What causes colon cancer?
Such tumor in the bowel can develop as a result of:
- systematic improper feeding, especially with excess intake of fatty meat products cooked with a lot of butter;
- nicotine and alcohol addiction;
- genetic predisposition to such kind of tumors.
The scientists haven’t ascertained the fact that the ecological situation, ultraviolet radiation and infections cause colon cancer development. Correctly balanced diet with the intake of vegetable fiber can be recommended as a preventive treatment for colon cancer. Vegetable fiber improves and supports the bowel functioning, normalizes its microflora and reduces the concentration of fatty acids that destabilize the colon walls.
Colon cancer doesn’t develop rapidly. The appearance of a malignant tumor can take months or even years. The disorders may appear either in one of genes responsible for cells division or in a few genes at once.
The most obvious symptoms that can point at colon cancer development include:
- a patient may feel that after defecation his bowel was not emptied completely;
- there can be different intestinal disorders: bloatedness, liquid stool or costiveness;
- bloody issues or mucus in fecal matters;
- a palpable tumor in abdomen region;
- overall health condition worsening like weight loss, weakness, anemia.
Colon cancer diagnostics in Germany
In order to diagnose colon cancer, a range of tests is usually taken. It must include X-ray imaging to detect cancerous tumors and other pathologic changes caused by colon cancer.
An efficient method of colon cancer diagnostics offered in Germany is colonoscopy. A gastroenterologist inserts a flexible hose into colon region to detect malignant tumors and other neoplasms, dissect small polyps or perform the biopsy of tumoral tissue for further analysis. This is the most efficient and popular method of colon cancer diagnostics in Germany.
Colon cancer treatment in Germany
There is no a universal algorithm of colon cancer treatment. The procedures are selected depending on the tumor location, stage and patient’s condition.
The major component of cancer treatment is a surgery. Such treatment includes tumor and metastases removal, as well as the dissection of lymph nodes located near the cancerous tissue. The surgery for colon cancer treatment is performed under general anesthesia, as usual. A surgeon makes incisions in the abdominal cavity. Laparoscopy is a highly efficient method of surgical treatment, actively practiced in German clinics. There are a lot of specialized centers in Germany for the treatment of colon cancer. We partner with the best German oncologic centers and specialists, offering the most effective treatment in this area.
During laparoscopic surgery an abdominal cavity is filled up with carbon dioxide. Then a laparoscopic tube with all required optical equipment is put inside. A surgeon inserts required instruments into small punctures and performs the surgery. There is no abdomen opening during such surgery that is much safer for a patient.
Laparoscopy and other surgical methods of colon cancer treatment are highly developed in Germany. Specialists of local clinics offer thorough diagnostics and huge variety of treatment methods. Alongside with surgical treatment, the doctors apply chemo- and radiotherapy that can be highly efficient on the initial stages of colon cancer. Moreover, German clinics feature high-quality colectomy and other methods of colon cancer treatment. High level of medical services with minimal risks to the patient’s life is offered in Germany.
If you have faced with such serious disease, we highly recommend you to consider German medical centers listed on our website for your treatment. If you have any questions, you can contact our specialists at any time.
Colon cancer surgery
The most important component in colorectal cancer treatment is surgical removal of the tumor. Colon cancer surgery usually means the only chance of complete healing. With the open and laparoscopic colorectal cancer surgery, two different methods are available.
Procedure for colon cancer surgery
Basically, there are two different surgical methods available:
- classically via an abdominal incision ("open surgery").
- minimally invasive keyhole technique ("laparoscopic surgery"), in which the smallest abdominal incisions are used to operate with camera optics and special working instruments in the abdominal area.
The open bowel cancer surgery allows the surgeon to get a good overview of the abdominal area. He can also feel tissue changes during surgery. This facilitates the complete tumor removal as well as the preservation of important neighboring body structures.
In contrast, laparoscopic colon cancer surgery requires significantly smaller abdominal incisions and is therefore considered to be particularly gentle on the patient. The recovery after laparoscopic bowel cancer surgery is usually slightly faster compared to open surgery and patients often have less pain. However, it is not suitable for every patient, usually takes longer and is much more costly.
Large studies have shown that the results are approximately the same with both methods. However, which method is more suitable for which patient must be discussed and decided individually with the doctor.
Curative (healing) bowel cancer surgery involves the removal of the entire tumor-bearing intestinal tract including its lymphatic drainage area in a package ("en bloc resection"). In the case of benign changes, such as polyps or adenomas, additional minimally invasive procedures are available.
Depending on the part of the intestine in which the tumor is located, the following standard surgical procedures are possible (open or laparoscopic).
If the tumor is located in the right colon (cecum, ascending colon, right colonic flexure or right transverse colon), a "hemicolectomy right" is performed. This removes the entire right right colon.
The end of the small intestine is then sutured to the transverse or descending colon. As enough residual colon remains after such an operation, normal defecation quickly resurfaces after a short period of getting used to in most patients.
