Screening for Colon and Rectal Cancer
Identification of Patients at High Risk for Cancer
Assessment and Treatment of Fecal Incontinence
Treatment of Disordered Defecation
Sphincter Preservation in Rectal Cancer
Treatment of Anorectal Disorders
Inflammatory Bowel Disease
Endoscopy
Laparoscopic Colon Surgery

Screening for Colon and Rectal Cancer
The American Cancer Society has recommended colon cancer screening for everyone 50 years of age or older. Unfortunately, only a small portion of the population receives proper advice in this regard. Screening programs are capable of detecting cancers at their earliest stages when they are still highly curable, so it is important for everybody, regardless of the presence of symptoms or family history, undergo screening. There are three types of colorectal cancer tests, including:

1. General screenings comprised of a stool test for blood and a flexible sigmoidoscopy (a short endoscopic examination) performed every three years. These are the least invasive means and, as such, may miss some tumors.
2. Flexible sigmoidoscopy and barium enema examination (x-ray) of the entire colon, which has less likelihood of missing tumors. This combination of tests should be performed at five-year intervals and is approved by Medicare and other insurance carriers.
3. Colonoscopy, which allows your doctor to examine the entire colon with a long flexible scope. If polyps or abnormal areas are seen, they can be biopsied or removed during the procedure. This screening usually requires sedation for patient comfort. Considered the most accurate way of examining the colon, it is performed at 10-year intervals provided symptoms or family history do not change in the interim. Medicare now covers colonoscopy for screening patients without symptoms.

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Identification of Patients at High Risk for Cancer

Approximately 10 percent of patients with colorectal cancer belong to high-risk groups because of an inherited susceptibility or a pre-existing condition, such as inflammatory bowel disease. Inherited susceptibility can usually be identified by a patient's family history of colorectal or other cancer. Identification of this susceptibility is of paramount importance for not only the patient with cancer, but also for family members at risk, since their screening programs will change as a result. Appropriate surveillance guidelines and genetic testing are provided through the Sandra Rosenberg Registry, which has been established to help patients determine their individual risk.

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Assessment and Treatment of Fecal Incontinence

Fecal incontinence is the inability to control the passage of stool or gas, a socially and emotionally disabling problem for patients and their families. It is also a common reason for institutionalizing elderly people. We provide state-of-the-art testing to determine the cause of a patient's incontinence including the use of an anal ultrasound of the sphincter muscle. Other testing may be required in conjunction with doctors from the Section of Gastroenterology at Rush. Treatment may include modifying diet and using medication to thicken stool and slow down its passage. In some cases, surgical reconstruction of the sphincter muscle may be required, especially for patients whose incontinence is due to an obstetrical injury or prior anal surgery. If the muscle cannot be repaired, an artificial sphincter can be implanted. The artificial anal sphincter provides a means of controlling stool for patients whose only other hope may have been a colostomy. The artificial anal sphincter resembles the product inserted for urinary incontinence which has been used for many years with a high degree of success. Our faculty have become leaders in the Chicago area with the artificial anal sphincter.

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Treatment of Disordered Defecation

Constipation is a common problem in the general population, affecting women more often than men by a factor of about eight to one. Patients can be categorized into two groups. One group consists of those patients who never feel the urge to defecate and cannot move their bowels without the aid of medications. This condition is called colonic inertia, and its cause is unknown. The other group has obstructed defecation caused by dysfunctional pelvic floor anatomy or muscles. Although the urge to defecate is there, patients simply cannot expel stool. Frequently, they must insert their fingers rectally or vaginally to facilitate defecation. Assessment of patients include calculation of colonic transit time through the use of x-rays and evaluation of pelvic floor function with defecography. Treatment is variable and is based on the underlying cause.

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Sphincter Preservation in Rectal Cancer

In most cases, the anus and sphincter muscle can be preserved, and most patients with rectal cancer do not need to have a permanent colostomy. Some tumors can be treated with transanal excision, which involves removing the lesion through the anus rather than through an abdominal incision. Rush is a national leader in a procedure called transanal endoscopic microsurgery, an operation to removes cancers that are beyond the reach of conventional instrumentation. Larger, more locally advanced tumors are removed through an abdominal incision. Radiation and chemotherapy may be recommended before surgery to shrink tumors and improve the likelihood that the sphincter muscle can be preserved. It is important that the operation is done by an experienced surgeon, someone trained in and experienced with pelvic surgery. Several published studies have linked a good outcome and cancer prognosis to the skill of the surgeon.

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Treatment of Anorectal Disorders

Common anorectal problems such as abscesses, fistulas, hemorrhoids, fissures, pilonidal cysts and rectal prolapse can cause significant symptoms. Fortunately, they often can be treated on an outpatient basis. Uncommon and complex fistulas, such as those arising as a result of Crohn's disease or an obstetrical injury, require the attention of a specialist. The Section of Colon and Rectal Surgery at Rush is a recognized authority in the treatment of these problems in the Chicago area.

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Inflammatory Bowel Disease

Crohns's disease and ulcerative colitis can be disabling diseases. Although initial treatment is usually nonsurgical, surgery is occasionally necessary because of complications. The doctors in the Section of Colon and Rectal Surgery work closely with gastroenterologists both at Rush and at other institutions to provide state-of-the-art, comprehensive care for patients with inflammatory bowel disease. With regard to surgery for Crohn's disease, preservation of as much bowel as possible is vitally important to avoid problems with malabsorbtion and malnutrition. To achieve this, a technique called stricturoplasty is used to relieve obstruction; this may be preferable to resection or removal of the diseased bowel. For ulcerative colitis, surgeons at Rush are skilled in the technique of restorative proctocolectomy, also known as the ileoanal pull through operation with J-pouch. During this operation, the diseased bowel is removed, and a fecal reservoir is created from portions of the small bowel. The J-pouch is then connected to the anus and a temporary ileostomy is usually created to promote healing of the pouch. The ileostomy is generally closed at a second operation three months later.

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Endoscopy

Our surgeons are skilled in colonoscopy, flexible sigmoidoscopy, rigid proctoscopy and anoscopy. After these screenings, reports are promptly issued to referring physicians as well as recommendations for future examinations.

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Laparoscopic Colon Surgery

Selected patients undergoing colon and rectum surgery may benefit from a technique called laparoscopic surgery, which can shorten hospital stays and speed recovery. However, until further study has been completed, we do not believe that laparoscopic resection of cancer should be performed outside of the realm of a research study. Benign diseases can be addressed laparoscopically as long as the extent of inflammation which sometimes accompanies these problems does not jeopardize a safe operation. The decision to proceed with a laparoscopic operation should be the domain of the treating surgeon and should not be driven by insurance companies or industry.

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