Colorectal Cancer

Diagnosis & Treatment of Colon and Rectal Cancer

Colorectal cancer: Introduction

What is colorectal cancer?

Colorectal cancer is cancer that starts in either your colon or your rectum. These make up the lower part of your digestive tract. In most cases, cancer does not start in both the colon and rectum. But both types of cancer have a lot in common. So they are often called colorectal cancer.

Understanding the colon and rectum

The colon is a muscular tube about 5 feet long that forms the last part of the digestive tract. It absorbs water from the remaining food matter. The rectum is the last 6 inches of the digestive tract. It acts as a storage space before waste (feces or stool) leaves the body through the anus. Together, the colon and rectum make up the large intestine. This is sometimes called the large bowel. The colon and rectum have an inner lining made of millions of cells. Changes in these cells can lead to growths that can become cancer.

What are the types of cancer in the colon and rectum?

Here is an overview of the types of cancer that can start in the colon and rectum:

• Adenocarcinoma. The most common type of colorectal cancer. More than 95% of colorectal cancers are adenocarcinoma. This cancer starts in the lining of internal organs. The tumors start in gland cells that release, or secrete, fluids.

Other types of cancer that can start in the colon or rectum are much less common:

• Gastrointestinal stromal tumor (GIST). These tumors start in special cells in the wall of the digestive tract. They may be found anywhere in the digestive tract. But they rarely appear in the colon. They may be benign, or not cancer, at first. But many do turn into cancer.
• Lymphoma. This cancer starts in a type of immune cell called a lymphocyte. Lymphomas often start in bean-sized groups of lymphocytes, called lymph nodes. But they can also start in the colon, rectum, or other organs.
• Carcinoid. This cancer starts in special hormone-making cells in the intestine.
• Sarcoma. These tumors start in blood vessels, muscle, or connective tissue in the colon and rectum wall.

How colorectal cancer starts and grows

Changes that occur in the cells that line the inside of the colon or rectum can lead to growths called polyps. Over time, some types of polyps can become cancer. Removing polyps early may stop cancer from ever forming.

• Polyps are fleshy clumps of tissue that form on the inner lining of the colon or rectum. Small polyps are usually not cancer. But over time, the cells in a type of polyp known as an adenomatous polyp, or adenoma, can change and become cancer. The longer a polyp is there and the larger it grows, the more likely this is to happen.
• Colorectal cancers most often start when cells in a polyp begin growing abnormally. As a cancer tumor grows, it can invade into the deeper layers of the colon or rectal wall. Over time, the cancer can grow beyond the colon or rectum and into nearby organs. Or it can spread to nearby lymph nodes. The cancer cells can also travel to other parts of the body, where they can form new tumors. This is known as metastasis. If colorectal cancer spreads, it most often goes to the liver first. But it can also spread to other organs.

What are the symptoms of colorectal cancer?

People with colorectal cancer often do not have symptoms right away. By the time symptoms occur, the cancer may have grown or spread to other organs. This can make it harder to treat. That’s why routine colorectal cancer screening is important.

Symptoms can include:

• A change in bowel habits that lasts for more than a few days, such as diarrhea, constipation, or a feeling that your bowel is not empty after a bowel movement
• Bright red or very dark blood in your stool
• Constant tiredness
• Stools that are thinner than usual
• Stools that look slimy or have mucous on them
• Ongoing gas pains, bloating, fullness, or cramps
• Unexplained weight loss
• Vomiting

When to see your healthcare provider

These symptoms can also be caused by many kinds of common health conditions. A healthcare provider will need to find out if your symptoms are caused by cancer. See one of our providers if you are concerned about any of these symptoms.

How is colorectal cancer diagnosed?

Your doctor might suspect you have colorectal cancer based on the results of a screening test to look for the cancer early. Or you might have symptoms that could be caused by colorectal cancer. You will need certain exams and tests to be sure. The process starts with your healthcare provider asking you questions. He or she will ask you about your

• Health history
• Symptoms
• Risk factors
• Family history of disease

Your healthcare provider will also give you a physical exam.

What is a biopsy?

