How and Where is the Colorectal Cancer Seen?

Colorectal cancers are more common in the left part of the large intestine, rectum, sigmoid and descending colon.  It is more common in males.Usually, small polyps appear first on the inner wall of the intestine, which can enlarge over time and become tumors.  There are different types of polyps and the frequency of their transformation into cancer varies.  In other words, some polyps have less risk and some polyps have much more risk to turn into cancer.After all, once polyps begin to emerge, we have a chance to catch cancer early or before it ever occurs. As long as it is not neglected and late!

Am I in the risk group?

Colorectal cancer is more common over the age of 50.It is more common in people with a family history of colorectal cancer, previous breast cancer or uterine cancer, and those with genetic diseases related to colorectal polyps. The most common cause is the presence of polyps in the intestine. The presence of inflammatory bowel disease such as ulcerative colitis and Crohn’s disease, smoking, and eating insufficient amount of vegetables and foods rich in protein are factors that increase the risk.

Can I prevent cancer from developing?

Actually it is partly possible, only a little caution is required. Colorectal cancer is one of the cancers that give the person time before it occurs. It is necessary to be very careful, especially after the age of 50, or even after the age of 40 if there is a family history of bowel cancer. In these age groups, even if there is no complaint, a colonoscopy procedure, in which the intestine is examined by entering a camera from the anus, should be performed, and then it should be repeated every 5 years even if there is no problem. Methods such as fecal occult blood test and looking for tumor markers from the blood are not very valuable in the diagnosis of the disease. They can easily cause mistakes and significant time loss.

I have occasional bleeding due to my hemorrhoids; can I also have cancer?

This does not mean you have cancer, but it requires you to be careful. The most important symptom of colorectal cancer is bleeding from the anus. Especially in older male patients and in female patients in the post-menopausal period, blood flow from the anus and low blood levels in blood tests are suspicious. Rectal bleeding can be seen for many different reasons other than these diseases. Therefore, in such a situation, colonoscopy should be performed without delay and one should be sure that there is no cancer.

What is the treatment for colorectal cancer?

When colorectal cancer is diagnosed in a patient, the stage of the disease should be determined first. According to this staging, the disease can be treated very simply by colonoscopy, and further treatments such as surgery, chemotherapy and radiotherapy may be required at later stages. . Surgical treatment of colorectal cancer can be performed either as closed (laparoscopic) or by open surgery or robotic surgery. You can decide on the most appropriate treatment method by talking with your surgeon.

How will my life change after bowel cancer?

This varies according to the stage of your disease and the treatment method performed. There is not much change in your life in cancer that was diagnosed early and resected with a successful surgical treatment. With regular oncological and surgical follow-up controls, you can continue your life without any problems.  In cases where the tumor cannot be removed in advanced stage cancers or depending on the surgical technique applied in rectal tumors, surgical methods (colostomy) can be applied where the intestine is mouthed to the abdominal wall permanently or temporarily.

Colorectal Cancer yazısı ilk önce Assoc. Professor Soykan Barlas üzerinde ortaya çıktı.

• Stage 1, it is always inside the anus. It is small but can bleed.
• Stage 2, it comes out of the anus due to straining during the toilet, enters back after defecation.
• Stage 3, it protrudes during defecation, but is too large to come in again spontaneously. It can be pushed back in by hand.
• Stage4, it is constantly outside, it will not enter if it is pushed in manually.

What are the symptoms of hemorrhoid (pile)?

The most common symptom is bleeding.After defecation, light red bleeding that drips into the toilet is observed. It does not mix with feces. Rarely tiny arteries may be involved and the bleeding may be more gushing. Another symptom observed is the protrusion and palpation of the hemorrhoid pads from the anus.

How hemorrhoid (pile) is diagnosed?

The diagnosis can sometimes even be made by eye and is confirmed by examining inside the anus with the help of a special illuminating instrument called anoscopy or by a finger to detect enlarged pads. More rarely, protruding hemorrhoid pads occasionally bleed into themselves, causing edema and swelling. This very painful condition is called thrombosed hemorrhoid.

How is hemorrhoid treated?

The treatment includes various steps from the regulation of diet to surgery. To summarize these briefly;

1. Regulation of the diet: In stage 1 hemorrhoids that occasionally bleed, increasing the amount of water consumed or even eating more fiber, vegetables, legumes is enough to prevent constipation from time to time.
2. Creams:Painkillers and cortisone creams can be used to reduce complaints in painful and edematous hemorrhoids. They do not have therapeutic properties, but they relieve the patient until the thrombosed hemorrhoid pads heal.
3. Drug treatments: The effects of oral drugs are also limited. They reduce edema and complaints, providing temporary relief.
4. Bandligation method:This approach can be applied in stage 1 and 2 hemorrhoids. The aim is to place rubber bands around the neck of the pads with the help of a special tool and to suffocate the hemorrhoids. This method can be applied in a polyclinic setting, and high success rates are achieved which can be increased when bandligation is performed together with sclerotherapy, drug injection under the hemorrhoid pads. However, the risk of recurrence is high after treatment.
5. Photocoagulation:This method involves burning the hemorrhoid pads with the help of a special device. Pain is relatively low. It is often used in combination with other methods. The success rate is high in suitable patients.
6. Surgical resection of hemorrhoids: This process defines the removal of the hemorrhoid pads by surgically cutting them with conventionally (by stitching) or with lasers or other special devices that seal the vessels. Surgical methods are a little more painful than other methods and the recovery process may take several weeks, but the hemorrhoids is least likely to recur after surgical resection.
7. Removal of hemorrhoids with a stapler: In this method, which was preferred in the past, a special device that cuts the vessels bringing blood to the hemorrhoid pads is used. However, in the technique, which was the subject of my specialty thesis, the possibility of hemorrhoid recurrence in the middle and advanced stages was found to be higher than other surgical methods. For this reason, it is not preferred as often as before.

