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colectomy, a surgeon removes the damaged section of the colon and joins the two severed ends. He or she then creates an artificial opening called a stoma, through which stool can be eliminated. He or she makes an incision in the abdomen and brings part of the colon through the incision in a procedure called a colostomy. The severed edges of the colon are then stitched to the skin at the edge of the incision to make the stoma. A bag to collect stool can be attached to the skin around the stoma with an adhesive. The bag is replaced after each bowel movement.

Stages of Colon Cancer

In most types of cancer, staging is used to determine how far the cancer has progressed. The cancer is described in terms of how large the primary tumor is, the degree to which the tumor has invaded surrounding tissue, and the extent to which it has spread to lymph glands or other areas of the body. Staging helps a doctor determine the most appropriate treatment. Doctors stage colon cancer in the following way:

• Stage 0 The cancer is limited to the innermost lining of the colon or rectum.

• Stage I The cancer has spread to the outer part of the lining of the colon or rectum.

• Stage II The cancer has spread from the intestine to nearby organs or tissues but not to the lymph nodes.

• Stage III The cancer has spread to nearby lymph nodes.

• Stage IV The cancer has spread to other parts of the body, such as the liver or lungs.

Treatment

For colon cancer that has not spread to other organs, surgery is the most effective treatment. If the cancer is confined to the colon, the surgeon will remove the growth and the surrounding areas of the colon on either side of the tumor in a procedure called colectomy (see previous page); the remaining healthy sections of the colon are stitched together to maintain a passageway for stool. If the cancer is very low in the intestine, you may need to have a colostomy (see previous page). Your doctor may recommend chemotherapy (see page 23) after surgery. Radiation therapy (see page 23) is used in combination with chemotherapy either before or after surgery to treat cancerous tumors that develop in the rectum.

Disorders of the Anus

The anus is the opening at the end of the digestive tract through which stool passes out of the body. It is a 1½-inch-long canal that leads from the rectum through a ring of muscles (the anal sphincter) to the anal opening. Normally an adult can easily control the anal sphincter, regulating when he or she wants to have a bowel movement. Because the function and structure of the anus are relatively simple, only a few disorders affect the anus.

Hemorrhoids

Hemorrhoids are swollen veins (varicose veins; see page 602) that protrude from the lining of the anus. The affected veins lie just under the mucous membrane that lines the lowest part of the rectum and anus. Hemorrhoids can occur anywhere in the anal canal. They may be hidden at the beginning of the canal or visible at the opening.

Hemorrhoids are a common disorder. Straining to pass stool puts pressure on the sphincter muscles and pressure on the veins of the anus, causing them to swell. Some people are more susceptible than others to developing hemorrhoids. Pregnant women and people who are obese can develop hemorrhoids from the extra pressure that increased weight can put on the abdomen and the veins of the anus. Often people who have advanced cirrhosis (see page 790) have hemorrhoids because blood flow to their liver is obstructed, which can increase blood pressure in the veins of the intestine and anus.

Symptoms

The primary symptom of hemorrhoids is bleeding from the rectum, which is often noticeable only on toilet paper or in toilet water. Blood may also be around, but not mixed in, the stool. The walls of the swollen, twisted veins are thin and rupture easily during bowel movements. External hemorrhoids may be visible at all times, or they may protrude outside the anus only during a bowel movement. The ruptured veins produce sore areas that can cause pain during bowel movements.