Teoh Colon, Rectum & General Surgery

Colon & Rectal Cancers

Colon and Rectal (Colorectal) Cancers are one of the most common cancers that afflict many people in the world. It is a growth that occurs in our large intestine. It is also commonly known as ‘Bowel Cancer’. 

The Colon is commonly known as the large intestine (bowel), that starts after the small intestine (near where the appendix arises) and ends at the Rectum. The Colon continues into the Rectum. The Rectum is the last part of the ‘Large Intestine’ and the Rectum ends at the anus.

A Cancer is a growth which is made up of abnormal cells that have ‘lost control’. Thus, cancers grow and can invade and spread to other organs. This makes cancers dangerous and life threatening.

Non-Surgical Treatment of Hemorrhoids

Hemorrhoids or Piles, as they are commonly known, are one of the most common problems that have afflicted mankind since time immemorial. It is responsible for much discomfort and suffering, though hemorrhoids are seldom life threatening or serious.

Hemorrhoids DO NOT cause nor lead to cancer. What is important, is to establish if the symptoms are caused purely by hemorrhoids, and not some other more serious condition. Further investigations like a colonoscopy may be necessary in some patients to rule out other causes.

Anal Problems

The commonest anal problems are usually related to haemorrhoids (piles). 

However, there are several other anal problems that are not due to haemorrhoids. It is often that patients assume that any anal problem is due to haemorrhoids. A careful history and proper examination will usually determine the actual source of a patient’s anal symptoms, which may not be due to hemorrhoids.

Gastroscopy & Colonoscopy

Gastroscopy and Colonoscopy are very common procedures. They are termed ‘Endoscopy’ which is broadly defined as inserting a scope with a camera into any body cavity. This can range from the Esophagus, Stomach, Colon, Rectum, Nose, Throat, Chest and Abdominal Cavity.

Screening for Colorectal Cancer 

Treatment of Early Stage Colorectal Cancer is associated with excellent outcome achieving cure in many cases. However, many colorectal cancers are diagnosed at a later stage. 

Increasing awareness and promoting Screening programs have been shown to increase early stage detection. Screening is also to detect and remove pre-cancerous polyps which if removed, may prevent cancer from developing.

Screening for Colorectal Cancer is directed at: 

• Early detection of cancer
• The detection of polyps – which are usually without symptoms 
• Removal of pre-cancerous polyps which may then reduce the chance of one developing colorectal cancer.

Surgery For Colon And Rectal Cancers

Treatment for Colon and Rectal Cancers usually involves surgery at some point. Although the term ‘Colorectal’ Cancer is used widely, Colon Cancers and Rectal Cancers are approached slightly differently. 

The Colon starts from the Cecum and where the small intestine joins the large intestine. It ends at the Sigmoid Colon. The Rectum starts at where the Sigmoid Colon ends and ends at the top of the anal canal (which is the anus). The Recto-Sigmoid Junction is where the Colon and Rectum meet. The terminology is confusing even for many doctors who are not well versed with treatment for Colorectal Cancer.

The reason of this differentiation is that Colon Cancers tend to spread or recur differently from Rectal Cancers. Rectal Cancer treatment can also be much more challenging due to the location in the confines of the pelvis which can be very limited in space, especially in males and obesity.

Local recurrence (recurrence at or around the site of surgery or anastomosis) of Colon Cancers is uncommon and the recurrences and spread tend to be to other organs and areas. 

Rectal Cancers recur locally (i.e. at or around the site of surgery in the pelvis or anastomosis – where the joint takes place) more frequently than Colon Cancers. Good surgical techniques are important and are targeted at good and meticulous clearance of the surrounding tissue. 

Although overall, local recurrences rates are low, good and experienced surgeons are noted to have lower local recurrence rates for Rectal Cancers. Additional Treatment for Rectal Cancers like Radiotherapy and Chemotherapy also have reduced local recurrence rates.

Distant recurrence of Colon and Rectal Cancers are reduced with adjuvant Chemotherapy, and the newer forms of targeted Immunotherapy.

Laparoscopic Surgery 

Laparoscopic Surgery or Key-Hole surgery is now very commonly performed by experienced surgeons. This entails much smaller incisions rather than a large, long incision. 

The exact same operation is performed in conventional surgery and in key-hole surgery, even though in key-hole surgery the incisions are much smaller. When surgeons experienced in Laparoscopic Colorectal Surgery perform the surgery, as much clearance of the cancer and its surrounding areas is removed Laparoscopically, as when conventional surgery is performed, resulting in similar cancer cure rates and this has been proven by many scientific studies. Risks and complication rates risks are also similar, although some Laparoscopic Surgeons believe that Laparoscopic Surgery is superior due to careful dissection resulting in less bleeding, meticulous and careful dissection resulting in faster recovery and similar cancer outcomes. 

Laparoscopic Colorectal Cancer Surgery is now commonplace in many centres in the world with developed healthcare systems, and is commonly offered as the first option.

Patients who are discouraged from Laparoscopic Surgery in the discussion of treatment options may approach surgeons who are known to be experienced in Laparoscopic Colorectal Surgery for further opinions.

General Surgery 
Gastrointestinal Problem