A biopsy is the removal of cells or tissue to be examined under a microscope. This exam can show if the tissue is cancer. For colorectal cancer, a biopsy is the only way to be sure of the diagnosis. The most common type of biopsy is an endoscopic biopsy. This is usually done during a colonoscopy. Other types of biopsies include a needle biopsy and a surgical biopsy. But these are not often used to diagnose colorectal cancer. Needle biopsies are sometimes used in other parts of the body to see if the cancer has spread. Surgical biopsies are used to take samples of large tumors. They are also used for tumors in hard-to-reach places.

Once your healthcare provider removes the tissue, he or she sends it to a lab. There a doctor called a pathologist looks at the tissue under a microscope to check for cancer cells. It usually takes several days for the results of your biopsy to come back. A biopsy is the only sure way to tell if you have cancer. And it is the only way to tell what kind of cancer it is.

Below are the 3 types of biopsies a healthcare provider may do:

Endoscopic biopsy

This is most common biopsy to diagnose colorectal cancer. It is done during a colonoscopy or a sigmoidoscopy. These are screening and diagnostic tests that use an endoscope. This is a tube with a small video camera on the end. There are types of endoscopes for different parts of the body. For a colonoscopy, the healthcare provider uses a colonoscope. For a sigmoidoscopy, he or she uses a sigmoidoscope. It is shorter and can only reach about 1/3 of the colon. If the healthcare provider finds a polyp or growth in the colon or rectum during 1 of these tests, he or she most likely will remove it. This is done using small tools passed down the endoscope. After cutting it from your colon wall, the healthcare provider will take it out through the tube. This is called a polypectomy. Your healthcare provider then sends the polyp to the lab to be checked for cancer. He or she will also take samples of any other growths to send to the lab. The lab will then be able to see if any of the growths are cancer.

Needle biopsy

There are 2 types of needle biopsies. One is a fine needle biopsy. The healthcare provider uses a very thin (fine) needle and syringe to remove liquid and a very small sample of tissue. The other is a core needle biopsy. The needle for this procedure is slightly larger. This biopsy is sometimes done to take tissue from a tumor found in some other part of your body, such as the liver. This test can help show if the cancer has spread. For a needle biopsy, the healthcare provider inserts a needle into the tumor and takes a sample of tissue. For tumors the doctor can feel, the biopsy can be done in the healthcare provider's office using a local anesthetic. For tumors that can't be felt, the healthcare provider may use a CT scan to help guide the needle. CT scans are detailed X-rays. Or your healthcare provider may use an ultrasound to help him or her guide the needle. These types of biopsies are done in a procedure room. A needle biopsy usually takes only a few minutes. You may receive sedation if needed to ease the discomfort. You don’t need to stay in the hospital overnight.

Surgical biopsy

Most biopsies can be done with 1 of the above methods. But if the polyp or mass the healthcare provider wants to examine is large or in a hard-to-reach spot, you may need to have surgery. You'll be given general anesthesia so that you fall asleep and don't feel anything. You may also have to stay overnight in the hospital. It may take several days before you can go back to your normal routine.

Most polyps are benign. That means they are not cancer. The biopsy will show exam will reveal if the polyps are abnormal cell growth (dysplasia) or cancer (carcinoma). If you have a dysplastic polyp, you are at higher risk for growing more polyps and cancer.

Colorectal Cancer: Treatment Choices

There are various treatment choices for colorectal cancer. Which may work best for you? It depends on a number of factors. These include the type, size, location, and stage of your cancer. Factors also include your age, overall health, and what side effects you’ll find acceptable.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. In fact, some insurance companies may require a second opinion. In addition, you may want to involve your family and friends in this process.

Understanding the goals of treatment for colorectal cancer

For many colorectal cancers, the goal of treatment is to cure the cancer. If cure is not possible, treatment may be used to shrink the cancer or keep it under control for as long as possible. Treatment can also improve your quality of life by helping control the symptoms of the disease. The goals of colorectal cancer treatment can include:

Remove the cancer in the colon or rectum Remove or destroy tumors in other parts of the body Kill or stop the growth or spread of colorectal cancer cells Prevent or delay the cancer's return Ease symptoms from the cancer, such as pain or eating problems caused by pressure on organs

Types of treatment for colorectal cancer

Several types of treatment can be used for colorectal cancer. Different combinations of treatment may be used, depending on the stage of the cancer and other factors. Each treatment has its own goals. Here is an overview of each type of treatment:

Surgery

This is the most common treatment for most early stages of colon and rectal cancer. The goal of surgery is to remove the entire tumor and any cancer cells that may have spread to nearby tissue. Depending on the stage of the cancer, surgery may be all that's needed. Or surgery may come before or after another treatment is used.

