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What to expect in Colon Cancer Surgery.

Understanding & dealing with Ostomy

“Between 725,000 and 1 million people in the United States are currently living with an ostomy, according to the United Ostomy Associations of America (UOAA), but there are still many misperceptions about what life after the procedure is like.”

Generally, colon cancer is treated based on the stage of cancer. Staging determines the severity of the cancer. Most cases of colorectal cancers are in Stage 2 or Stage 3 when diagnosed. However, early diagnosis based on widespread screening colonoscopy can catch tumors at an earlier stage. Treatment options include the use of surgery, chemotherapy, immunotherapy and radiation.

If a section of the colon has to be removed during surgery to ensure that the cancer is removed, there may be a need for an ostomy.

An ostomy is a type of surgery that creates an opening in the body (usually in the lower belly area) that allows stool to exit the body rather than its natural path through the colon and rectum. This is more common for patients with a rectal tumor and for patients who are in stage 3 or 4 of colon cancer and have an obstruction in the bowel. For many, this is a temporary condition, meaning that the ostomy and ostomy bag to remove waste isn’t permanent. At some point in the future, the surgeon may be able to reconnect the areas of the colon so that waste can be removed from the body naturally.

A majority of patients need a temporary ostomy , only about 10% of colorectal cancer patients need a permanent ostomy.

When a section of the colon or rectum is removed during surgery, the healthy parts can usually be reconnected, allowing the patient to eliminate waste normally. When reconnection is not immediately possible, the surgeon connects the colon to an opening (stoma) that is made in the skin of the abdomen, allowing waste to leave the body. When the stoma is connected to the colon ( also called the large intestine) it is called a colostomy; when the stoma is connected to the ileum (part of the small intestine) it is called an ileostomy.

To perform an ostomy, the surgeon makes a hole in the lower belly wall and pulls a piece of the large intestine or small intestine through the hole. The surgeon then rolls the bit of tissue back like a shirtsleeve, leaving a small, round pinkish or reddish piece of flesh. Similar to a belly button, a stoma may lay flat on the belly or it may stick out some. This reddish tissue looks raw and tender, but it doesn’t hurt or even feel tender because it doesn’t have nerves. Usually a flat bag, held in place by a special adhesive, fits over the stoma to collect waste. Most patients with colon or rectal cancer who require a colostomy need it only temporarily, until the colon or rectum heals from surgery. After healing takes place, usually in 6 to 8 weeks, the surgeon reconnects the ends of the colon and closes the stoma. A permanent colostomy is necessary more often for rectal than for colon cancer patients.

Dealing with an ostomy bag, needs time and understanding of what to expect.

The two main supplies you’ll need are an ostomy bag, also called a pouch, and a skin barrier. Your cancer care team will help you decide which pouch and barrier system will be optimal for you. The two main types of ostomy pouches are:

· Drainable Pouch: This bag has an opening at the bottom so you can drain liquid or soft waste without having to remove the bag. You can use this type of pouch for 3 to 5 days at a time.

· Closed Pouch: This bag doesn’t have an opening at the bottom. It is typically used for solid stool. You’ll remove it and throw it away after each use.

There are 2 types of skin barrier systems ( also called flange) , which seal the pouch to the skin around the stoma.

· One-piece System: This barrier comes attached to the pouch. You’ll need to attach the whole piece to your skin at once.

· Two-piece System: This barrier is separate from the pouch. You’ll need to attach the barrier to your skin around the stoma, then connect the bag to the barrier.

It is necessary to keep the skin around your stoma (called peristomal skin) clean.

The stoma area needs to be gently cleaned whenever you change your pouch. It is important to realize that the stoma skin is very delicate and does not have nerve endings, so if you rub too hard or irritate the skin area it may not be possible for you to tell. Stomas also have a lot of blood vessels in them, so it is common to bleed a little when you clean the area and change the pouch. If the bleeding doesn’t stop, contact your stoma care team immediately. Soap is usually not needed and you can gently remove the adhesive with warm water. Use a soft cloth or soft paper towel or special wipes formulated for stomas. Avoid regular baby wipes, alcohol-based cleansers, or other harsh chemicals and oil-based or perfumed/moisturizing soaps which can make it hard to stick the pouch to your skin.

After you clean the area, gently pat it dry. Make sure it is completely dry before you reattach the skin barrier. No special clothes are needed for everyday wear. Most ostomy pouches are fairly flat and hard to see under most clothing. The pressure of elastic undergarments won’t harm the stoma or prevent bowel function.

Despite taking good care of the skin around your stoma, the area can still get irritated easily—just from the daily, often multiple times of pulling the barrier off and replacing pouches.

Some of the causes includes:

· Contact with stool due to ill-fitting stoma bag

· An allergic reaction or sensitivity to the adhesive

· A pouch and barrier left in place for too long

· Forceful removal of barrier

· Unintentional vigorous scrubbing

· Skin infections related to yeast

Ostomy supply stores carry barrier powders or skin protectants that help create a barrier between irritated skin and ostomy adhesive, but still maintain the stickiness of the adhesive.

However, not all skin issues around the stoma can be treated at home. Make sure you let your stoma or cancer care team know if you experience any of the following issues:

· Wart-like, pimple-like or blister-like bumps around the stoma site

· Recurrent pouch leakage of stool

· Pus or discharge from or around the stoma

· Skin that isn’t healing well after the surgery

· Skin around the stoma that looks red, chapped, flaky, scaly, raw or burned

· Sores or breaks in the skin surrounding the stoma site

In addition you can also have fatigue, nausea, cramps, vomiting or abdominal discomfort related to the ostomy and additional cancer treatments. It helps if you and your caregiver are prepared and trained by your cancer care team so that several of these issues can be addressed early before they have a chance to become worse. Here is a checklist of questions to ask your cancer care team about your ostomy site and how to live with it.

“How long will it take to feel normal again?”

An ostomy procedure is not trivial and patients need psychological support because it creates many life changes, regardless of whether they are temporary or permanent. Learning how to live with the ostomy takes patience, understanding and support. Specially trained nurses, and enterostomal therapists (health professionals trained to care for people with stomas) will help you figure out how to use the ostomy site and what supplies you will need. It helps if you and your caregiver are prepared and trained by your cancer care team so that several of these issues can be addressed early before they have a chance to become worse.

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Reason to Hope

There is new research from Brigham and Women’s Hospital that indicates a Western-style diet that is rich in red and processed meat, sugar and refined grains/carbohydrates is tied to higher risk of colorectal cancer through the intestinal microbiota.  Gastroenterology, 2022;DOI:10.1053/j.gastro.2022.06.054 

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