Colon Cancer

Cancer of the Colon remains the most common cancer affecting men and women. More than 120,000 new cases of colon cancer are diagnosed each year in the United States. While the cause of colon cancer is not yet known, experts agree that there is a relationship between benign colon polyps and cancer. Polyps are either flat or grape-like collections of slightly abnormal colon tissue. When polyps first appear in the colon they are small and usually cause no symptoms. As they enlarge they may cause either hidden (occult ) blood to appear in the stool or may bleed, causing bright red blood to appear on or in the stool. When polyps grow to an inch or more in diameter the chances of degenerating into a cancer increase. Cancers not only bleed but can cause pain, weight loss and intestinal blockage. Polyps can usually be diagnosed and treated non-surgically when they are small and before they degenerate into cancers. The American Cancer Society recommends that people over fifty years of age undergo yearly testing for occult blood in their stool. Every three years a flexible Sigmoidoscopy is recommended. People with a family history of cancer or with a tendency to develop polyps may require more frequent examinations and Colonoscopy . The treatment for colon cancer usually involves removing the portion of the intestine that is diseased. Operations are usually performed through incisions but may sometimes be accomplished by laparoscopic techniques. Blood tests are usually performed and a CAT scan is frequently obtained before surgery. Preparation for surgery is accomplished on the day prior to operation and involves cleansing the colon with laxatives and enemas and taking oral antibiotics to help prevent surgical infections. Intestinal continuity can almost always be reestablished and colostomy is rarely needed. Advanced stage cancers are sometimes treated with chemotherapy after...

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Rectal Cancer

The causes of rectal cancer and the symptoms that result from it are similar to colon cancer. The Rectum is the last six inches of the large intestine and is located just inside the anus. Because of its proximity to the anal sphincter muscle special surgical expertise is required in order to prevent serious complications that can result from surgery. Cancers in the top 1/3 of the rectum can invariably be removed and intestinal continuity can be restored through an abdominal operation. Early stage cancers of the bottom 1/3 of the rectum can frequently be removed by an operation performed through the anus, avoiding major surgery. More advanced cancers of the lowest part of the rectum usually require removal and creation of a permanent colostomy . Modern surgical techniques also permit the removal of most mid-rectal cancers without the need for permanent colostomy. Ultrasound examination of the cancer is frequently performed pre-operatively in order to determine its stage. Radiation and chemotherapy are sometimes used pre- and /or post-operatively in to improve the results of...

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Crohn’s Disease

Crohn’s Disease is an inflammatory disease of the intestinal tract. The cause of Crohn’s Disease is not yet known although scientists and researchers believe that it is probably related to an immune phenomenon. Unlike Ulcerative Colitis which only involves the mucous membrane lining of the large intestine, Crohn’s Disease can involve all the layers of the intestinal tract any place between the mouth and the anus. Crohn’s Disease usually occurs in one of four anatomic patterns. The Ileocolic pattern affects approximately 50% of patients with Crohn’s Disease. This pattern involves disease in the last few inches of the small intestine and the cecum, the first part of the large intestine. Approximately 25% of patients with Crohn’s Disease have involvement of only the small intestine. An equal number of patients have disease that affects only the large intestine. A very small group of patients (1-3%) present with Crohn’s Disease that only involves the anal canal. Symptoms of Crohn’s disease include abdominal pain, nausea, vomiting, diarrhea with or without blood, fever, and weight loss. Patients with anal Crohn’s usually present with complicated fistulas, fissures and hemorrhoids. The initial treatment of Crohn’s Disease is always with medicines and diet. Complications of Crohn’s Disease include intestinal obstruction, internal and external fistulas, abscess formation and failure to respond properly to medicines (intractability). When these complications occur surgery can sometimes be very helpful. Over the years many new procedures have been developed that preserve the intestine and the sphincter, thereby avoiding the need for colostomy or ileostomy. The Cleveland Clinic is one of the foremost institutions for treating Crohn’s Disease in the world. During their Fellowship training in Colon and Rectal Surgery at the Cleveland Clinic, Drs. Launer and Worsey had an extensive experience in the surgical management of Crohn’s Disease under the guidance of Dr. Rupert B. Turnbull, Dr. Victor W. Fazio and Dr. Ian C....

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Diverticulosis/Diverticulitis

Diverticulosis is a condition of the large intestine that usually results from consuming insufficient dietary fiber. As a result of higher than normal pressure in the large intestine (colon) small hernias or “out-pouches” develop called diverticula. In most people diverticulosis causes no symptoms. Diverticulitis is a disease that is caused by inflammation of diverticulosis. Patients with acute diverticulitis experience left lower abdominal pain that is sometimes associated with fever, constipation or diarrhea. The treatment of uncomplicated diverticulitis includes dietary restriction and antibiotics. Occasionally patients require hospitalization for intravenous antibiotics. A small percentages of patients with severe diverticulitis can develop intestinal obstruction, perforation or hemorrhage . If patients with severe diverticulitis do not respond rapidly to medical treatment, surgery may be necessary to remove the diseased portion of the large...

