Colorectal Surgery

Colorectal Surgery And What You Need To Know

Colorectal Surgery is a field of medicine that deals with disorders of the rectum, anus and colon. Doctors specialising in this field of medicine are called colorectal surgeons. They are fully trained in general surgery before completing advanced training in this area of the body.

About the Colon, Rectum and Anus

The colon is part of the large intestine and the final part of your digestive system. Its primary job is to form the food you ingest mixed with the digestive juices in your stomach into firm stools for excretion.

The rectum is the part of your digestive system that comes after the colon. Here, the colon empties into the rectum as waste collects as bowel movements.

The rectum then empties into the next part of your digestive system, the anus. The anus is where bowel movements leave your body.

Colorectal Surgical Disorders

At ParkCity Medical Centre, our Colorectal Clinic offers the best surgical and non-surgical treatment for a wide range of conditions including:

  • Colorectal cancer – cancer of the colon and rectum
  • Anal cancer
  • Haemorrhoids (piles) – varicosities or swelling, and inflammation of veins in the rectum and anus
  • Anal fissures – unnatural cracks or tears in the anus
  • Perianal abscess and anal fistula – abnormal connections or passageways between the rectum or other anorectal area to the skin surface
  • Diverticular disease – the presence of small pouches in the large intestinal wall
  • Severe constipation conditions
  • Rectal prolapse – protrusion of the walls of the rectum through the anus
  • Other general surgical conditions including any injuries to the anus, removal of objects inserted into the anus etc.

Colorectal Centre at Parkcity Medical Center

As a one-stop colorectal centre, ParkCity Medical Centre’s services include:

  • Cancer screening and prevention
  • Diagnostic endoscopy including sigmoidoscopy and colonoscopy under day-care settings
  • Advanced therapeutic endoscopy including polyp removal
  • Virtual (CT) colonography
  • Faecal occult blood test

Our colorectal surgeons share their expertise and work together to provide patients with up-to-date, evidence-based treatment including minimally invasive techniques.

PMC believes in a multidisciplinary team approach to treat cancer with the best physicians, oncologists, rehab specialists and other support services working together to optimise patient care. Our surgeons combine the latest surgical techniques with advanced equipment to achieve the best possible outcomes.

We also provide a full subspecialty service in pelvic floor disorders and functional disorders of the bowel such as constipation and incontinence. Our clinic is one of the few private centres in Malaysia equipped with biofeedback and anal manometry facilities. Other state-of-the-art facilities include 3D endoanal ultrasound, MRI defecography, Anorectal biofeedback and colonic transit studies.

3D Endoanal Ultrasound (3D-ERUS)

An established technique for imaging the rectum and the anal canal. It provides an accurate visualisation of the five-layer structure of the rectal wall and of all the pelvic organs surrounding the rectum.

MRI Defecography

A non-invasive test that uses magnetic resonance imaging to obtain images at the different stages of defecation to assess how good the pelvic muscles are working and give insight into rectal function.

Anorectal Biofeedback

A treatment programme that uses neuromuscular conditioning techniques to treat patients with faecal incontinence or chronic constipation that is associated with dyssynergia constipation.

Colonic Transit Study

A test that depicts how rapidly food passes through the digestive system. It is also known as a pellet study. A patient will be given some pellets to swallow consecutively for a few days. They will then have to come into the hospital for an x-ray.

What Should You Expect At An Appointment With Colorectal Surgeon?

You should expect your first appointment with your colorectal surgeon to take around 30 to 45 minutes. During your appointment with our PMC colorectal specialists, expect to be asked questions regarding your general and colon health followed by an abdominal exam, a digital rectal exam or both.

In an abdominal exam, you will be requested to lie down so that our doctor can examine your stomach for any abnormalities. A digital rectal exam, however, involves your colorectal surgeon examining your back passage with a small device called an anoscope to view the insides of your bowel. This procedure isn’t distressing, and your colorectal surgeon may request that you come in again for further investigation if necessary.

After your appointment, your colorectal surgeon will meet with you to give you your results and discuss anything that they may have been discovered during the examination.

Preparing Your Bowel For Your Visit With The Colorectal Surgeon

Before a colonoscopy or sigmoidoscopy visit, you will need to do some preparation. Your colon and bowel needs to be empty and clean for the colorectal surgeon to conduct a good examination. So, you may be asked to get ready for the procedure by cleaning out your colon and bowel.

