Coloproctology is a broad medical specialty related to Gastroenterology that is directed to the study of cancers of the large and small intestines, besides rectum and anus, as well as the pelvic floor, and other pathologies, whether in surgical or non-surgical treatments. The main ones are: colon cancer, rectal cancer, and colorectal cancer.
Types of colorectal cancer
The most common type of colorectal cancer and that represents 95% of the tumors that affect the large intestine is Adenocarcinoma. Other types, although more uncommon, can also affect the large intestine.
- Neuroendocrine tumor
Originates from neuroendocrine cells located in the large intestine. Neuroendocrine tumors can produce hormones, and when this happens the patient can present several symptoms related to this production.
Originates in the lymphocytes, that is, the defense cells that are located in the large intestine. Despite being located in a solid organ, it is a hematological neoplasm, because its cell of origin is from the hematopoietic system. The doctor responsible for its treatment is the hematologist.
- Gastrointestinal Stromal Tumor
They originate from the Cajal Cells, which are responsible for regulating the peristalsis of the digestive tract. In most cases, they have molecular characteristics that are used as therapeutic targets.
These originate in the melanocytes located in the intestinal mucosa. They are rare tumors and represent less than 1% of all cancers of the large intestine. Mucosal melanomas have different clinical and prognostic features than melanomas originating in the epidermis.
Originating in the smooth muscle cells that make up the large intestine.
Types of surgery in Coloproctology
The main surgical forms of treatment in this medical field include:
Collectomy is surgery to remove part or all of the colon and the nearby lymph nodes. If part of the colon is removed, it is called a hemicolectomy, partial colectomy, or segmental resection. If the entire colon is removed, it is called a total colectomy. Often, total colectomy is not necessary to treat colon cancer. It is usually performed only if there is disease in the part of the colon without the cancer, such as hundreds of polyps or sometimes with inflammatory bowel disease.
- Ileum / colostomy
Ostomy is the generic term describing the opening of a hollow organ from inside the body (digestive, respiratory, urinary) on the surface of the skin, creating a stoma. Ileostomy or colostomy are intestinal bypasses in which the ileum (small intestine) or colon (large intestine) is exteriorized into the abdominal wall, forming a new place for stool output. After an ileostomy or a colostomy, the patient uses a special bag attached to the skin to have their stool collected and collected.
Some early colon cancers or polyps can be removed during a colonoscopy. When this is done, no incision is needed in the patient’s abdomen.
In polypectomy, the tumor is removed as part of the polyp, usually by passing a wire loop through the colonoscope to cut the polyp from the colon wall with an electric current. In local excision the procedure is a bit more extensive and can remove superficial tumors and a small amount of tissue near the colon wall.
On some occasions, the narrowing of the intestine (stenosis) is so great that even dilation instruments cannot pass through. In these cases, and in some other situations, a stenoplasty procedure is performed. This consists of making small incisions in the region of the stenosis with the help of a stylet that is passed through the working channel of the endoscope. These small incisions help open up the narrowing, facilitating the passage of dilators and speeding up the treatment process.
Hemorrhoidectomy is known as the surgery to remove the internal or external hemorrhoid. Some doctors use electric scalpels in the procedure. Closure (with stitches) or not, is also an option for doctors.
There is also the PPH technique, which is a way to remove the hemorrhoids using a stapler (ring), which promotes the removal of the prolapsed hemorrhoid nipples.
Another technique is the so-called TDH, indicated only for internal hemorrhoids, performed with an anuscope, which presents itself as a flexible rod, one centimeter thick, helping the surgeon to identify the artery in the region of the surgery.
The objective of anoplasty is the restoration of the normal function of the anus, by dividing the constriction and widening the anal canal.
Possible Side Effects
The possible side effects of surgery depend on several factors, such as extent of surgery and the patient’s general state of health before surgery. Some changes may include post-surgical bleeding, infections, and blood clots in the legs.
After surgery, adhesions in organs or tissues can occur, sometimes even blocking the bowel, requiring additional surgery.
Some patients may require a temporary or permanent colostomy (or ileostomy) after surgery, which may take some time to get used to and needs some lifestyle adjustments.