Colorectal Cancer

This article has been written to help patients with colorectal cancer. It will help them to understand the disease and consider the best treatment options for them.

Anatomy of the colon

The small intestine is almost twenty feet in length while the colon is measured about 5 feet in length. The large intestine starts from the cecum and ends at the rectum. The main parts of a colon or large intestine are:

  • The right portion of the colon is called Ascending colon
  • The middle part of the colon is called the Transverse colon
  • The left part of the colon is called Descending colon
  • The lower part of the colon is called the Sigmoid colon

The ascending colon starts from the cecum exactly at the region where the small intestine discharges into the colon. The transverse colon moves at the top of the colon circuit from the left side to the right side. The descending colon moves from the transverse colon to the downside  , sigmoid colon. The rectum and colon are connected by an S-shaped sigmoid colon. The rectum elongates almost eight inches towards the anus. There is a transitional zone present between the keratinized and non-keratinized stratified squamous epithelium cells. The anus is the last part of GIT and is almost 4 to 6 cm long.

All the parts and organs of GIT are in correspondence to ensure the safe intake and defecation of the products. There are billions of bacteria in the lining of the colon that aids in process of reabsorption.

Both nervous systems such as the parasympathetic system and sympathetic system are involved with GIT. They start sending signals and aids in the coordinated symphony movements that help in the movement of contents from GIT to the colon passing through the small intestines. The enzymes released from the pancreas, intestinal glands liver helps in the formation of chyme activate the movements of the food. The churning movements help the food contents to contact with intestinal lining ( villi) from the lumen. There is the release of water and mucus. Mechanical and chemical digestion takes place throughout the GIT.

The contents of the bowel move forward by rhythmic and propulsive movements known as segmentation and peristalsis respectively. These are circular and longitudinal. The contents are moved into the cecum and colon through the peristalsis. Almost 1 liter of illeal contents is stored in the colon every day. The water and electrolytes are removed from the illeal content as it moves through the ascending colon, the contents become more concentrated and a solid form of contents enter the sigmoid colon. Then it moves into the rectum and is finally expelled through the anus.

When the stool comes in contact with rectal walls the process of defecation is stimulated. The anal sphincters are relaxed and the stool is expelled out. Following things can cause dysfunction of the normal rectal and anal control:

  • Tumors
  • Blockage
  • Nerve damage

Colorectal cancer

If there is an increased production of cells in the lining of the colon and colon lumen then this condition is called colorectal cancer. The extra cells continue to divide without any restrictions and turn into a tumor. These cells have no proper shape and orientation. If they come in contact with the healthy cells they can destroy them too. The tumors are painless and they keep growing inside the body until they become very large. Tumor cells can be poorly, moderately, or well-differentiated.

If there is a growth or bumps present on the epithelial mucosa at the intestinal lining the condition is referred to as adenomatous polyp. This adenomatous polyp is a reason for almost 95% of cancer cases. Polyps may be:

  • Cancerous
  • Raised
  • Flat
  • Benign
  • Precancerous

A polyp leads to severe conditions such as dysplasia, carcinoma in situ cancer, and metastasis. If the polyps are removed earlier then it will save a patient from severe conditions.

Risks

Some risk factors enhance the chances for a patient to develop colorectal cancer. These are:

  • Age: People with age 50 or above have higher chances to develop colorectal cancer
  • History: Patients with a history of any polyps, tumors, or surgeries have higher risks of colorectal cancer
  • Heredity
  • Smoking
  • Crohn’s disease or colitis
  • Diet with high fats
  • Red meat
  • Energy drinks
  • Inactive lifestyle

Late signs and symptoms

Though colorectal cancer is curable if diagnose earlier but in many cases, the symptoms are very late. The symptoms depend on the size, location, kind of the tumor.

For instance, the tumors present in the left side of the abdomen don’t cause any obstruction and there is no change in the stool and bowel movements.

But the tumor on the left side grows into the lumen and causes an obstruction that leads to vomiting, diarrhea, less stool output, bloating, and abdominal pain.

Earlier screening

Colonoscopy now is considered the best screening option for determining colorectal cancer. It’s very easy and helps in the detection of the polyps residing in the colon. A person of age 50 and above must go for the screening and people with a family background should start screening above age 40.