Chemotherapy

The goal of chemotherapy is to stop cancer from growing or spreading. It does this by using medicines to either kill the cells or stop them from dividing. If the medicines are given in a way that lets them enter the bloodstream, they treat cancer cells throughout the body. That way they can treat cancer that has spread. This type of treatment is called systemic. Medicines can also be given to attack cancer cells in specific organs, such as the liver. This treatment is called local. Chemotherapy might also be used before surgery to shrink tumors. When used before surgery, it is called neoadjuvant therapy. It might be used after surgery to kill or control any remaining cancer cells. When used after surgery, it is called an adjuvant therapy.

Radiation therapy

The goal of radiation therapy is to kill cancer cells using high-energy X-rays. It has a major role in treating rectal cancers, but it may be used in some colon cancers as well. Like chemotherapy, it may be used before surgery to shrink tumors. This treatment is called neoadjuvant radiation therapy. This may lower the chance that a person will need a permanent colostomy. When it's used after surgery, it is called adjuvant radiation therapy. Then the goal is to reduce the chance that the cancer will come back.

Targeted therapy

This type of therapy uses medicines that target proteins or cell functions that help cancer cells grow. Some of these medicines are given along with chemotherapy medicines, while others are used by themselves. The goal is to prevent the cancer from growing. It may also be used to help chemotherapy get inside the tumor. This can help it be more effective.

Immunotherapy

The goal of this type of treatment is to help the body's own immune system attack the cancer cells. Medicines called checkpoint inhibitors can be used to treat some advanced colorectal cancers in which the cells have certain gene changes. This treatment might be an option for some people who have already had chemotherapy.

Ablation and embolization

These methods can be used to treat tumors that have spread to other parts of the body, such as the liver or lungs. Ablation is the use of heat, cold, or other methods to destroy tumors rather than removing them. For embolization, a substance is injected into a blood vessel to try to cut off a tumor's blood supply or to deliver chemotherapy or radiation directly to the tumor.

Supportive care

Your healthcare provider may advise therapies that help ease your symptoms, but don’t treat the cancer. These can sometimes be used along with other treatments. Or your healthcare provider may suggest supportive care if he or she believes that available treatments are more likely to do you more harm than good.

Colorectal Cancer: Surgery

Surgery is often part of the treatment for colorectal cancer. Different kinds of surgery may be done. Which type you have depends on the type of cancer, where it is, how much it has spread, and other factors.

When surgery may be an option:

Colorectal polyps and early stage colorectal cancers are often first seen during a colonoscopy. If you have a colonoscopy, your healthcare provider may see a polyp that might turn into cancer or might already have cancer. He or she might be able to completely remove the polyp by passing small tools through the tube or colonoscope. No surgical cut or incision is needed.

In other cases, surgery might be needed:

• You've had a colonoscopy, but your healthcare provider could not completely remove a polyp. Surgery is then needed to remove the rest of the polyp. That's because it might contain cancer cells that could spread to other areas. The only way to know if a polyp has cancer is to remove all of it and check it under a microscope.
• You've had a polyp completely or partly removed, and that polyp has invasive cancer cells in it. Your healthcare provider will be able to tell this by looking at the polyp under a microscope. Surgery may be needed because the cancer may have spread beyond the polyp. If your provider thinks the cancer has not spread, you may not need surgery.
• You have a stage I, II, or III colorectal cancer. These cancers have not spread to distant sites, so surgery may be able to remove all of the cancer. Other treatments such as chemotherapy or radiation therapy may be needed as well.
• You have stage IV (advanced) colorectal cancer, but it has only spread to areas of the liver or lungs that can also be removed with surgery. Surgery on both the main tumor and the site where it has spread may be able to remove all of the cancer in certain cases. Other treatments such as chemotherapy or radiation therapy may be needed as well.
• You have advanced cancer that threatens to block or obstruct the colon or cause other major problems. In these cases, surgery may be used, but not to try to cure the cancer. Instead it may be used to fix the problem and ease symptoms. For example, if the colon is blocked by a tumor, surgery may be done to create a colostomy. This connects the part of the colon before the blockage to an opening in the skin of the belly. This allows waste to leave the body.