You will be given instructions ahead of your appointment. Go through them thoroughly and should you have any questions, contact your colorectal surgeon.

Clear your calendar for the evening before and the day of your appointment and make plans for a family member or friend to accompany you for your appointment.

Tweaking your diet a few days ahead of your procedure can help the cleansing process and opt to eat light three or four days before. You are recommended to have a low fibre diet as it's easy to digest and will leave your system quickly. You may have foods such as white bread, pasta, rice, cooked vegetables, fruits without skin or seeds, lean meat, chicken, fish or eggs. Stay away from fatty foods, tough meat, whole grains, raw vegetables, seeds, nuts, popcorn and fruit with seeds or peel. During this time, your doctor may instruct you to stop taking supplements or medication that you use regularly.

The day before your appointment you would have been instructed not to eat anything solid, you would only be able to consume clear liquids. It's important to stay hydrated by drinking clear liquids such as apple juice, clear soup, sports drinks and water. Avoid any drinks that may have red, blue or purple colouring as they can discolour the colon lining and make it harder for your colorectal surgeon to see. Also, stay away from alcoholic drinks and anything you can’t see through such as milk or orange juice.

The night before your procedure, you would have been given strong laxatives by your doctor to clear your digestive tract. Once the laxatives start working, you will experience frequent diarrhoea and may have some cramps and bloating. The purging process may still be happening as you make your way to your appointment. If you are worried about having an accident, you may consider wearing adult diapers and packing an extra set of clothes.

If you have completed the process and the laxative working effectively, your excrement should look like clear liquid. While the process isn’t easy, it is a small step to protecting your health.

However, if you are experiencing severe pain or bleeding in your rectum, tell your Colorectal Surgeon because you may not need to do a bowel preparation. Also inform your colorectal doctor if you are taking medication to thin your blood.

At PMC, you can rest assured that you will be in good hands with our award-winning doctors and professionally-trained staff.

Our Colorectal Surgeons

Dr Law Chee Wei

Designation
Consultant General & Colorectal Surgeon
Specialty
General Surgery, Colorectal Surgery
 




Colorectal Cancer

Colorectal Cancer occurs in the colon or rectum and is sometimes referred to as colon cancer or rectal cancer, depending entirely on the location the cancer first appears. Colon cancer usually begins anywhere in the colon (5 feet long) and absorbs water from the stool. On the other hand, rectal cancer begins in the rectum (5 inches of the colon) that assists the body in storing stools until you have a bowel movement.

Tumour growths may be benign but malignant and cancerous tumours can spread to other parts of the body. Colon cancer and rectal cancer are often grouped together because they have various features in common. The occurrence of cancer comes about when the cells in the body start to grow out of control.

The Origin of Colorectal Cancer and Its Prevalence in Malaysia

Colorectal cancer is the most common cancer to occur among Malaysian men (14.8/100,000), and the second most common cancer to occur among Malaysian women (11.1/100,000). Besides other cancers, colorectal cancer is the 2nd most common cancer in Malaysia and the 3rd most common cause of cancer death among Malaysians. Reason being, about 66% of colon cancer in men and 65% of colon cancer in women are often detected at a later stage (3rd or 4th stage).

Colorectal cancer starts off as a growth on the inner lining of the colon or rectum. These are known as polyps. Over the years, some polyps would turn cancerous and the chances of polyps turning cancerous depend entirely on the type of polyp that is formed in the colon and rectum.

Types of Colorectal Cancer

There are various types of colorectal cancer that are often present among men and women. The types include:

  • colorectal adenocarcinoma
  • gastrointestinal carcinoid tumours
  • primary colorectal lymphomas
  • gastrointestinal stromal tumours and
  • leiomyosarcomas

Risk Factors

Like any other cancer, colorectal cancer has its fair share of risk factors as well. The risk factors of developing colorectal cancer include:

  • Finding a polyp larger than 1cm
  • Finding more than 3 polyps
  • Finding dysplasia (a pre-cancerous condition, in which the polyp in the affected area looks abnormal, however, it hasn’t become cancerous) in the polyp after it is removed.
  • Age – colon cancer may be diagnosed at any age (young or old), however, a majority of people diagnosed are older than 50 years. The rate of colon cancer among young people is, however, on an increase
  • A personal history of colorectal cancer or polyps – There is a greater risk of colon cancer if you’ve been diagnosed with colon cancer or non-cancerous colon polyps before.
  • Low-fibre, high-fat diet – Studies have found an increased risk of colon cancer in people who consume diets high in red and processed meat, which is a typical western diet.