Other common methods of screening are:

  • Sigmoidoscopy
  • Biopsies
  • Ct scanning
  • MRI

Stages

There are four total stages of colorectal cancer written as 0 to IV.

Colorectal cancer has a very slow progression. There are chances to detect the polyp at an earlier stage and start treatment.

Treatments

Cancer has many options as treatment. The most common treatment worldwide are:

  • Chemotherapy
  • Radiotherapy
  • Surgery

The type of treatment is decided after determining the stage of cancer and the condition of the patients.

Almost 75% of colorectal cases are treated with removal of the polyps or the tumors along with lymph nodes. The main surgeries are termed as:

  • Anastomosis
  • Resection of colostomy
  • Abdominoperineal resection

If only a small portion of the colon is removed then the remaining parts can be stitched together. But if there is major surgery and the whole colon is removed then a colostomy is needed which results in a stoma on the abdomen.

Surgery is the best option for patients with stage 0 to II cancer.

The patients at stages III & IV need chemotherapy. Chemotherapy involves drugs that enter the body and destroy the cancerous cells.

Radiotherapy is another option for patients with colorectal cancer. Ultraviolet rays can help in shrinking the tumor and it can be removed after the surgery.

Urostomy

A surgical procedure that allows bowel content to exit the body through a hole in the abdomen is known as Ostomy. And the type of Ostomy that allows only urine to leave the body is called a urostomy. After urostomy urine will leave your body via the stoma.

A stoma is made from a portion of the small or large intestine, it can be observed as it is protruding above the skin. It is an alternate pathway for urine to leave the body and to be stored in a pouch worn outside. The site and the size of the stoma are dependent on the figure of your abdomen.

Most of the stomas look similar. They have the following characteristics:

  • Different size
  • Elongates almost an inch above the skin
  • There are no nerves in the stoma
  • Red and wet

Why an Ostomy is needed?

The main reasons for the urostomy are:

  • Birth defect
  • Injury
  • Rebuke
  • Blockage of urine
  • Cancer
  • Diseased

There are two main types of a urostomy:

  • Non-continent urostomy
  • Continent-urostomy

Non-continent urinary diversion is termed urostomy. In this procedure, urine changes its path to exit the body. Ureters are removed from the bladder and attached with the stoma. You can’t control your urination, that’s why it is called a non- continent. Urine continues to drain outside in the pouch.

Continent urinary diversion is a surgery in which your intestines are used for creating the pouch that remains inside your body. In this type of surgery, you can hold urine for some time in the body. Continent urostomy has two types:

Neobladder: You urinate as before. The urine passes from the internal pouch to the urethra and then leaves the body through the stoma.

Catheterizing: You need to insert a catheter to drain your pouch four to six times a day.

Urostomy is the most common type of urinary diversion.

Urinary system

A human urinary system involves two kidneys, two ureters, one bladder, and a urethra. The water reaches the kidneys where it is filtered and then it moves into the bladder through the ureters. The urine remains in the bladder until it is forced out of the body. It leaves the body through the urethra.

The surgery

A urostomy is performed to redirect the urine from the kidneys to the stoma on the abdominal surface. In the case of a conventional urostomy, a piece of ileum is used for making a pouch called an ileal conduit. One terminal is stitched closed to it and the other is attached to the surface of the abdomen to crease stoma. The ureters are removed from the bladder and attached to the stoma. The urine leaves the body through the stoma and is collected outside in the pouch. If your surgeon uses a portion of the colon then the conduit is called colon conduit.

The output of the urostomy

You will observe that urine starts flowing from the stoma directly into the pouch just after the surgery. It might give a red and damp appearance until it becomes normal. You may observe a small amount of mucus along with the urine in the pouch. This is because the urine passes through a portion of the intestine.

Stents

Your surgeon will place some tubes referred to as stents to extend your stoma. These are used for the sake of swelling after the surgery. These are removed after some days. You will feel no pain while removing these stents. They can be removed once the surgeon observes that there is a decrease in swelling.

Pouching system:

The pouching system is helpful because:

  • It helps in controlling the odor
  • Collection of urine
  • Protection of skin nearby the stoma

If urine comes in contact with the skin around the stoma it can cause discomfort and rashes.