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Hemorrhoids

Internal and external hemorrhoids are dilated veins that are located in and below the anal canal. They are part of the normal anatomy but can produce problems when they become enlarged and inflamed. While some people develop symptomatic hemorrhoids as a result of a genetic tendency to hemorrhoidal enlargement, the majority of people develop problems with hemorrhoids because of constipation due to inadequate dietary fiber . The symptoms caused by hemorrhoids include pain, bleeding, protrusion, soiling and itching. The type of symptoms are related to whether the internal hemorrhoids, external hemorrhoids or both are symptomatic. Symptomatic hemorrhoids rarely cause life-threatening problems but can sometimes significantly affect people’s ability to carry on their normal daily activities. It is extremely important to determine the cause of rectal bleeding since some anal, rectal and colon cancers can cause bleeding that is indistinguishable from hemorrhoidal bleeding. There are a variety of medical and surgical treatments for hemorrhoids. The majority of symptoms will usually resolve simply by increasing dietary fiber . This can be accomplished by increasing the intake of fruits and vegetables or consuming the many psyllium or methyl cellulose products that are available without prescription. Medicated suppositories are sometimes very helpful. The application of tiny rubber bands around the base of hemorrhoids is an efficient, painless means of outpatient treatment of internal hemorrhoids. Patients who do not respond to or are not candidate for simple methods of treatment can undergo an operative hemorrhoidectomy utilizing either conventional or laser...

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Fistula in-ano

An anal fistula is an abnormal connection between the inside of the anal canal and the skin around the anus. A fistula usually arises as a consequence of an infection of one of the glands that are located within the anal canal. Bacteria that are normally present in the anal glands begin to multiply and form an abscess that burrows through the wall of the rectum and to the skin surrounding the anus. Some abscesses will rupture or break open spontaneously. Others will require surgical drainage. A fistula develops when the tract that extends between the inside gland and the outside opening does not heal. While most fistulas are caused by infection, some are caused by cancer, trauma and Crohn’s Disease . Women can sometimes develop fistulas between the rectum and the vagina after childbirth. This usually results from failure of an episiotomy to heal. Symptoms of anal fistulas include pain, bleeding, recurrent anal infections, soiling with pus or blood. The treatment of anal fistulas is usually surgery. The type of surgery is dependent on the location of the fistula and its complexity. Surgery is usually accomplished at an outpatient surgicenter under a local, general or spinal...

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Fissures

Anal Fissures, sometimes called Fissure-in-Ano , are small tears in the lining of the anal canal. They are most commonly caused by constipation, diarrhea or trauma. They cause burning or sharp pain in the anal canal that is set off by bowel movements and usually lasts for several hours. Typically, bright red blood is present either on the stool or the toilet paper or in the bowl. Most fissures will heal by themselves in 24-48 hours if bowel movements return to and remain normal. The medical treatment of anal fissures includes fiber supplements, medicated suppositories and creams. If patients do not respond to medical treatment outpatient surgery is sometimes...

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Pruritis Ani

Pruritis ani , or anal itching is one of the most common complaints related to anal pathology. Itching tends to occur in and just around the anus. It is frequently more pronounced at night. Itching can be associated with benign conditions like symptomatic hemorrhoids, anal fissures, anal fistulae and contact dermatitis. Malignant skin conditions (Paget’s Disease and Bowen’s Disease ) can also present with itching as the primary symptom. Most commonly, prurutis ani is caused by foods that are eaten, vitamins, minerals and medications that are consumed and creams, lotions, solutions and soaps that are applied. Everything that is ingested is converted into basic chemicals by the intestinal tract. Those chemicals appear in all body secretions, including the mucus that is in the rectum. When the mucus comes into contact with the skin around the anus the chemicals can irritate the skin. Such irritation is frequently perceived as itching. Of course, the natural reaction to itching is scratching. Scratching compounds the problem by removing the lining of skin that prevents itching. If the irritated inflamed skin is washed with soap (especially those that contain perfume or deodorant) the problem is compounded. People with pruritis ani should have a complete evaluation to exclude serious anal or rectal disease that may require medical or surgical treatment. Itching can then be treated by dietary restrictions and topical...

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Hernia

Hernia is one of the most common problems seen in a general surgical practice. A hernia is a defect in the abdominal wall. Hernias can also be located in the umbilicus or in previous surgical incisions (incisional hernia). Hernias usually present as a mass or lump in the groin that becomes more pronounced during the day, only to disappear when the patient reclines. Hernias can sometimes cause local discomfort. On occasion, the intestines may get caught in a hernia (incarceration). Since most hernias will increase in size and cause increasing symptoms with time, the presence of a hernia is usually an indication for surgical repair. Due to refinement of surgical techniques hernia repair is now a relatively simple procedure that is performed as an outpatient and permits early return to work and physical activities. Most modern hernia repairs include the use of a prosthetic nylon mesh that decreases tension (and therefore pain), strengthens the abdominal wall and reduces the risk of recurrence. Hernia repairs can be accomplished by incisional (open) or laparoscopic...

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