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Oxford University Hospitals NHS Foundation Trust

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Colorectal Surgery - conditions we treat

Bowel (colorectal) cancer and anal cancer

We provide a comprehensive service for all aspects of colorectal and anal cancer, including:

  • diagnosis, multidisciplinary assessment and treatment
  • all colorectal cancer surgery; all patients with suspected anal or colorectal cancer have their cases discussed and their treatment planned at a specialised multidisciplinary team meeting
  • recurrent and locally advanced colorectal cancer surgery
  • anal cancer surgery
  • family history clinics for advice, screening and further genetic referral if required
  • minimally invasive surgery (robotic and laparoscopic)
  • fast-track diagnostic investigations for suspected cancers
  • treatment for early rectal cancer which aims to treat cancer without removing the rectum
  • combined strategies for 'organ preservation' of the rectum with the aim of avoiding removal of the rectum where possible.

If your GP thinks your symptoms may be due to bowel cancer, they will refer you via the 2 Week Wait (2WW) suspected cancer pathway and you should have your first test or investigation or outpatient appointment within two weeks.

The 2 Week Wait nursing team will arrange your tests promptly.

These tests may include CT scans, ultrasound scans, endoscopy or an outpatient appointment. It is important to make yourself available for these tests to be carried out.

Although your symptoms could be caused by conditions other than cancer, if you are experiencing any of the following, you should see your GP who may refer you for further investigations.

  • Bleeding, which you may notice in your stools, on the toilet paper or in the toilet after a bowel motion
  • Changes to your normal bowel habits, constipation and/or diarrhoea, lasting longer than six weeks
  • Stomach pain or bloating
  • Rectal pain
  • Unexplained tiredness or weight loss

Surgery for bowel cancer

Often patients with cancer in the colon or rectum will need surgery. Usually this will be a bowel resection, which involves removing the affected part containing the cancer and then rejoining the bowel. In many cases, bowel cancer can be cured in this way with no need for further treatment.

In rare cases, more radical surgery may be needed. Some patients may also need chemotherapy or radiotherapy either before or after treatment for bowel cancer.

Cancer of the anus is rare and is treated primarily with radiotherapy. Surgery is reserved for cases which do not respond to treatment or recur.

In Oxford we have particular expertise in treatments for rectal cancer which aim to avoid removal of the rectum where possible.

For more information please see:

Surgery for colon cancer - www.cancerresearchuk.org

Anal cancer - www.bowelcanceruk.org.uk

Inflammatory Bowel Disease (IBD)

We offer a specialist service for sufferers of inflammatory bowel disease, particularly Crohn's Disease and ulcerative colitis.

We work closely with our colleagues in the Department of Gastroenterology and most cases are discussed at the IBD multidisciplinary meeting where we have colorectal surgeons, gastroenterologists, dietitians, pharmacists and radiologists.

Our service covers:

  • all aspects of diagnosis, medical management and surgery for IBD
  • ileo-anal pouch and Koch pouch surgeries and the management of complications following such surgery
  • peri-anal complications resulting from inflammatory bowel disease (e.g. complex and fistulae)
  • nutritional support including intestinal failure management.

Benign anorectal disease

We treat all diseases in and around the anus. When surgery is required, these procedures are often carried out in the Horton General Hospital in Banbury.

These include:

  • pilonidal disease surgery
  • anal fistulae surgery including complex and recurrent disease
  • haemorrhoids assessment, surgical and non-surgical management.

Pelvic floor disorders

We offer a specialist pelvic floor assessment service, including endo-anal ultrasound, anorectal physiology, defacating proctography and transit studies.

We also offer advice and treatment for:

  • bowel dysfunction, including biofeedback
  • faecal incontinence
  • irritable bowel syndrome
  • constipation.

Effective treatment for complex pelvic floor disorders requires combined care from a multidisciplinary team (MDT) of surgeons, nurses, radiologists and physiotherapists.

At the Pelvic Floor MDT there is open discussion between everyone in the team and results are reviewed. This helps to provide 'joined-up care', giving patients the best possible chance of recovery.

When your doctor refers you to us, you will first see a surgeon in our Pelvic Floor Clinic. The surgeon will ask questions relating to your symptoms to try to establish their underlying cause, and will examine you. It is very likely that they will then refer you to other team members for investigation.

The next stage will vary according to your symptoms, but many patients will have a defaecating proctogram and transit study performed in the X-ray department by radiographers, with the results analysed by radiologists.

You may also have anorectal physiology and ultrasound, which is undertaken by nurse specialists and physiologists.

We will often see if we can improve your symptoms with simple measures such as dietary changes, laxatives and pelvic floor exercises or pelvic floor retraining. Many people find that their symptoms are completely resolved by such measures. Much of this advice and help will come from our specialist nurses.

A small number of people will be suitable for surgery for their symptoms, and we will counsell them carefully as to the advantages and disadvantages of surgery by their surgeon in clinic before being added to a waiting list.

Links

Links to useful websites

DEPARTMENTS AND SERVICES