Ostomy bags are very easy to carry anywhere. They are very light in weight. Your Ostomy nurse or doctor can guide you about the best Ostomy pouching system for you.

Pouching system and its types:

  • After the surgery, a pouching system is needed for the protection of stoma and collection of urine. You can access one-piece and two-piece pouching systems.
  • The one-piece pouching system has no separation between the barrier and the pouch
  • The two-piece pouching system has a separate pouch and a skin barrier.

Urostomy pouch

All types of urostomy pouch have some special features that prevent the backflow of the urine in the stoma. The urine leaves through the stoma and is stored in the drain. There can be a tap or a nozzle at the end of a drainage pouch.

Some pouches have a mark to show the capacity of the pouch, it can be seen only when the pouch is off.

Color of the pouch

Pouches can be transparent or opaque.

Pouches come in different sizes according to your urine volume

An ostomy pouch belt can be used around the pouching system to protect it from slipping while doing any physical activity such as swimming.

Pouch covers are really helpful in concealing the Ostomy bag

Daily care tips:

You should drain your pouch after every two to four hours.

You must drink eight to ten glasses of plain water every day, except if your doctor asks you not to do so.

How to empty the Ostomy pouch? Pouch emptying skills

After your Ostomy surgery, the foremost thing you need to learn is how to change your Ostomy bag or pouch. This is the most important and basic part of Ostomy life.

This article is going to help you with all the possible things you should know.

Proving the pouch level

It is always recommended to empty your pouch when it is almost one-third filled. If your pouch gets too much filled with the contents then it will become heavier and pulls the skin barrier off the skin. As you can’t control the feces or don’t feel the flow of the feces you need to check it from time to time. You can do it by putting your hand on the pouch have a rough estimate.

Decide the best position

You should ensure enough water and you must have proper space in the bathroom so that the feces don’t spoil your clothes. The best position for you can be varying depending on the size and location of your stoma.

Your ease is the priority.

  • Sit on the toilet seat spreading your legs wide and in a forward position
  • Sit or stand while your face is toward the toilet and you are leaning backward
  • In case of a side position, you can sit or stand beside the toilet seat.

Draining or emptying the feces

  • You can sit leaning backward on the toilet seat or stand over it.
  • You must have a piece of toilet paper near you.
  • Then raise the opening end of the pouch.
  • Slowly open the pouch and unclamp or unfold the sealed drainage.
  • Lower down the opening point in the toilet seat. Move your hand’s side of the pouch to drain out the feces.
  • In case if you are in a standing position, then you need to flush out many times also you need to place toilet paper on your legs and in toilet seats. It will prevent the splashback of the feces.
  • Then wipe the opening and closing of the pouch with a toilet paper
  • Add the deodorant if needed
  • At last, put the clamps back or seal them again.

Changing the pouch

You need to change your whole one-piece pouching system every three to seven days. If you experience itching or burning under your pouch it means you need to change your pouch without any delay otherwise it will lead to an infection.

Bring all the supplies near you

The supplies you need are:

  • A new pouch
  • Wipes or toilet paper or moist towel
  • Pen or marker to write the size of the stoma
  • Scissors
  • Plastic bag
  • Stoma paste if needed
  • Skin barrier if needed
  • Pouch odor filter if required

Dispose of the old pouch

  • Start with peeling off the one end of the skin barrier.
  • Then start moving to the other corners and keep pushing it away from the skin. You can use a wet towel or adhesive remover to help yourself.
  • Put this old pouch into a disposable plastic bag.
  • If you use a clamp don’t put it with the pouch. Keep it for later use.

Cleaning and observing

  • Observe your skin around the stoma and observe the color of the stoma. The stoma must look red and damp.
  • Look for any redness or rashes. The skin must appear the same as the normal skin. You may use a mirror to have a clear view of the stoma.
  • Use warm water to clean the skin around the stoma. Don’t use oils because it will reduce the adhesion property of the barrier. Also, avoid:
  • Soaps Baby wipes
  • Pat dry the skin slowly and completely
  • You can use a little amount of skin powder if you experience slipping or weepy skin around the stoma. This powder helps in absorbing moisture.