Stages of Colon Cancer

The TNM staging system is a tool used by oncologists to discover and describe the different stages of colorectal cancer. Oncologists use the results from the diagnostic tests and scans to answer the following questions:

  • Tumour (T): Has the tumour grown into the wall of the colon or rectum? If so, how many layers?

  • Nodes (N): Has the tumour spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are then combined to determine the stage of cancer for each individual.

Being at the Frontline of Colorectal Surgery

ParkCity Medical Centre (PMC) has taken the first step in leading the way in Colorectal Health. PMC is committed to delivering the right diagnosis and treatment and sharing their expertise for anyone who requires assistance in colorectal health. Our long list of experts at our Colorectal Clinic includes colorectal surgeons, physicians, oncologists and rehab specialists to ensure we always provide optimised patient care.

Dr Law Chee Wei

Designation
Consultant General & Colorectal Surgeon
Specialty
General Surgery, Colorectal Surgery
 




Colon cancer screening

Colon cancer screening should be an important part of routine health care as colon cancer (CRC) is the most common cancer among Malaysian men, the second most common cancer among Malaysian women, and the third leading cause of cancer deaths in the country.

About 66% of male CRC cases and 65% of female CRC cases are detected at a late stage, increasing the risk of cancer death. However, it doesn’t have to be that way because getting a colon cancer screening test could save your life if you are 50 or older. 

Screening tests are used only when one does not have irritable bowel syndrome symptoms. Colorectal cancer often develops from precancerous polyps (abnormal growth) in the rectum or colon.  Screening tests can detect precancerous polyps, allowing them to be removed before they turn into cancer. Regular screening can also help detect colorectal cancer while it is still in the early stages, when treatment works best. Current screening methods are divided into stool-based tests and visual (structural) exams.

Types of Colon Cancer Screening Tests

  • Stool-based tests

These tests look for signs of colorectal cancer or polyps in the stool. Because these tests can be done at home, it is more convenient and easier for some people than getting a test instead of colonoscopy. However, these tests must be done more frequently. If one of these stool tests returns a positive result, a colonoscopy test is required to determine whether you have cancer.

  • Faecal immunochemical test (FIT)

Looking for occult (hidden) blood in the stool is one way to screen for colorectal cancer. The faecal immunochemical test (FIT) looks for hidden blood in the lower intestines' stool.

  • Guaiac-based faecal occult blood test (gFOBT)

The guaiac-based faecal occult blood test (gFOBT) uses a chemical reaction to detect occult (hidden) blood in the stool. It works differently than the FIT, but, like the FIT, it cannot distinguish between blood from the colon and blood from other parts of the digestive tract (such as the stomach).

  • Stool DNA test

A stool DNA test, also known as a multitargeted stool DNA test, looks for abnormal DNA sections from cancer or polyp cells, as well as occult (hidden) blood. DNA mutations in specific genes are common in colorectal cancer or polyp cells. Cells with these mutations frequently end up in the stool, where tests may be able to detect them.

  • Visual (structural) exams

These tests examine the insides of the colon and rectum for any abnormalities that could signify cancer or polyps. These tests can be done less frequently than stool-based tests, but more planning is required ahead of time and may carry additional risks not seen with stool-based tests.

  • Colonoscopy

The doctor uses a colonoscope, a flexible tube about the width of a finger with a light and small video camera on the end, to examine the entire length of the colon and rectum. It is inserted through the anus, into the rectum, and into the colon. If necessary, special instruments can be passed through the colonoscope to get a biopsy (take a sample) or remove any suspicious-looking growths like polyps.

  • CT colonography (virtual colonoscopy)

This is a more advanced computed tomography (CT) scan of the colon and rectum that can detect abnormalities such as polyps or cancer. Special computer programmes create 3-dimensional images of the colon and rectum using x-rays and a CT scan.