What should I do to prevent the disease from recurring after hemorrhoid surgery?

Changing the diet and lifestyle after a successful surgery is usually the first goal at this stage. Avoiding standing for long timesas well as constipation are generally helpful for preventing the recurrence of the disease. Regularly checking pads that start to protrude after the surgery allows detecting the disease at an early stage and enables treatment with non-surgical methods.

What is Hemorrhoid? yazısı ilk önce Assoc. Professor Soykan Barlas üzerinde ortaya çıktı.

What Causes Anal Fissure?

There is always a history of constipation in patients with anal fissures, and it occurs when hard stools rupture the anal skin while going out. Sudden tears usually occur together with straining after diarrhea or constipation and is called acute anal fissure. It generally heals spontaneously within four to six weeks. It is important that there is no constipation or diarrhea during recovery, so that the condition does not recur.  If the disease continues for more than two months and a deep ulceration of wounds has formed at the site of the rupture, then the disease becomes chronic and requires medical intervention.

When the anal fissure becomes chronic, that is, it will last for a long time and does not heal easily, a deep tear (ulcer) and a skin fold called acrochordon, which patients often think of as hemorrhoids, develop in the anus, indicating that it is time to intervene in the disease.

Apart from these reasons, anal fissures or ulcers can be encountered more rarely in pregnancy, in the individuals with intestinal diseases such as Crohn’s disease or ulcerative colitis, bacterial or viral infections around the anus and also with skin cancer around this region. Therefore, in the presence of symptoms such as anal pain, bleeding and wound around the anus, it is useful to consult a surgeon without delay.

How is Anal Fissure Treatment Performed?

The main problem in anal fissure disease is the increase in the pressure in the muscles in this area due to the wound and pain.  Even if the disease heals in this way, the increase in the pressure is persistent and it causes partial stenosis in this area, thus, increases the risk of re-tears. When the anal fissure re-occurs, the muscle pressure increases a little more and increases the possibility of further anal fissure to recur. In this way, a vicious circle occurs.

For this reason, the main purpose of anal fissure treatment is to break this vicious circle in chronic and ulcerated fissures, while the main purpose is supportive treatment in newly formed cracks. Non-surgical treatments performed for this purpose are indicated below;

1. Supportive treatment:

It is applied as the treatment of newly formed breech cracks. Stool softening drugs and painkillers are given to prevent constipation. To prevent constipation, patients should drink plenty of water, and eat legumes and fibrous foods. To reduce pain, hot water baths and pain relief creams before and after defecation are helpful.

2. Topical treatments:

Rectal muscles are generally made of smooth muscles and some special creams can be used to reduce the pressure of these muscles. Creams prepared from some drugs such as diltiazem and nifedipine used in patients with hypertension are applied 2-3 times a day to the as anus region and 1-2 cm inside of anal canal.  The aim is to decrease the muscle pressure in this area. Treatment is usually beneficial in half of the patients and it should be applied for at least six to eight weeks.

3. Botulinum toxin administration:

It is a method that is frequently preferred especially in America and increasingly preferred in our country in recent years. Botulinum toxin, which is also used for cosmetic purposes, is applied around the anus and in this way, it is aimed to reduce muscle pressure. It provides 60-70% efficiency, but its effectiveness decreases in advanced disease. The risk of recurrence of the disease is higher than the surgical method and its administration is painful.

How is Anal Fissure Surgery?

Anal fissure surgery aims to remove some of the anus muscles with increased pressure and thus reduce the pressure.  It is performed under operating room environment. After the patient is under general anesthesia, a very small incision, approximately 1-2 cm, is made on the side of the anus and half or a little less of the muscles called internal sphincter, which also allow stool retention, are visualized and removed according to the developed stenosis.

Reduced pressure in the anus can be felt by examining by palpation.  Surgical method is the most effective method in the treatment of anal fissures and provides 95% success.  At the same time, the risk of recurrence of the disease is lower after surgical treatments than other methods. However, as with any surgery, there is a risk of complications in this surgery. Temporary or permanent stool and gas incontinence complaints may occur due to excessive muscle removal. However, this risk is very low if performed by anexperienced surgeon.

Anal Fissure yazısı ilk önce Assoc. Professor Soykan Barlas üzerinde ortaya çıktı.