colorectal cancer treatment

Colorectal Cancer Treatment


Early diagnosis of Colorectal Cancer and advanced treatments can enhance the survival rate. Treatment may involve a colonoscopy to remove polyps or cancerous cells from the lining of the colon. Advanced stages require surgery to remove some of, or, in rare cases, the entire colon. Be sure to discuss all the options with the multidisciplinary team of  Colorectal Cancer experts, to find the best treatments. 

Major treatments:

Transanal removal of anorectal cancers/polyps:

This procedure is to take away polyps or cancer in the anus. A local trans-anal resection is suggested for removing some early 'stage I'

rectal cancers that are relatively small and not too far from the anus. The procedure is done with instruments that are put into the rectum through the anus. The surgeon cuts through all layers of the rectal wall to take out the cancer tissues as well as some surrounding normal rectal tissues, and after that, the hole in the rectal wall is then closed. 

If the cancers in the rectum are at a position that can't be reached using the standard transanal resection, transanal endoscopic

microsurgery is suggested. This is an appropriate alternative to conventional rectal resection. A magnifying scope is put through the anus and into the rectum. This allows the surgeon to do a transanal resection with great precision and accuracy. 

A major advantage of these methods is that the surgeon doesn't have to cut into the abdomen (belly).

Sphincter saving procedure: 

Patient with colorectal cancer in the lower part of the colon may have to remove both the rectum and the anus. As a result, the patient needs a permanent colostomy, through which an end of the intestine is fixed on the abdominal wall to pass the stools out, which is covered by a device called 'colostomy bag' that collects stool in a pouch attached to the abdominal wall. Majority of times the patients don't seek treatment for the fear of this permanent colostomy. But experts like Dr. Shabnam Bashir, who is trained from the highest volume cancer center of the country, and is an organ-specific Onco Surgeon, know how to use various modalities to downsize and downstage the tumours to make sphincter-saving procedures/surgeries possible. Sphincter saving procedures need expertise and precision.

Sphincter-sparing surgery is a more advanced type of surgery that eliminates the need for a permanent colostomy. This procedure allows for the safe removal of the tumour and saves the anal sphincter muscle. The method lowers the risk of cancer cells left behind in the pelvis, as the surgeon removes tumours outside the layer of tissue surrounding the rectum, working in a plane that preserves the sphincter muscle while clearing cancer completely. This helps the patient to eventually return to passing bowel movements through anus. 

  • Patients with very low rectal carcinoma are offered  Intersphincteric Resection (ISR) with colo-anal anastomosis. This method is the ultimate anal preservation surgery by both abdominal and anal approaches which consists of TME and excision of the internal anal sphincter. 
  • Cancers in the upper part of the rectum (close to where it connects with the colon) can be removed by Low Anterior Resection. In this method, part of the rectum containing the tumour is removed and the remaining part is reattached to the remaining rectum, which helps the patient to move the bowels in a usual way. This helps to avoid a permanent colostomy. 
  • Another sphincter-saving procedure has been developed for the treatment of very low-lying rectal cancers, known as "Ultralow Anterior Resection".

Abdominoperineal Resection (APR)

The method can be used to treat some stage I, II or III cancers in the lower part of the rectum or anorectum; to be precise, that is very close to the anal verge. It's often needed if the cancer is growing into the sphincter muscle, the muscle that keeps the anus closed and prevents stool leakage or the nearby muscles that help to control urine flow (levator muscles).

Here, the surgeon makes a cut or incision in the skin of the abdomen, and another in the skin around the anus which helps to remove the rectum, the anus, and the surrounding tissues, including the sphincter muscle.

Because the anus is removed, a permanent colostomy is created (the end of the colon is connected to a hole in the skin over the abdomen) to allow stool to leave the body.

Authored by Dr. Shabnam Bashir

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About Dr. Shabnam Bashir

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Dr. Shabnam Bashir has time and again proved her extensive and versatile expertise as a Colorectal Cancer Surgeon. This is validated by the successful cases of patients that she has dealt with.

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