Correspondingly, in the case of a tumor in the left large intestine (left colon transversum, left colic flexure, descending colon) the so-called hemicolectomy on the left takes place.
The middle of the transverse colon is sutured here with the rectum.
If the tumor lies in the "sigmoid colon", sigmoid resection occurs.
To restore intestinal continuity, the descending colon is sutured to the rectum.
Surgery for rectal cancer
In the case of rectal cancer, the surgical procedure depends on the exact tumor localization and tumor penetration depth.
It depends on these factors, whether or not a sphincter-like and therefore continence-preserving operation is possible. If the distance from the tumor to the sphincter or other important structures is not sufficiently large, the complete endgut removal including the sphincter muscle must be performed. Thereafter, a lifelong intestinal output is required. With an artificial intestinal outlet is also an excellent quality of life possible!
Nevertheless, the goal of therapy is to maintain the sphincter whenever possible. The following operational procedures are available:
Anterior rectal resection
As part of the (deep) anterior rectal resection, the surgeons remove the sigmoid and the upper (+ - middle and lower) rectum with the tumor. This procedure is possible if the tumor in the upper, middle or lower portion of the rectum has sufficient distance from the sphincter, so that it can be preserved.
Then the experts sew the descending colon with the remaining rectum. The fatty tissue, which lies in a ring around the rectum and contains the lymphatic vessels, must be sufficiently removed with. This all-important technique is called "partial" or "total mesorectal excision."
It is very important to ensure that the underlying nerve fibers for bladder emptying and sexual functions are not injured.
In order to allow a normal bowel movement again, it is necessary in deep anastomoses (reconnections) to restore the reservoir function of the distal rectum (so-called pouch formation).
There are various options for this, which should be discussed individually with the surgeon. In some circumstances (e.g., after radiation), the patient may require a temporary colostomy for about 2-3 months after surgery. This protects the surgical sutures on the rectum until they have healed safely. The artificial intestinal outlet does not pass the feces past the fresh surgical scars, but rather outward over the abdominal wall.
Abdominoperineal rectal extirpation (Miles operation)
If the tumor is located in the lower section of the rectum and very close to the sphincter, abdominoperineal rectal extirpation must be performed. This removes the sigmoid, the rectum and the sphincter with the anus. The surgery is primarily similar to the anterior rectal resection previously described. However, the natural intestinal exit is also removed.
The pelvic floor is closed and the descending colon is discharged as an artificial intestinal outlet in the left lower abdomen. Since complete tumor removal is a top priority for prognosis, physicians should not compromise on these types of tumors.
Many large studies confirm that the modern technology and special training of patients and therapists, even with an artificial bowel, a very good quality of life is possible. This includes the feasibility of many sports activities including swimming, but also intimate relationships.
Minimally invasive colon cancer surgery
Here, the operation is carried out with long, thin instruments, which are inserted into the abdomen over five to ten millimeters in size. In order to see what you do in the abdominal area, another kind of "puncture" with illumination is introduced into the abdomen via another puncture. This optic is connected to a video screen and now everyone in the operating room can see what is happening in the abdomen.
This "video laparoscopy" is the crucial difference to the past, where only the surgeon could see through the optics and all others were, so to speak, "blind". Therefore, no one could help with the operation and the technique was almost unlearnable.
The operation itself is very similar to open access through the abdominal wall. The appropriate intestinal components are prepared and excised. The diseased intestine is removed via a small incision in the right lower abdomen, comparable to the skin incision for appendix removal.
Although the overview of the entire abdomen is a bit more laborious, but the detail view is much more accurate and it can also be operated in places where you normally do not look.
The preparation of the intestine is carried out with the ultrasound preparation device, with which one can work particularly blood-saving. The union of the two severed bowel parts is usually done with a stapler.
In principle, almost all types of colon surgery up to the rectal surgery are possible. Nevertheless, not all patients are (for the time being) suitable for this method. This depends, among other things, on the disease, the general condition of the patient and the type of procedure.
Wedges or segmental resection
This operation is used to remove benign polyps that could not, or could not be, completely removed during colonoscopy. Since in these cases it is sufficient to remove a small section (segment, wedge or pathway) of the intestine, this operation can almost always be performed laparoscopically.
Transanal endoscopic mucosectomy (TEM)
In benign or early-detected malignant changes in the rectum, the "transanal endoscopic mucosectomy" or "full-thickness resection" can be used as a smaller and gentle variant. With this technique, it is possible to perform the entire operation through the anus in the anal canal. Thus, no abdominal incision is required.
The benefits of the operation
The advantage for the patient in the recovery phase is enormous.
- Much less pain from just three small punctures and a small abdominal incision about the size of an appendectomy.
- In most cases, only minimal blood loss, in most cases, the patient does not need blood.
- The intestine recovers faster and the patient feels well and fit again in a much shorter time than after the big abdominal incision.
- Often it comes through the large abdominal incision to the occurrence of scar fractures. The likelihood of scarring is almost negligible due to the small incisions. If it does happen, the scale is minimal and can be easily corrected.
