Sex And The Colostomy Patient.

The affection and love that human beings have for each other is precious and wonderful and not based solely on physical attraction. Nonetheless, the patient with a colostomy may feel reluctant about sexual activities. This hesitation is understandable, but almost always unfounded. The colostomy constructed by modern surgery and cared for by proper irrigation and general cleanliness is not a repellent object or a source of offensive odor, as many people fear.

 
Patients who are sexually active should have no embarrassment in continuing their sexual lives. Older patients who are sexually active should act similarly. The patient and the patient's partner will quickly realize how little the colostomy affects their physical activity and mutual regard. Colostomy surgery, in contrast to major prostate and bladder surgery, does not interrupt or damage the nerve pathways that excite and maintain sexual arousal; thus sexual performance and response should be unaffected by a colostomy, at least physiologically. If problems occur in this aspect of one's life, they should be openly discussed, since they are more likely to be psychological than physical.

FOLLOW UP
After an operation for large bowel cancer, patients will have to see their doctor periodically for follow-up. The main goal of these visits, which will occur every few months for the first few years after treatment, will be to detect any recurrence of the tumor or the development of a new one. Hence it will be necessary to have checks of the intestinal secretions for occult blood, periodic sigmoidoscopic examinations, and, from time to time, a colonoscopy or a barium enema with air contrast, or both. The main reason for these examinations is that the patient who has had cancer of the large bowel has an increased risk of developing another one at a different location within the large bowel. Periodic chest X rays and general examinations are performed at the same time.

Recently, follow-up of patients has been aided by a new test called the carcinoembryonic antigen (CEA) test. This is a blood test that detects a substance produced by the large bowel tumor that may provide an early warning. The test is useful but not perfect, because the CEA may be elevated in persons who smoke or have other conditions.

IF THE BOWEL TUMOR RECURS
At the present time about half of all patients with large bowel cancer will develop a recurrence. On occasion a simple area of spread detected in the lung or in the liver can be removed and the patient will have another chance for a cure. This is one reason for careful follow-up after the initial treatment.
Recurrence follows one or more of several patterns. Patients who have recurrent rectal cancer often develop pain in or near the perineum, and radiation therapy is particularly effective in controlling a tumor at that site. The cancer may spread through the lymph channels or veins to the liver. Treatment with effective drugs can be administered directly into the liver. If the cancer has spread to the liver or to other areas of the body, chemotherapy administered orally or intravenously can be beneficial.

Cancer specialists regard cancer of the large bowel as a "transitional"
tumor, meaning it is beginning to show responsiveness to drug treatments. Although 5-fluorouracil has been the standard anticancer drug
used in large bowel cancer, the present trend is to employ other drugs as
well. Hence the patient may receive three or four different chemotherapeutic drugs, including 5-fluorouracil. This approach makes possible
long-term relief and a high quality of life.

SUMMING UP
Cancer of the colon and rectum are very common in most developed countries, including the United States. At present about half of all patients who develop large bowel cancer will be cured. Wider application of currently available screening methods along with more intensive use of available diagnostic methods are capable of detecting cancers of the colon and rectum in their early, most treatable stages. If these screening and diagnostic techniques are combined with appropriate operative treatment and careful follow-up, many more than the present 50 percent of patients can be cured. In the past, many people have avoided prompt medical attention when they suspected bowel cancer, fearing that the treatment would greatly diminish the quality of life. For example, many people still assume that colon cancer surgery automatically means a colostomy, when, in fact, colostomies are the exception rather than the rule. Even when a colostomy is required, most people learn to care for it before they leave the hospital. In short, large bowel cancer is in the process of coming under control in every sense of the word.