Measure and cut the opening of the barrier

  • It is very crucial that the opening of your skin barrier is the same size as your stoma. After three months of the surgery, the stoma will stop shrinking. Initially, you need to measure the stomal size and cut the barrier according to it.
  • You should put a piece of paper or tissue over the stoma if there is a danger of any leaking when you’re measuring the stoma.
  • Then start measuring. You can use your measuring grid and mark according to the size of the stoma. If you have an irregular stoma then your doctor will give you a template according to it.
  • Then hold the measuri9ng at the backside of the barrier and trace the exact size.
  • Use the scissors for cutting the skin barrier. Don’t cut the front side of the pouch it will cause leakage and odor.
  • Place the new barrier on the stoma.

Place the new pouch

  • Peel of the lining from the back of the flange or skin barrier
  • Place the center opening over the stoma.
  • After placing the skin barrier around the stoma keep pressing the side for almost thirty seconds. Start from the area near the stoma. Always ensure that is properly attached to the skin.
  • In case of a drainable pouch close the opening.
  • Lower down the pouch
  • Clip your Ostomy belt if you use any of them.
  • Keep the supplies back to the place for using them again.

Ostomy accessories

Stoma care can be very easy and simple. You can use different accessories along with the pouch. You can take help from your ET nurse in this regard.

Stoma Paste

Stoma paste is used for contouring the uneven skin around the stoma. It fills all the gaps and creases and helps the pouch to remain in place.

You should apply the paste in a single layer. In case of very rough skin, you can add the layers but add the next layer after the first one dries completely. If you experience any allergic reaction to the paste, stop using the paste immediately.

Barrier rings

It is issued for the same purpose as stoma paste. It helps in contouring the gaps and prevents leakage. They are non-alcoholic. Don’t touch them too much it will reduce their sticking property.

Skin sealant or skin barrier

It is in spray form and provides a plastic coating to prevent the leakage of liquid.

Pouch deodorants or filters

They are used to reduce the foul-smelling In the pouch.

Adhesive remover

It is used while changing the pouch and helps in removing the old pouch without pulling or ripping the skin.

Common problems after an Ostomy

Ostomy is major surgery and it brings a lot of changes in your life. Initially, you feel very disturbed and frustrated due to this dramatic change, but gradually you will learn to live with it.

Common Issues:

Most of the patients complain about the following issues following a surgery:

  • Red and annoying skin
  • Dysfunction of stoma
  • Adhesion problems
  • Loss of water or dehydration
  • Stomal problems i.e. bleeding prolapse, retraction
  • Emergency conditions

In this article, we will discuss these problems and their solution so that you can easily handle your Ostomy.

Annoying or red skin:

You may notice that the skin around your stoma is turning red and irritated. This is the most common issue among Ostomy patients. The main reasons for this condition are pulling off tape and barriers roughly, feces contact with the skin.

What should you do about this?

  • You should observe your skin each time you change your pouch.  You can look all around your stoma by using a mirror.
  • You should always measure your stoma and cut the barrier according to it.
  • You should not wear it on the flange for a long time. The recommended time is three to five days. Pouch wearing time is dependent on
  • Frequency of your pouch changing
  • Sweating rate
  • Physical activities
  • Body physique

You can use skin-friendly powder if you feel irritation or wetness in your skin. Apply a little powder and remove the excess by using a brush.  Then you can apply a skin barrier (pouching system).

If you notice that the feces is in contact with the skin or skin fold, you can use stoma paste or foldable rings to conceal the gaps.

If you have any questions do not hesitate to ask. If you delay any of your issues it might worsen your condition. You can take help from an ET nurse.

Determining some common skin issues

It may be a very difficult task to determine the cause of the skin problems. Given below are some common skin issues and how can you treat them. If you notice no betterment in next coming days, you should seek help. You can call your PCP and ET nurse.

Red skin above the stoma

If the barrier is not about the size of the stoma then you might notice redness above your stoma. Apply skin powder in case of wet and irritating skin and then apply skin barrier. You will observe that the stoma will look better in the coming 3 to 5 days.