  • Flexible sigmoidoscopy)

A flexible sigmoidoscopy is similar to a colonoscopy in that it examines the colon. However, the doctor will only be able to see less than half of the colon and the entire rectum.  A sigmoidoscope is inserted through the anus, into the rectum, and then into the lower colon. Images from the scope are displayed on a video screen, allowing the doctor to identify and potentially remove any abnormal areas.

Finding the Right Tests For You

There is no such thing as the “best test” for anyone. There are pros and cons for each test. Consult our highly experienced colorectal specialists about which test or tests are suitable for you and how often should one be screened. At ParkCity Medical Centre, our colorectal specialists provide exceptional care for gastrointestinal conditions by utilising advanced clinical techniques and innovative technologies.

Dr Law Chee Wei

Designation
Consultant General & Colorectal Surgeon
Specialty
General Surgery, Colorectal Surgery
 




When Should You See a Colorectal Specialist

Colorectal cancer is becoming more common in adults under the age of 50. Many of these cases are being diagnosed at later stages of the disease, when the cancer is more difficult to treat. In most instances, young people do not recognise the symptoms of colorectal symptoms, pay any attention to the signs, and are unsure of what to do or who to contact regarding this matter. So, when should you see a colorectal specialist?

It is important for one to be familiar with colorectal cancer and its symptoms, so that they may take appropriate action to increase the chances of being diagnosed as early as possible and receive the best treatment from a colorectal specialist. 

Symptoms of colorectal cancer may include:

  • Weight loss with no explanation
  • Persistent abdominal pain
  • Narrow or pencil-thin stools
  • Rectal bleeding, either dark or bright red colour
  • Anaemia from iron deficiency due to chronic bleeding
  • Tenesmus (the feeling that you need to empty your bowel but there is no excretion)

Colorectal cancer symptoms in its advanced stages may include:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Uncontrollable weight loss
  • Deteriorating physical condition
  • Abdominal pain, bloating or bowel obstruction

Risk Factor

Certain conditions increase a person's risk of developing colorectal cancer. It is better to be safe than sorry when it comes to health, so take these factors into consideration and consult our colorectal specialists to reduce your chances of getting colorectal cancer.

The following risk factors have been linked to the development of colorectal cancer:

  • Having a personal history of colon, rectum, or ovarian cancer
  • Having a first-degree relative with a history of colon or rectal cancer
  • Having inherited changes in certain genes that put you at risk of developing familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary nonpolyposis colorectal cancer)
  • Having or had chronic ulcerative colitis – Crohn's disease for at least 8 years
  • History of inflammatory bowel cancer
  • Breast, ovarian, or uterine cancer in the family
  • A diet high in red meat, processed meat, fat, and low in fibre
  • Smoking and drinking alcohol
  • Being obese

As you grow older, age becomes the main risk factor for most cancers and the chances of you getting cancer increases.

Diagnosis

A patient who wants to do a colorectal cancer screening must see a colorectal specialist for a full clinical and physical examination to determine the risk. At ParkCity Medical Centre, our colorectal specialists can conduct multiple tests to detect colorectal cancer in patients. Should there be a risk or if you show signs of colorectal cancer, PMC’s colorectal specialists will discuss the risks with you, the treatments and the follow-up appointments that you may require.

The following tests and procedures to diagnose colorectal cancer are:

  • Physical exam and health history
  • Digital rectal exam
  • Colon cancer screening

Our colorectal specialist will determine the best treatment plan for you based on multiple factors, such as:

  • The location of the cancer in your colon
  • How far the cancer has spread

Colon Cancer Surgery Preparation

As always, surgery should never be taken lightly. However, there are several things you can do to increase the possibility of a successful surgery.

  • Follow your doctor's diet recommendations, which usually include consuming only clear liquids for 1 or 2 days before surgery
  • Stop smoking and, if you drink, temporarily abstain from alcohol
  • Do not eat anything after midnight on the day before surgery
  • Before surgery, cleanse your bowels with laxatives or an enema

Post-surgery, you will be encouraged to live on a liquid or soft food diet. This is until your bowels are healthy enough to form normal stools. You should be able to consume the food you love and resume your regular activities once you have fully recovered.

At ParkCity Medical Centre (PMC), our patients receive extensive cancer care . We strive to provide a wide range of cancer care pathways, support, and treatments to meet the individual needs of each patient.

Dr Law Chee Wei

Designation
Consultant General & Colorectal Surgeon
Specialty
General Surgery, Colorectal Surgery