Important Facts That You Should Know About Rectal Cancer Treatment.

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Improved surgical techniques mean fewer patients need colostomies, the often dreaded procedure that diverts bodily waste through an opening made in the abdomen. Meanwhile, people who do need the procedure say advances in designs of colostomy bags and other colostomy-related products have sharply reduced the inconvenience of living with one.

“Rectal cancer treatment has undergone significant improvements over the last 20 years on all fronts,” says Robert Cima, a colorectal surgeon at Mayo Clinic in Rochester, Minn.

Rectal cancer is a subset of colon cancer, occurring in the last 6 inches of the colon, which processes food and expels solid waste. Cancers of the colon and rectum are the second-leading cause of cancer mortality in the U.S., behind lung cancer. However, the death rate has been dropping for more than 20 years thanks to better screening and treatment, according to the American Cancer Society.

Cancers of the rectum can be trickier to remove than cancers higher up the colon, which pose less risk to full bowel function. If the tumor is very close to the end of the digestive system, the surgeon may need to create a new exit point for waste via a colostomy.

But some new techniques are making this type of surgery less common.

Doctors are increasingly targeting tumors with radiation and chemotherapy before surgery to shrink them and ease their removal. In many cases this approach “allows you to preserve a small amount of rectum and reattach the colon to that part of the rectum, not interfering with the anal muscles at all,” says Jonathan Efron, a colorectal surgeon at Johns Hopkins Kimmel Cancer Center in Baltimore.

In the past, surgeons would only reconnect and preserve the bowel if 5 or more centimeters of healthy tissue remained between where the cancer had been excised and the anus. They felt they needed this to prevent the cancer from returning, and to ensure proper bowel function. Now surgeons will often reconnect the bowel with margins of less than 1 centimeter of healthy tissue.

Jim Murray emceed a party in Pensacola, Fla., in 2013, eight years after his colostomy surgery. ‘I have never let the surgery slow me down,’ he says. ENLARGE
Jim Murray emceed a party in Pensacola, Fla., in 2013, eight years after his colostomy surgery. ‘I have never let the surgery slow me down,’ he says. PHOTO: JIM MURRAY
Better surgical staplers have also helped make these procedures possible, doctors say.

The advances have contributed to a rise in so-called sphincter-sparing procedures and a drop in colostomies. One analysis of 48,000 U.S. patients who underwent surgery for rectal cancer found the rate of sphincter-sparing procedures rose to 60.5% in 2006 from 35.4% of surgeries in 1988, according to results published in 2010 in Diseases of the Colon & Rectum.

Another, involving data on 5,000 U.S. veterans, found sphincter-sparing procedures rose to 79.3% between 2005 and 2010. That was up from 60% of rectal cancer surgeries between 1995 and 1999, according to study results published in 2014 in Annals of Surgical Oncology.

One worrisome finding: Several studies have shown that colostomy rates are higher in smaller towns and in hospitals that perform few rectal cancer surgeries, or that lack specialized colorectal surgeons. Sphincter preservation is typically higher at hospitals that perform a high volume of rectal surgery, the studies show.

“We can certainly improve the access for all patients to get the very best coordinated treatment and surgery,” Mayo Clinic’s Dr. Cima says.

The risk of rectal cancer recurring appears to be roughly similar after colostomy and sphincter-sparing procedures, doctors say. Some data suggest the risk might actually be slightly higher in patients who get colostomies, possibly because the surgeons who perform them aren’t removing enough of the fatty tissue surrounding the rectum, Dr. Efron says.

Many patients have satisfactory bowel function after receiving sphincter-sparing procedures, but some suffer varying levels of incontinence. Martin Weiser, a colorectal surgeon at Memorial Sloan Kettering Cancer Center in New York, says for some patients, “the price you pay for avoiding a colostomy is poor bowel function.”

Although most patients are petrified of colostomies, “I would say most people who end up with a colostomy are happy,” Dr. Weiser adds.

Some patients who have received colostomies agree, and say improved design of colostomy-related devices has helped. Colostomy bags, which some wearers prefer to call pouches, have become thinner and lighter, and the adhesives used to secure them to the body have become more secure.

Jim Murray, a 73-year-old former Marine in Pensacola, Fla., says he uses an irrigation device—a kind of water enema—to clear out his system every few days. That allows him to control the timing, and to wear a mini-pouch between sessions, which usually remains empty, he says.

A decade past surgery, Mr. Murray says he is as active as ever, going on frequent cruises with his wife and participating in several local Mardi Gras krewes, which stage elaborate parades each year. As a board member of the United Ostomy Associations of America, he also provides counseling to other patients facing the prospect of a colostomy. “Having a colostomy is a cure. If I didn’t have mine, I’d be a dead person,” he says.

Cheryl Ory, a 54-year-old nurse from Mount Carmel, Tenn., who works in a neonatal intensive care unit, says the discreet design of devices allows her to wear the same clothes she did before her colostomy surgery.

When she first learned she needed a colostomy in 2008, Ms. Ory says she balked, deciding she would rather “let the cancer take its course.” But her distraught daughter convinced her to go through with the surgery. With time, she says she’s fully adjusted.

“You’ll see me outside mowing the lawn once a week. I do aerobics, I go on cruises. I do everything in life I used to do and more,” she says.

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