Itching and red skin around the all-around stoma

In the case of sensitive skin and pulling off skin barrier roughly this condition takes place. You should remove the tape gently and slowly. You may use a remover (adhesive remover) or you have the option to try another pouching system.

Skin infections due to fungus

This happens mostly in wet and moist areas like under the flanges or skin folds. Initially, it becomes red and forms a bulge, and then it becomes hot red. Occasionally there is a white lining around the stoma. You may experience itching and soreness. You can seek help from your doctor or apply any anti-fungal ointment.

Hair follicle infection

This situation occurs nearby the entrance of the hair. Your skin under the flange should be completely dried before you apply the flange because wetness is the main reason for hair follicle infection. You should trim the hair nearby the stoma. You can use a scissor and electric shaver as well.

Do not shave over the wet skin.  

Difficulty in adhesion of the skin barrier

The type of your pouching system depends on the type of your stoma. Some of the stomas are flat with the skin, some move inward and some outwards. Your Et nurse or stomal expert can help you to the best one for you.

How can you overcome this issue?

  • If there is an adhesion problem then you should follow the below-mentioned steps:
  • You should use a wet towel to clean your skin. You should was your skin properly after using any soaps or wipes ensuring that there is nothing on your skin.
  • Make 100% sure that your skin is completely dry
  • You should warm up your flange before applying it.
  • You should trim your hair around the stoma
  • In case if you sweat a lot then you must use skincare powder and remove excess of it.
  • You should empty your pouch every 3 to 4 hours and use an ostomy belt for support.
  • If you experience a problem is an adhesion and you need to change your barrier two to three times a day. You should call your ostomy expert for further solutions.

Excessive loss of water

If your consumption of water is less than loose of water then there can be excessive loss of water and salts from your body. This condition is termed dehydration. If there is frequent vomiting or stool, you have a high chance to have dehydration. That’s why most ileostomy patients need to come back to the hospital.

How can you treat this condition?

Avoiding dehydration

You must drink eight to nine glasses of plain water.

Don’t eat spicy and oily foods that lead to diarrhea.

You should not take foods such as caffeine, alcohol, carbonated drinks.

You should keep a record that how often you need to drain or empty the pouch.

Some common symptoms of dehydration:

  • Feeling thirst
  • Arid mouth
  • Less urination
  • Faintness

How to avoid diarrhea

You should increase the consumption of water. You can try supplement drinks, for example, broth, electrolytic drinks.

You should eat foods that result in thickened feces for example whole grains, pasta, bananas, bread, and peanut butter.

Your ET nurse and doctor can properly guide you about how to take oral replacements.

Dysfunction in stoma 

Typically a stoma is always active. In case of nausea and cramps, you may feel blockage or you may experience zero output. These conditions are:

For the 4 to 6 hours after the ileostomy

24 to 36 hours after the colostomy

It might be because of food particles’ adhesion or blockage.

How can you treat this?

  • You should chew your food properly. Avoid eating high-fiber foods like whole grains, raw veggies, and fruits, celery, skins, and corn.
  • You should massage your abdomen near the stoma if food is the reason for the blockage.
  • Blood from stoma
  • You may notice some blood on your stoma while changing and emptying your pouch. The reason is that the stoma is very rich in blood supply. So there is nothing to worry about this.

How can you treat this?

  • You should make sure that after changing the pouch the bleeding must be stopped. It may take few minutes.
  • You should use a damp cloth or towel and apply gentle pressure for about 60 seconds.

Stoma Prolapse

In this condition, your stoma protrudes out, elongating the stoma.

How can you treat this condition?

  • Until or unless the stoma is moist and red, there is nothing to be worried about. There is no emergency.
  • If you are worried you can ask about this condition from your doctor and nurse.

Stoma retraction

  • If you notice the shrinking of the stoma or if you feel your stoma is slipping inward this condition is termed stoma retraction.
  • If your feces output is normal as before there is nothing to be worried about.
  • You can seek help from your nurse and doctor and tell them about your condition. It may disturb the adhesion of your pouching system. Your ostomy nurse or team can help you in placing the pouching system properly.