Types of surgery

The type of surgery you have depends on the stage and location of the tumor, your health and preferences, and other factors. Surgery for colon and rectal cancers may include:

Polypectomy

This is the removal of a polyp, often done during a colonoscopy. It does not require an incision in the skin.

Local excision

This is the removal of the cancer and a small area of the tissue around it. It is typically done during a colonoscopy to remove very shallow tumors. It may also be done in the operating room.

Surgical resection of the tumor

This is the removal of part of your colon or rectum and nearby lymph nodes. It is most often done through an incision (or incisions) in your belly. The type of surgery depends on whether the cancer is in your colon or rectum:

• Colon cancer. The most common surgery for colon cancer is called a colectomy or hemicolectomy. The surgeon removes the part of the colon that has cancer, as well as a small amount of normal colon on either side. Nearby lymph nodes are removed as well and checked for cancer. This surgery can be done through 1 long incision in the belly, called an open colectomy. Or it can be done by using long, thin surgical tools passed through several smaller cuts in the belly. This is called a laparoscopic-assisted colectomy.
• Rectal cancer. There are several different types of surgeries for rectal cancer. The type of surgery will depend on the stage of cancer and where it is in your rectum. Some early stage cancers can be treated with transanal resection and transanal endoscopic microsurgery (TEM). They use tools passed through the anus. There is no surgical cut in the skin. 

Other more extensive rectal cancer surgery options include:

• LAR or lower anterior resection.This surgery removes the part of the rectum that has cancer.
• Proctectomy with colo-anal anastomosis. Removes the whole rectum. The colon is then joined to the anus.
• APR or abdominoperineal resection. Removes the anus and the tissues surrounding it, including the sphincter muscle. This surgery results in a permanent colostomy.
• Pelvic exenteration. Removes the rectum as well as nearby organs if the cancer has spread there. These include the bladder, the prostate in men, or the uterus in women. This surgery results in a permanent colostomy.

Risks and possible side effects

All surgery has risks. Some of the risks of any major surgery include:

• Reactions to anesthesia
• Excess bleeding
• Blood clots in the legs or lungs
• Damage to nearby organs

Getting ready for your surgery

A few days before your surgery, your healthcare provider will prescribe laxatives and enemas to help clean out your colon. Your healthcare provider will tell you when and how to use these. You may also be told to follow a special diet.

Before you have surgery, you will meet with your surgeon to talk about the procedure. After you have discussed all the details of the surgery, you will sign a consent form. This gives the healthcare provider permission to perform the surgery.

You will also meet with the anesthesiologist. This is the provider who will give you general anesthesia, the medicine that puts you to sleep so that you won't feel any pain during surgery. He or she also monitors you during surgery to keep you safe. He or she will ask about your medical history and your medicines.

What to expect during surgery

When it is time for your surgery, you will be taken into the operating room. Your healthcare team will include the anesthesiologist, the surgeon, and nurses.

During a typical surgery:

• You will be moved onto the operating table.
• Someone will place special stockings on your legs. These are to help prevent blood clots.
• You will have electrocardiogram (EKG) electrodes put on your chest. These are to keep track of your heart rate. You will also have a blood pressure cuff on your arm.
• You will be given anesthesia through an IV or intravenous line into your arm or hand.
• When you are asleep, the surgeon will do the surgery.
• A urinary catheter will be put into the bladder during surgery.

What is removed during surgery and where your incisions are will depend on the type of surgery you have. This is based on where the tumor is.

What to expect after surgery

You will wake up in a recovery room. You will be watched closely by healthcare providers. You will be given medicine to treat pain.

You may have to stay in the hospital for up to 7 days, depending on the type of surgery you have. People who have a laparoscopic-assisted colectomy can often go home sooner. That’s because they have smaller incisions that can usually heal faster.

You can slowly return to most normal activities once you leave the hospital. But you should not lift heavy things for several weeks. Always follow the instructions you get from your healthcare provider or nurse.

It will take time to get back to eating normally and having regular bowel movements. If you have an ostomy, you'll also learn how to take care of your hole or stoma. You will still have the urinary catheter in your bladder to drain urine. It is usually removed before you go home.

After surgery, you may feel weak or tired for a while. The amount of time it takes to recover after surgery will vary for each person. But you will probably not feel like yourself for a few months. You will be able to get your incision wet. But to reduce your risk of infection, don’t take baths or go swimming. You likely won't be able to drive for a while, as directed by your healthcare providers.

