For patients diagnosed with low rectal cancer, many are faced with the prospect of living with a permanent colostomy (or stoma) and impaired sexual function.
However, here at Basingstoke we have a long-standing interest in avoiding this, by offering restorative surgery (joining the bowel back up again) in selected patients with low rectal cancer. Currently, less than 10% of our patients end up with a permanent stoma (colostomy).
One thing to bear in mind is that low rectal tumours are associated with poorer post-operative bowel function than higher tumours, because more of the rectum is removed. For those patients whose bowel is joined up again, there is a significant risk of having some degree of incontinence, which is worsened by having pre-operative radiotherapy. It is up to the individual to decide what is the best solution for them along with advice from the multi-disciplinary team – very low rectal surgery and radiotherapy can leave patients with little control and each individual has to decide whether a colostomy will be the right decision.
One factor that is critical is how many centimetres the cancer is from the lower edge of the anal verge. If the answer is less than 3 cm, then a permanent colostomy is almost certainly necessary.
Whilst there remains a widespread belief that avoiding a permanent stoma affords a better quality of life, our own research has shown that patients with permanent stomas can enjoy an equally good quality of life. With simple techniques such as colostomy irrigation that patients can do for themselves, it is possible to live a full and active life. To read about one man’s very active life using irrigation, see Richard Allardyce’s story, written August 2010.
We strongly believe that every patient should be treated according to their individual circumstances and beliefs, with the aim of achieving the best possible outcome – both with respect to cancer survival and bowel function. We are dedicated to improving all aspects of care for low rectal cancer.