Emergency conditions

  • You should visit your ostomy nurse or doctor without wasting any time, if:
  • There is a major cut in the stoma
  • You notice the change in size, color, or orientation of your stoma. This could indicate there is an inadequate supply of blood to the stomal tissues.
  • There are almost four tablespoons of blood in your pouch.
  • Frequent vomiting and nausea
  • Diarrhea and loss of water
  • Intense skin problems (breakdowns)
  • Obstruction in stoma output for almost four to six hours.

Everything about Ileostomy and Colostomy

A surgical procedure that alters the passage of bowel contents outside the body is known as Ostomy. The hole that is made in the abdomen, as a result, is called a stoma.

The type of Ostomy which allows a patient to pass out feces through the stoma is referred to as ileostomy or colostomy.

A stoma is a part of the large intestine (colon) or small intestine (ileum) that is pulled throughout the cut in the abdomen (stoma). It is an alternative path that allows feces to leave the body.

The feces are then collected in a pouch that is worn outside the stoma. The shape of your abdomen and kind of ostomy decides the size and site for the stoma.

Typically, all stomas are the same and they will:

  • Protrude outward, such as inch over the skin
  • Differ in size
  • Have eclipse or round sphere shape
  • Red and damp
  • No sensation
  • It will look swollen initially but then it will shrink with time.

Which individuals demand Ostomy?

Any reason that causes blockage in the drainage and flow of the feces demands Ostomy. These conditions are:

  • Cancer
  • Trauma
  • Diseased colon
  • IBD

In case if the repair of the intestine is not possible, then an Ostomy is needed. Then the feces are directed to a new path (stoma).

What do you need to know about your digestive system?

Food enters your mouth and passes through the esophagus and finally reaches into the stomach. The breakdown of food takes place in the stomach and then it goes to the small intestine.

Enzymes work on the food particles in the small intestine and convert them into a thick liquid. Then water and important vitamin are absorbed. This liquid-type material is then passed into the colon, a part of the large intestine. The reabsorption of water takes place in the colon. Stool moves from the colon into the rectum and it is defecated out through the anus. In an Ostomy, either the small or large intestine is brought to the abdominal surface.

Ileostomy

When a surgeon uses a small intestine (ileum) for the creation of a stoma is called an ileostomy. . Ileostomy can be permanent or temporary. Less water is reabsorbed in the ileostomies because they are higher. The bowel content as a result is watery. It will become loose over time.

Colostomy

When a colon is used to create a stoma and passing out feces, the Ostomy is called a colostomy.

The colostomies have been assigned different names based on their location. For example: ascending colostomy, descending colostomy, sigmoid colostomy.  Colostomy can be permanent or temporary. The feces formed as a result are more firm.

All you need to know about your pouch

When your feces leave the body it is collected in a pouch or bag termed Ostomy bag or pouch. This pouch collects the feces and can be changed from time to time. You can’t control your bowel movements after the Ostomy. That’s why you always need to wear a pouching system over your stoma.

The pouching system has sticking and adhesion properties. It helps in:

  • Collection of the stool
  • Captures the foul smell
  • Protects the peristomal skin

There is nothing wrong if the feces come in contact with your stoma, but if the feces remain intact with the peristomal skin it can cause irritation and infections.

Pouching systems vary in size and orientation. They are very light in weight and easy to carry around.

You can seek help from your PCP or ET nurse for the selecting best pouching system for you.

Types of pouching systems

The ostomy pouching system consists of a pouch that is issued for the collection of the feces and a skin barrier or flange that keeps the pouch in place. The pouching system has two types

  • One-piece pouching system
  • Two-piece pouching system

One piece-pouching system

The flange and the pouch are attached.

Two-piece pouching system:

There is a spate pouch and skin barrier.

Drainable pouch:

The pouch that has an open end to drain out feces is known as a drainable pouch. You don’t need to remove it off the skin. You can hold it in the same place for several days.

Closed-end pouch

It has no opening and you can simply dispose of it off when it is filled. It is not recommended for ileostomy patients because it needs to be changed frequently.

Pouch accessories

You can use different products to keep your pouching system in place and sealed properly.

Clamp

Pouch filters are used for lessening the odor in the pouch

Ostomy belts or wraps are used to keep the pouching system in place while physical activities such as swimming.

Pouch covers are worn over the pouch. They help in concealing your pouch under the clothes.