Help me please

[janette]

Hi my mom has had bad colitis for the past two years, and had a colonoscopy this last friday. Well bad news that she has cancer. They said the mass is about 5 Centimeters, and they want to take out not only her colon, but her rectum. The doctor said this is the best thing to do, so there is no chance of cancer spreading. we are waiting today for the results if it has spread. Should she have the rectum taken out also? Should we get a second opinion?? My mom is my best friend, and I can barely cope. Can i get some advice. Thanks so much.

[shylo]

Janette,

The same thing happened to me. I had to have my colon and rectum removed because I had FAP (thousands of precancerous polyps). I wanted to tell you I had the same feelings about getting a second opinion mainly because everyone I told my problem to said "I hope you get a second opinion." I ended up not because I was confident in my doctor and found out he was the best surgeon in my state. Are you confident in the doctor? If you don't like him or get a bad vibe I would say "yes" get a second opinion. It wouldn't hurt. Is she going to have an ileostomy?

I am sorry that you are going through this. From my personal experience, it's better to be safe than sorry. If they think it could spread she should have it removed. She'll probably feel a lot better after they've been removed since she has colitis too. Let me know if you have any questions.

[missjv]

hi,
well my advice is get another opinion. i am stage 4 getting ready to undergo liver resection and if i had just stayed with my 1st onco i would not be around long. i had to refer myself to another doc and im so glad i did now i have a chance of beating this stuff where as before i was just put on palliative chemo to keep the liver lesions in check well to me that wasn't good enough and i did research and got advice from different people on this board who were stage 4 and now cancer free. docs opinions are so different 1 told me i would be dead in 2 years the other say i can have curative surgery and there is a chance cancer will never come back but no gaurantees but hey i can live with that. it does not hurt to get another opinion especially if a life depends on it. good luck to your mom.

missjv

[Hannah]

I know that your instinct is probably to "get the cancer out as soon as possible!" but you do have time to get a second opinion, and I definitely think you should do so. If you hear the same thing, you will probably feel more confident in the decision - and if you hear something different, your mom will have another option.

If at all possible, get an opinion from a certified colon/rectal surgeon. Those surgeons (rather than general surgeons) are really the most qualified to make decisions such as whether or not your mom's rectum can be saved. It's not that other surgeons can't do the surgery (and they may want to), but survival outcomes are statistically better when using a colon/rectal surgeon.

Also, be sure to ask the current surgeon (and any second opinion docs) how many of these kinds of surgeries s/he has done in his life, and how often s/he does them now. You want someone who has already done hundreds and does them on a regular basis now (at least several times a month, if not more often).

If you need to find a colon/rectal surgeon in your area, go to the American Society of Colon and Rectal Surgeons: http://www.fascrs.org/displaycommon.cfm ... clenbr=104. You can look up all the ones in your state.

The good news is that if your mom's rectum does have to come out, she can have a colostomy and live a very full life with it! This was not always an option.

Hannah

[janette]

Thanks

[janette]

Thanks to everyone for responding. I sent mail to all of you and hoped it got to you. Trying to figure this system out. All of you are kind, and I hope you are all doing well. Dealing with this is hard, and support helps. have a great day. janette

[PGLGreg]

The good news is that if your mom's rectum does have to come out, she can have a colostomy and live a very full life with it!

Does removal of the rectum imply having a colostomy? I didn't think so.

[Hannah]

The rectum is the very last part of your GI system and is the very very end of the colon. In it are the rectal muscles that push your poop out! So yes, if you completely remove the rectum that would imply a colostomy.

You can certainly remove the colon and not have a colostomy (I know many people for whom this is true), but if the rectum is gone there is no "hole" to use!

Hannah

[PGLGreg]

The rectum is the very last part of your GI system and is the very very end of the colon. In it are the rectal muscles that push your poop out! So yes, if you completely remove the rectum that would imply a colostomy.

I'm just not sure that the anal sphincter counts as part of the rectum. At any rate, it is possible to lose part of the rectum without a colostomy. I had a cancer in the rectum 5 cm. up from the anus, and my surgeon managed to spare my sphincter. No colostomy. Pushing the poop still works with no problem.

[Hannah]

You are right - and I should have been more specific about the exact differences between the rectum and the anal canal. Technically yes, if you don't have the entire anas/anal sphincter removed then you don't absolutely require a colostomy. Some surgical options (ie j-pouch) are available even if you have your colon and entire rectum removed.

However, most of the time (the vast majority) if the entire rectum is removed, the anus will also be removed to make sure that there are clean margins around the tumor - that is, if the tumor is large enough to require the removal of the entire rectum, there will probably be a colostomy (just to make sure the surgeon got it all).

But again, you are right PGLGreg - doctors are becoming more aware of the surgical options and are becoming more skilled in doing them. Do you have a j-pouch? Either way, you had a great surgeon!

Hannah