If you had an open surgery, you may have a 5 to 7-inch scar running up and down through your belly button. This will likely heal into a thin scar.

After surgery, you may have either chemotherapy or radiation to reduce the chance that any remaining cancer cells will spread. Treatment after surgery is called adjuvant therapy.

Eating after surgery

You may not be able to eat for the first few days after surgery. You may get some nutrients through an IV line that’s put into one of your veins. At first, you will be on a clear liquid diet until there are signs that your bowels are moving again. Then you may be able to add some soft foods and then normal foods. It may take your colon several months to heal after surgery. To rest your bowels, your healthcare provider may advise that you eat a low-fiber diet. Be sure you talk about your diet with your provider. He or she may refer you to a nutritionist or dietitian to help you plan your meals.

Bowel function after surgery

After having a section of your colon removed, you may have more bowel movements than normal. Some people have 7 or 8 a day in the first months after surgery. You may also have a more urgent need to have a bowel movement. This means that once you feel the urge, you may have to get to the bathroom quickly to avoid leaking. These side effects usually get better over time. It may take as long as 2 years to fully adjust. Even then, you’re likely to have bowel movements several times a day. And you may still have bowel urgency.

If your tumor was in the rectum, your surgeon may have made a special pouch called a J-pouch. It holds stool as your rectum did before surgery. Your surgeon forms the J-pouch during the same surgery to remove your rectum. The surgeon loops the colon back on itself and staples it together. This creates a pouch that looks like the letter J. Stool collects there until you can get to a bathroom. This helps you to get back to a stable bowel pattern more quickly after surgery. You may be able to have stable bowel function after a few months.

Depending on the type of surgery you had, your healthcare provider may have created an ostomy in your belly. This allows waste to leave your body. This may be short-term or permanent. If you have an ostomy, a specially trained therapist can help you learn how to care for it and adjust to having one.

Colorectal Cancer: Frequently Asked Questions

Here are some answers to frequently asked questions about colorectal cancer:

What are the colon and the rectum?

The colon and the rectum are part of the digestive tract. Together, they form a long tube called the large intestine. This is also called the large bowel. The colon is the first 5 feet or so of this tube. It absorbs water from digested food and stores waste until it passes out of the body. The rectum is a pouchlike structure that makes up the last six inches of the large bowel. It expands to hold waste matter before it passes out of the body through the anus as a bowel movement (stool).

Who gets colorectal cancer?

Colorectal cancer is the third most common cancer in both men and women in the United States. Anyone can develop it, even younger people. There are, though, some people at higher risk. People with a family history of this cancer are at increased risk. So are people who have had it before. People with inflammatory bowel disease (ulcerative colitis or Crohn's disease), type 2 diabetes, or with certain inherited conditions are also at increased risk. Older age is also a factor. About 90% of people with colorectal cancer are older than age 50. The risk is slightly higher in men than in women. African-Americans develop colorectal cancer at a higher rate than other ethnic groups. Jews of Eastern European descent may also be at higher risk. Other people at increased risk include smokers and people who are obese or physically inactive.

What causes colorectal cancer?

Scientists don't know the exact cause. Studies show, though, that genetics, environment, and lifestyle all play a role. For instance, a family history of this cancer increases a person's risk. Some studies show that a diet high in red or processed meat increases the risk. A diet high in fruits and vegetables, on the other hand, may reduce the risk.

Is colorectal cancer inherited?

Most cases of this cancer are "random." That means they are not inherited. But a person who has a parent, sibling, or child who has had this cancer is at higher risk. That risk is even higher if the cancer happened at a young age. Some conditions that can be passed on in families may also increase the risk. An example is inflammatory bowel disease.

Can colorectal cancer be prevented?

A key to prevention is to lower the risk. Diet is one way to do this. The diet should include lots of fruits and vegetables. Little or no exercise seems to increase the risk. Routine exercise may lower it. Being obese (very overweight) also increases risk, so staying at a healthy weight may help prevent it. Studies show that drinking more than moderate amounts of alcohol and smoking increase the risk for this cancer. So avoiding both can lower it. Another important way to lower the risk is to have regular screening tests starting at age 50 and having polyps removed from the intestine.

What is a polyp?

