Colonic Tumors
Diagnostics
About half of the patients suffering from colonic tumors show no symptoms for a long time. Every change in bowel movement after the age of 40, displaying diarrhoea, constipation or stool with blood or slime coverage, is suspect of a malignant colonic disease.
60 % of all malignant tumors (including those of the rectum) are discovered during a rectoscopy, up to 98 % are discovered during colcscopy.
An ultrasonic examination of the liver as well as a radiographic (X-ray) examination of the lungs will be performed to exclude the existence of metastatic tumors. In individual cases a CT of the abdominal cavity and the liver will be performed additionally.
Surgery
The surgical aim is to resect the malignant tumor with a sufficient safety-distance and the removal of the lymph nodes which could be affected by the malignant tumor.
The extent of the hemicolectomy depends on the part of the colon that is affected and will be discussed with the patient in detail before surgery.
The operation is usually performed by a vertical incision in the middle of the abdomen, heading south from the belly- button. After the resection of the affected part of the colon the two bowel ends will be connected with a suture.
In early stages of colonic cancer the operation can be performed by minimal invasive surgery.
Surgical Risks
The suturation of the two end of the colon (Anastomosis) is a highly standardized and high precision part of the operation. An insufficient healing of this suture with extravasation of stool can lead to life threatening infections. In our case material the risk of such an insufficiency is about 5 %.
The risk of post-surgical wound infection is under 5 % and depends on the fact if surgery was planned or an emergency one. The dosage of antibiotics before and during surgery lowers the risk of an infection.
Closures with stenosis of the colon can occur after every extensive abdominal operation, and can lead to intestinal obstruction (ileus) even years after the operation. Another danger is the development of postoperative hernias, which can occur frequently during wound infections.
Special Questions
- The prognosis of a colonic cancer depends on the stage in which the tumor is diagnosed. This stage is determined on the tumor's expansion in the intestinal wall and the affection of the lymph nodes. The result of the preparation's examination will be given by the pathologist 3-4 days after the examination, and it will be discussed with the patient in detail.
- In the case that cancer population is detected in the lmph nodes we urgently advise a chemotherapy after surgery. Chemotherapy is usually administered over the course of 6 month and increases the chances for a good prognosis.
- Your stay in hospital will take 7-12 days. Early nourishment, an early removal of drains from the abdominal cavity or the bladder, a sufficient pain therapy as well as an early mobilisation will shorten your stay in hospital. Therefore, the active participation of the patient is very important. Every patient should – under a sufficient pain therapy- stay out of bed as long as possible, which means sitting on a chair or walking around, to lower his /her risk of thrombosos or danger of embolism.
- Pre-operative care requires a complete evacuation of the bowels, which will be performed on the day of your admission to hospital. It is certainly possible to begin with the pre-operative measure at home.
- The application of an artificial anus because of a partial resection of the colon is very rare and only necessary under certain circumstances.
- The wound will be closed with invisible dermal stitches that make a removal of sutures after surgery obsolete.
- Every cancerous disease harbors the risk of the development of metastasis. The risk of metastatic spread is at its height in the first two years after surgery, and will decrease in the course of time after surgery. Therefore, we have a post-treatment scheme, which detremines the date on which you should show up in our ambulance for a medical check-up.
