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Stomas and Colostomies
"What is a stoma?"
The word stoma means an opening. In this case, it refers to an
opening of the bowel. Stomas are created when the bowel is brought
up and out onto the abdominal wall and sewn to the skin. This allows
the stool to be emptied out of the intestine and into an appliance
or bag that can be secured to the abdominal wall. If the colon is
brought to the abdominal wall, it is called a colostomy. If the
small bowel is brought to the abdominal wall, it is called an ileostomy.
"Is it likely that I will need a colostomy?"
If you have a colon cancer, the risks of a colostomy are all but
zero. The surgeon will remove the tumor and the involved segment
of bowel, and then will sew the bowel back together again. Therefore,
the risks of colostomy at the initial operation should be nil. If,
however, the area does not heal well, then it may be necessary to
do a temporary stoma before you leave the hospital. The chances
of this should be less than 1%.
Rectal cancers are somewhat different. As the tumors get closer
and closer to the anal muscles, it becomes technically increasingly
difficult to remove the tumor and still put the bowel back together
again. The skills and experience that surgeons have in this area
varies greatly. For tumors in this area, it is probably worthwhile
counseling an individual who has extensive experience in avoiding
colostomies.
"When do I need a colostomy for rectal cancer?"
You should ask the physician if the tumor directly involves the
anal muscles. If the tumor directly involves the anal muscles, then
a colostomy is always necessary. If the tumor does not directly
involve the anal muscles, then a colostomy can usually be avoided.
Margins
The pathologist will also examine the tissue to make sure that
the margins are negative. By this, it is meant that the pathologist
has looked at all of the places where the bowel and tissues were
cut to make sure that there are no cancer cells at these cut margins.
This is reassuring that no cancer cells were left behind. The extent
of these margins is not clear, however, for most rectal cancers
the surgeons would like to get at least an inch below the tumor.
One might think that the greater the margins, the better. In general,
this is probably true for local control of the cancer, but it does
not influence whether or not cells have already escaped from this
region and might have established tumors in the liver, lungs, or
other places.
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