- Of course, the cosmetic result is much better.
- Most patients can be discharged home faster and are fully recoverable sooner.
The disadvantages of the operation
- The operation is considerably more expensive because of the many special instruments.
- The surgery usually lasts longer than an abdominal surgery.
- The operation is more difficult for the surgeon to perform.
- In some cases, however, it is necessary for the operation to be stopped by a conventional abdominal incision.
The postoperative follow-up is done according to the fast track principle ("fast track") and the principle "little stress brings fast recovery".
The staff removes the breathing tube and nasogastric tube immediately after surgery. The patient is either for a short time for monitoring in the intensive care or directly back to the normal ward. Also, the bladder catheter and any wound drains (tubes for the discharge of wound secretion) do not have to remain with the patient for a long time.
From the first postoperative day, the patient may at least take tea, soup and rusks. In addition, he receives liquid by infusion and the doctors initiate a specially adapted pain therapy. In addition, the patient can actively participate in his healing process by staying in bed as little as possible. This helps along with wearing compression stockings and heparin injections to help prevent thrombosis and embolism. Each patient can also apply for cure through the social service.
Complications after bowel cancer surgery
Every surgery involves risks and dangers. In particular, pre-existing comorbidities (e.g., of the heart or lungs) may increase the risk of complications. Therefore, before a patient undergoes surgery, their individual risk profile should be determined. This is a prerequisite for the operation to be successful. The aim is to reduce the risk of complications in advance through special measures.
In order for the patient to be able to actively participate in the preparation of the operation, extensive medical education by his doctor is of great importance in the run-up to the operation. Thanks to modern methods, even extended operations are less and less stressful for the patient these days. The risk of complications is much lower than a few years ago. However, complications that endanger the patient's health and prolong hospitalization remain possible.
Serious complications after bowel cancer surgery are:
The risk of relevant rebleeding is low at 1%. The main risk of rebleeding from minute blood vessels or wound areas is within the first 24 hours after surgery. Bleeding from larger blood vessels is extremely rare, but dangerous.
Anastomotic leakage is a leaking seam between two bowel ends. This is a relevant complication that typically occurs around the 7th postoperative day.
The reason is usually a reduced blood flow in the area of the new intestinal connection (anastomosis). There is an increased risk of anastomotic leakage in operations near the sphincter and after radiation therapy. The overall rate should be less than 5% in good hospitals.
In up to 5% of cases, postoperative wound infections occur. These are usually harmless, but can prolong the hospital stay. They are caused by intestinal germs, which can contaminate the abdominal wall during surgery, despite all hygiene measures and the administration of antibiotics.
If the bowel does not work after surgery, it is called postoperative bowel palsy. This condition should be kept as short as possible. Therefore, it is important to drink and exercise the first day after surgery. If this is not enough, you can temporarily administer enteric-stimulating drugs.
The goal is to mobilize the bowel in the first 2-3 days after the operation so that winds or bowel movements are eliminated.
The pain after surgery can vary greatly from patient to patient. Of course, the goal of pain medication is of course always to get the patient as completely pain-free as possible, so that a quick mobilization (medical and breathing gymnastics) and thus the prevention of thrombosis or pneumonia are possible.
Possible lasting consequences after colon cancer surgery
Consequences after a colon operation can be for example digestive problems. Depending on the extent of the removed intestinal section, however, after a period of getting used to it, no major impairment of stool quality should occur. Initially, you may experience mushy bowel movements or diarrhea, as the thickening of the stool is now shorter, but the bowel gets used to it quickly. Persistent diarrhea can usually be treated with motility-inhibiting or thickening drugs.
Following rectal surgery, increased stool urgency and incontinence (inability to control wind or defecation) of varying severity may occur in the initial stages. Again, the patient can exercise and improve.
Furthermore, bladder and sexual function disorders are possible if irritation or injury has occurred during surgery on nerves that are in close proximity to the surgical site. Thanks to the latest and advanced surgical techniques, however, these symptoms are usually temporary, persistent problems are less common than in the past.
Suitable rehabilitation measures after the bowel operation
Depending on which section of the intestine is removed, the recovery time varies. When the surgeon removes part of the right colon, many patients hardly notice a difference in digestion. Distant parts of the left colon are more likely to cause problems. Here nutritional advice helps to adjust the eating habits and shorten the recovery period. In general, it is advisable to eat several small portions throughout the day following a bowel operation. The intestine needs time to get used to the new situation.
After bowel cancer surgery, regular aftercare is important. This way, metastases or new ulcers can be detected and removed in good time. Colorectal cancer follow-up includes colonoscopy, blood tests and ultrasound examination of the abdomen.
After appendix removal, recovery usually takes place within a few days. The day after surgery, light food is the best choice. The hospital stay is on average between three and five days.
Patients with a stoma (colostomy) must be trained by trained personnel to handle it properly. Any wound pain and skin irritation at the appropriate place are supplied with ointments and professionally cleaned.
After major intestinal surgery, a stay in a rehabilitation facility makes sense.