Enterostomy Is Not Necessary For Colon Cancer Surgery | Dr. Ip Shing Fai, David

Colorectal cancer is now the second most common cancer in Hong Kong, with an annual incidence of more than 5,500 cases Its incidence rate is around 200 cases less than the first one, lung cancer. An unhealthy diet that includes lots of meat, fast food, fried food, and lack of dietary fibre, is the leading cause for the increasing intestinal cancer incidence rate in the past decade.

Colorectal cancer is developed from colon polyps. The risk of having colorectal cancer is greatly reduced once the polyps are removed timely. Even if you are diagnosed with colorectal cancer, there is no need to worry too much as the advanced medical technology is able to cure it. 70%-80% of colorectal cancer patients are still alive 5 years after the cancer surgery, if the cancer cell has not spread into other organs.

The primary treatment for colorectal cancer is by surgical operations of either a laparotomy and a minimally invasive surgery. Laparotomy is a traditional surgical incision into the abdominal cavity to remove the cancerous tumours and the cancerous tissues; Minimally invasive surgery is to make small incisions on the abdomen (belly) and utilise an endoscope to remove the cancerous tissues. The minimally invasive surgery has a faster recovery period as no big wounds are made. However, by either method, the relevant segment of the intestine will also be removed in the treatment based on the spreading of cancer and the lymphatic condition. The doctor may consider adopting chemotherapy (chemo) to help improve the condition by finding out the stage of the colorectal cancer from the cancerous tumour and lymphatic condition. Generally, patients of Stage I or Stage II colorectal cancer only need to remove the infected intestine segments, while Stage II to Stage IV colorectal cancer patients usually need further chemo after the removal surgery.

There are both permanent and temporary enterostomy. The temporary one is adopted because the risk of dealing with the wound near the anus is higher after rectal surgery. Therefore, a temporary opening is made and the intestines will be connected to the anus again once the wound is healed; The permanent one is adopted when the colorectal cancer is close to the anus and the intestines are unable to connect to the anus after surgery. The patient needs to wear a stoma bag permanently.

The average length of the colon of an adult is 70 cm - 80 cm. The doctor is able to connect the intestines after removing the infected segment. Back in the time when medical technology was relatively not as good, patients undergoing complex colon surgery were required to receive enterostomy and had to permanently wear a stoma bag to defecate. With today's advanced medical technology, the patients are not required to permanently wear a stoma bag after the surgery, if the cancerous tumour is at least 5 cm away from the anus.

There was a patient diagnosed with Stage I colorectal cancer when undergoing colonoscopy. Although it was only a very early-stage tumour, it was located too close to the anus and eventually the segment could not be connected back to the large intestine and required to wear a stoma bag for the rest of his life. This unfortunate case shows the importance of having a regular colon checkup. The chances of having colorectal cancer can be greatly reduced as long as we have regular checking to look out for polyps that may be cancerous, and receive timely treatment once it is found. It is recommended to follow medical advice to receive a colonoscopy for people who are age 50 or above without any symptoms and people who have any symptoms of colorectal cancer, such as change of bowel habits, bloody stool etc.