhoidectomy becomes appropriate when there are very large internal hemorrhoids, sometimes when internal hemorrhoids continue to cause symptoms after surgical treatment, when large external hemorrhoids cause significant discomfort in the anal area.


During the surgical procedure of hemorrhoidectomy, general anesthesia or spinal anesthesia is administered on the patient so that no pain is felt. Incisions are made in the tissue around the hemorrhoid. The hemorrhoid is removed and the swollen vein inside the hemorrhoid is tied off to prevent bleeding. The surgical area could either be closed with suture or left open. Surgery is performed using a scalpel, a cautery pencil or laser. Sometimes a circular stapling device is used to remove the hemorrhoid and close the wound. Here no incision is made. The hemorrhoid is lifted and stapled into place in the anal area. Recovery from hemorrhoidectomy may take about two to three weeks.


Normally the patient experiences pain after surgery . The doctor prescribes medicine to alleviate the pain. Some bleeding is normal after hemorrhoidectomy is performed, especially with the first bowel movement. Ice packs are recommended to be applied in the anal area to reduce swelling and pain. Sitz bath, with frequent soaks in warm water helps to relieve pain and muscle spasms. Stool softeners that contain fiber may help to make bowel movements smooth.


Hemorrhoids are found to recur in about 5% after hemorrhoidectomy. Hematoma, incontinence and infection in the surgical area and fecal impaction are some of the early side effects of hemorrhoidectomy. Late problems of hemorrhoidectomy could include stenosis or narrowing of the anal canal, formation of fistula between the anal and the rectal canal and rectal prolapse when the rectal lining slips out of the anal opening.

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Collection of Pages - Last revised Date: December 15, 2018