Minimalist Movement: Preventing Ostomies in Colorectal Cancer

Preoperative chemoradiation and advanced surgical techniques can prevent the need for ostomies in some with colorectal cancer.
BY LEAH LAWRENCE
PUBLISHED: MARCH 17, 2017
After living just a few days with an ostomy — a bag designed to catch waste through a hole created in the stomach wall — Marjorie Wassermann knew it was not the type of lifestyle she wanted to have permanently, if she could avoid it.

“I would frequently wake up in the morning to find that the bag hadn’t done its job overnight,” she recalls. Diagnosed at age 43 with a large tumor low in her rectum, Wassermann had just completed six weeks of radiation and chemotherapy to shrink her tumor before undergoing sphincter-sparing surgery, which removed the tumor but spared the muscle that allowed her to squeeze and hold stool. In order to give what remained of her bowel enough time to heal after the surgery, Wassermann received a temporary ostomy and was told that there was a 90 percent chance that the ostomy would be reversed in a few weeks.

An ostomy is a surgically created opening in the body used for the discharge of body wastes, in this case stool. Through the ostomy, surgeons leave a small piece of exposed bowel to which patients must attach an ostomy bag to catch waste. Patients with colorectal cancer may have a colostomy, an opening where the remaining large intestine (colon) is brought through the abdominal wall, or an ileostomy, an opening where the small intestine (ileum) is brought through the abdominal wall.

Although every effort is made to preserve the intestines during surgery, for some patients with colorectal cancer, a permanent ostomy may be the only life-saving option. People living with ostomies often face issues with body image and depression, odor control and sexual activity. However, in recent years, the use of neoadjuvant radiation and chemotherapy — treatment given prior to surgery — and improved surgical techniques have led to an increase in the proportion of sphincter-sparing procedures.

STANDARD TREATMENT

It is estimated that, in 2016, about 135,000 people were diagnosed with colorectal cancer, and about 50,000 people died from the disease. If the disease is caught early, when it is localized (stage 1), the five-year relative survival rate is greater than 90 percent. If the disease has spread to local lymph nodes (stage 2 or 3), the five-year relative survival decreases to about 71 percent. In cases where the cancer has metastasized or spread to other parts of the body (stage 4), the five-year relative survival is only about 13 percent.

Surgical resection is the most common treatment for colorectal cancer and typically involves removal of the tumor, some surrounding healthy tissue and nearby lymph nodes. A majority of patients with locally advanced disease will also undergo chemoradiation treatment prior to surgery to attempt to shrink the tumor, according to Johanna Bendell, M.D., director of the gastrointestinal cancer research program at Sarah Cannon Research Institute, in Tennessee.

This approach was established based on the results of a study published in 2004 that showed that patients with locally advanced rectal cancer who were treated with a combination of radiation and a chemotherapy drug called fluorouracil prior to undergoing surgery experienced improved local control of their disease and reduced toxicity. These treatments also lower the long-term risk of recurrence and mortality.



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