Polyps are benign (noncancerous) growths. They form on the inner wall of the colon or rectum. They are common in people older than age 50. Polyps can cause bleeding or mucus with bowel movements. Large ones can block bowel movements. Some polyps may become cancerous. Polyps are usually found during a screening test. They can be removed by colonoscopy.

Is there some way to find colorectal cancer early?

Screening tests help find the cancer early. It can then be treated before it spreads. These tests also help find polyps before they become cancer. One test is a fecal occult blood test (FOBT). This test checks for blood in the stool. For a sigmoidoscopy, the doctor inserts a lighted tube to see inside the rectum and the lower colon. For a colonoscopy, the doctor inserts a lighted tube inside the rectum and the entire colon. During either test, the doctor can remove polyps or other abnormal tissue or a biopsy. The doctor can then look at the tissue under a microscope for signs of cancer. Other tests that can be used for screening include double-contrast barium enema (an X-ray test), virtual colonoscopy (a type of CT scan), and a stool DNA test (which looks for gene changes seen in cancer cells).

What is a double-contrast barium enema?

This is a screening test that uses X-rays. First the doctor puts liquid that contains barium into the rectum. Barium is a silver-white compound. It coats the large intestine. That makes the colon and rectum easier to see on X-rays. Then air is pumped into the colon and rectum to expand it. Doctors can then see any growths or tumors. These will need to be removed with a colonoscopy.

What is virtual colonoscopy?

This test, also called CT colonography, is an imaging test used to screen for colorectal cancer. A special type of CT scan is done to create a three-dimensional view of the colon and rectum to allow the doctor to look for polyps. This test is not as invasive as sigmoidoscopy or colonoscopy, but if polyps are seen, a regular colonoscopy will need to be done to remove them.

What is a digital rectal exam?

This exam is also called a DRE. It helps find changes in the lowest four inches of the rectum. To do this test, a doctor or nurse practitioner inserts a lubricated gloved finger into the rectum. The doctor or nurse then feels for lumps. This is not an adequate test by itself to screen for colorectal cancer.

What are the symptoms of colorectal cancer?

Common signs of colorectal cancer include these things:

• A change in bowel habits that lasts for more than a few days
• Blood (either bright red or very dark) in the stool
• Diarrhea, constipation, or a feeling that the bowel is still not empty
• Gas pains, bloating, fullness, or cramps
• Stool that is thinner than usual
• Weakness and fatigue
• Weight loss for no known reason

How is colorectal cancer treated?

Treatment choices depend on several things, including:

• The person's age and general health
• The location of the cancer in the large bowel
• Whether it has grown through the bowel wall
• How far it has advanced
• The results of lab tests on the cancer cells

Surgery is the most common treatment for early stage cancers. The goal is to remove the cancer. Even then, these other treatments may also be used to try to be sure all of the cancer has been treated:

• Radiation therapy
• Chemotherapy

More advanced cancers may be treated with:

• Chemotherapy
• Targeted therapy
• Radiation therapy.

What is a colostomy?

A colostomy is a surgical procedure that creates an alternate outlet for stool to leave the body. For it, a surgeon connects a part of the intestine to an opening in the abdominal wall. This opening is called a stoma. This connection gives stool a new way to leave the body. Afterward, the person wears a special bag to collect stool. For most people, this is temporary. After they heal from surgery, the intestines are reconnected and they no longer need the bag. But for some, the stoma and bag are permanent. Most surgeons attempt to maintain a functioning anus whenever possible so that a permanent stoma is not needed.

Is a stoma painful or uncomfortable?

A well-cared-for stoma is painless. It should also not cause discomfort. A person who has one should be able to resume physical activity. A therapist called an enterostomal therapist (ET) can help a person learn how to take care of a stoma. He or she can also help a person adjust to life with a stoma.

Can the body function the way it is supposed to without a large part of the intestines?

Yes. People can live normally without a portion of the small intestine. They can also live normally without the entire large intestine.

What are the sexual side effects from colon or rectal cancer surgery?

Most people return to normal at the end of a recovery period. Sexual side effects are more likely after rectal surgery. For some men, nerves in the rectum may be damaged if the cancer is in the part of the large intestine that is low in the pelvis and near the anus. These nerves are involved with erection. For some women, the vagina may have to be reconstructed. In both cases, it is usually still possible to be intimate.