What is colorectal cancer? Colorectal cancer is the development of malignant changes in the large intestine (colon carcinoma) and in the rectum (rectal carcinoma). We now know that the risk of developing colorectal cancer increases rapidly from the age of 50. Since colon carcinomas often do not cause any symptoms in the early stages, it is therefore all the more important to go for screening colonoscopy (link) from this age onwards. The appearance of changes in bowel habits (diarrhoea, constipation) and blood in the stool can be the first signs of colorectal cancer. Tissue samples (biopsies) taken using colonoscopy (link) are used to precisely characterise the tumour. In most cases of colorectal cancer, surgery of the tumour is an important step in treatment. Whether other therapies, such as chemotherapy or radiation, are required in addition to the operation depends on the stage of the disease.
Today, tumour surgery of the large intestine is usually performed minimally invasively using laparoscopy. For the patient, this means faster mobilisation after the operation, fewer wound infections, less pain and less adhesions. In the radical tumour operation, the part of the intestine affected by the tumour and the associated lymph nodes, lymphatic and blood vessels are removed. For many patients, the idea of having an artificial outlet (stoma), even if only temporary, is terrifying in addition to the cancer diagnosis itself.
In principle, most surgeries of colon carcinomas as well as rectal carcinomas in the upper / middle third of the rectum can be performed without a temporary artificial outlet. However, a more complicated starting situation, such as presence of a simultaneous peritonitis or a tumour that already breaks through the intestinal wall, may require a temporary stoma.
The situation is somewhat different for rectal cancer in the lower third of the rectum, i.e. in the immediate vicinity of the anal canal. In addition to safe tumour removal, the primary goal of the operation is to preserve the sphincter to prevent faecal incontinence. This may require a very deep suture connection close to the anus. In these cases, an artificial outlet is temporarily created. In this way, the intestine in the operating area should be relieved with the fresh suture so that it can heal. For tumours in the lower third of the rectum, preoperative radiation therapy is almost always carried out to reduce the size of the tumour.
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