Karen Manzini is a Southern girl, both by birth and by choice. Raised in Georgia and now living in the state again after a 25-year hiatus in Italy, she speaks with a drawl, participates in gardening clubs and was raised not to discuss bodily functions like gas and bowel movements.
So when she was recovering from surgery to remove a tumor in her colon about two years ago, she was startled when her clinicians treated passing gas and moving bowels as cause for celebration: “Those were applauded when they came” because they signaled a normal recovery, remembers Manzini, who’s now 60 years old and participating in a clinical trial for a drug to treat her cancer, which recurred last fall.
While Manzini has since become comfortable discussing all things gastrointestinal tract – even becoming a volunteer for the Colon Cancer Alliance, which aims to reduce colon cancer deaths – other patients’ politeness may hinder their ability to prepare appropriately for colorectal surgery and its recovery.
If you’re one of them, bring a loved one with you to appointments and be sure to take notes, Manzini suggests. Then, take a deep breath and ask your doctor these questions:
1. Where exactly are you going to operate?
Not all bowel surgeries for cancer are created equal. Those of the rectum, or the last 20 or so centimeters of the bowel, are much riskier and more complicated than those of the colon – the larger, upper portion of the bowel. “If [the cancer] is in the colon, we go directly to surgery; if it’s in the rectum, we usually do chemo and radiation before going to surgery,” says Dr. Marcia Cruz-Correa, a gastroenterologist at the University of Puerto Rico Comprehensive Cancer Center and a member of the American Gastroenterological Association’s governing board.
2. What exactly are you going to do?
There are two main approaches to colorectal surgery to remove a cancerous tumor: a laparotomy – in which a surgeon makes a 6- or 7-inch abdominal incision, removes the cancerous portion of the bowel and connects the two new ends – and a laparoscopy, a newer, minimally invasive procedure in which the surgeon removes the diseased bowel through a smaller incision. While both options have similarly good long-term outcomes, patients who undergo a laparoscopy tend to recover faster, are able to eat normally sooner and have fewer immediate complications, Cruz-Correa says. “The beauty of laparoscopy is that short-term outcomes are better.”
3. Are you the best doctor for me?
While research suggests that general surgeons are just as capable as specialists in removing cancers of the colon, patients needing rectal surgeries should seek a colorectal surgeon, Cruz-Correa says. “Colorectal surgeons can preserve the [rectum’s] normal anatomy,” she explains, reducing the likelihood of recurrence and the need for a colostomy bag. You might also want to ask potential surgeons about their experience and whether they’re board-certified in colorectal surgery, says Dr. John Marks, director of the Colorectal Surgery Center and chief of the section of colorectal surgery for The Main Line Health System and The Lankenau Hospital in Wynnewood, Pennsylvania. “Whether guys or gals are doing things in a minimally invasive fashion or [robotically] would likely indicate they’re more attuned to some of the advances in the field,” he adds.
To find a hospital with qualified surgeons in your area, check out the latest U.S. News Best Hospitals ratings, which for the first time include colon cancer surgery as one of the nine common procedures and conditions evaluated.
4. Will I wake up with a colostomy bag?
If you’ve chosen a qualified surgeon, your likelihood of needing a permanent colostomy bag after colon surgery is slim to none, Marks says. Among rectal cancer patients, the risk of requiring one ranges between 10 and 25 percent, depending on the location of your tumor and the expertise of your surgeon, he adds. If you do end up with one, keep in mind that many people – including major league baseball players – have lived full lives with colostomy bags, Marks says. “At first it seems like a daunting change, but most people adjust to it quite well,” he says. Still, as the focus of colon cancer surgeries has shifted from saving people’s lives to preserving a high quality of life, more and more surgical techniques are being developed with the sole goal of avoiding that result.
5. Will I ever poop normally again?
As Manzini, who’s undergone both a laparoscopy and a laparotomy for her now-stage 4 cancer, experienced, it takes a few days for the pipes to start moving again. And once they do, you’ll probably have to adjust to a “new normal,” Marks says. “It sounds obvious and silly to say that after you have intestinal surgery, your bowel habits will change,” but it’s worth repeating, he says. That’s not necessarily a bad thing. If you used to go to the bathroom once or twice a day, you may start going two or three times – all frequencies in the normal range, Marks says. In some cases, your bowel function may even improve, since the surgery could have removed a tumor that was causing tummy trouble. “It’s a matter of relearning the signals and relearning what you can trust as things go on,” Marks says. “It’s a small price to pay in people’s minds in order to avoid having to use colostomy for the rest of life.”
6. How will the surgery affect my sex life?
While some treatments for colorectal cancer – particularly radiation of the rectum – can make sex “difficult, painful, and undesirable – or in some cases, impossible,” according to the organization Fight Colorectal Cancer, most patients who’ve undergone colorectal surgery can return to their normal sexual activities – even anal sex – within four to six weeks, Cruz-Correa says. As for other types of activity, doctors encourage patients to walk as soon as they’re able and build up from there on a case-by-case basis, Cruz-Correa says. Exercises like weight-lifting that stress your abdominal wall will take longer to resume, she adds. “Recovery from surgery is never linear; it’s not that every day you’re going to be better, Gardner says. Over the course of weeks, however, you should improve.
7. What can I eat and when?
Once your bowel wakes up, you can expect to go on a sort of liquid diet. About a week later, most patients can start eating a soft, low-fiber diet stripped of known gut irritants like oatmeal and broccoli, Cruz-Correa says. “We want to have very low residue in the bowel while things get healed,” she explains. Over time, you may learn that some foods upset your stomach that didn’t before, since you have less colon to do the job. “By trial and error, see what things do and don’t work for you” in all areas of health, Marks says. One lifestyle change that won’t hurt: adopting a diet low in saturated fats and red meats like the Mediterranean diet, which has been shown to reduce recurrence of cancer in colon cancer survivors, Cruz-Correa says. Surviving cancer, she points out, is “an opportunity to do things healthier.”