Colorectal (14)

Saturday, 02 March 2013 09:10

Love Your Colon

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March is Colon Cancer Awareness Month!




                Fecal Occult Blood Test           Colonoscopy



Colorectal Cancer Awareness Month




          March is celebrated worldwide as Colorectal Cancer Awareness Month. Colorectal cancer is the third most common cancer in the world. According to the Philippine Cancer Society, there were about 5,797 new cases in the Philippines for the year 2010, of which, there were 3,208 male and 2,579 female cases. This month is therefore a great opportunity for Filipinos to learn more about the prevention and treatment of this dreaded disease.


 “Colorectal cancer is one of the most curable cancers, especially when detected early”, according to Dr. Robert L. Chang, President of Philippine Society of Colon and Rectal Surgeons (PSCRS). “This is why it is important to know the significance of screening, as well as the common symptoms and risk factors”.  According to Ms. Christine, a colon cancer survivor, “I am fortunate that my cancer was diagnosed early . . . timely detection can spell the difference between survival and death”.


            Colorectal Specialists, in collaboration with Medicard Philippines, is launching a community-based colorectal cancer screening program in Makati  for all Medicard members and non-members alike starting this March, 2013 .   Scientific evidence is strong that increased awareness of, and comprehensive screening for, colorectal cancer saves lives.


 * What are some common misconceptions about hemorrhoid treatments?

One misconception about surgery for hemorrhoids is that it can cause fecal incontinence, or the inability to control farting or defecation.  Again this is not true. Properly done hemorrhoid surgery, using any of the techniques discussed previously, does not entail cutting or injuring the anal muscles.  Therefore no complication such as incontinence should develop. 

Another misconception about hemorrhoid treatment is the use of lasers.  A true LASER is defined as Light Amplification by Stimulated Emission of Radiation, and in medical applications is used as a very fine, and precise cutting instrument (such as when in ophthalmology).  The technology is very expensive, and therefore using a true laser for hemorrhoid surgery makes the procedure quite prohibitive

There are other misconceptions in the public about hemorrhoid treatment. Unfortunately this is propagated by many false claims and unscrupulous practices.  Hemorrhoids are a very common condition that is often bothersome, sometimes very painful, but never life-threatening.  All symptoms must be evaluated by a doctor to make sure one truly has hemorrhoids. There are a variety of surgical and non-surgical options, and these should always be discussed first with an expert prior to making a decision on treatment.

* Note: This information is not intended as a substitute for professional medical advice. For any inquiries please Visitor calls your specialists.

* What are the advances in hemorrhoids treatment?

Due to this reputation of being a painful operation, advances in hemorrhoid surgery have focused on making it less painful.  One such operation is stapled hemorrhoidectomy. Using a specially-designed, single-use stapler instrument (which was modified from the staplers used to reconnect intestines during major abdominal surgery), the hemorrhoids are excised and the anus repaired from the inside, something which is difficult to do with traditional surgery.  The end result is that the surgical wound is inside, and no wound is visible outside the anus. Scientific studies have proven that this is less painful than traditional surgery, although with a small recurrence rate.


     Stapled Hemorrhoidectomy                           Transarterial Hemorrhoidal Dearterialization (THD)

Another advanced surgical technique is Transarterial Hemorrhoidal Dearterialization (THD).  Using a doppler ultrasound, the blood vessel supplying the hemorrhoid is identified and ligated with stitches.  Deprived of its blood supply, the hemorrhoid then shrinks and shrivels.   Again there is no wound outside and is therefore almost painless.  However, because it is a new technique, not very many studies evaluating its long-term effectiveness have come out.

 All surgical procedures for hemorrhoids, whether traditional or innovative, may sometimes develop complications such as bleeding, infection and stricture. It is important therefore when seeking treatment, to see an expert in anal diseases.

 * What are the forms of treatment – surgical and non-surgical?

Hemorrhoids only require treatment when there are symptoms.  And the type of treatment depends on the severity of symptoms.  Mild symptoms may be managed just by eating a lot of fiber and taking in bulk laxatives such as psyllium to improve the consistency of stools and ease bowel movement.  Some over-the-counter creams may provide symptomatic relief.

Non-surgical and almost painless treatments for hemorrhoids include injection sclerotherapy, infrared photocoagulation (often mislabeled as “laser treatment”), and rubber band ligation, any of which can be done safely in the clinic as an out-patient procedure.  In scientific studies comparing these methods, rubber band ligation was found to be the most effective and cheap, which is why it is the most common non-surgical procedure for hemorrhoids in the world today.

Non-surgical treatment is often ineffective for large, incarcerated or thrombosed hemorrhoids.  Surgery is usually recommended in these situations, and also when non-surgical treatment has failed to relieve symptoms.  Traditional surgery requires cutting out the hemorrhoid using a variety of instruments such as scissors, knives, cautery, and ultrasonic dissectors. Unfortunately, any wound created in the outer skin of the anus results in often Sever post-operative pain, which is responsible for the reputation of hemorrhoid surgery being one of the most painful of operations.

 * What are the symptoms of hemorrhoids? 

Bleeding from hemorrhoids is usually bright red, often dripping into the toilet bowl, or noticed when wiping. The stools themselves are normal looking, indicating that the bleeding is originating only from the anorectal area.  Sludge of dark blood and stool mixed thoroughly together is usually from a source within the small and large intestines and not hemorrhoids. Hemorrhoidal bleeding is painless, and this differentiates it from anal fissures, which is also a very common anal condition that presents with similar bright red bleeding during defecation, but with anal pain.

Hemorrhoids only become painful when they thrombosed or incarcerated.  Thrombosed hemorrhoids occur when blood clots within the hemorrhoids, causing very obvious swelling and pain.  While surgery for this may be effective during the first 4 days of the attack, if left alone the swelling and pain gradually subside and disappear after 2 weeks.  Usually this occurs just once or twice in a person’s lifetime, and it is uncommon to have repeated episodes of thrombosis. 

Doctors often classify patients as to having either external or internal hemorrhoids.  External hemorrhoids are located just outside the anus, and hence are always visible on routine inspection.  Many people have them without suffering from any symptoms, and therefore these may be safely left alone.  Sometimes external hemorrhoids may make cleaning difficult, allowing sweat and anal discharge to hide between folds, resulting in anal itching.

Internal hemorrhoids arise from inside the anus and are therefore only visible when, because of excessive laxity, they protrude outside.  This condition is called prolapsed, and usually occurs during defecation.  When internal hemorrhoids prolapsed they may either slip back inside on their own, or require manipulation by the person for it goes back in.  When the prolapsed hemorrhoids cannot be returned, they become trapped outside, resulting in pain and swelling.  This scenario is called incarcerated hemorrhoids.

* How do hemorrhoids look and feel?

Hemorrhoidal cushions are skin, vascular and soft tissues that line the anal canal, playing a small role in defecation and continence.  Everyone has them, although with our daily travails of straining and movement, they do change over time, becoming more lax or loose as we age. 

Hemorrhoidal disease occurs when these changes result in bothersome symptoms such as bleeding, prolapsed, or pain.  Almost everyone may develop symptoms at some point in their life, but these are not life-threatening, and may be safely observed. Treatment is usually required for those whose hemorrhoidal symptoms impact on quality of life and daily living.

Colorectal Specialists is team of colon and rectal surgeons who have decided to work together as a professional group practice committed to the advancement of colorectal surgery in the Philippines.The team advocates for state-of-the-art colorectal treatment that is evidence-based and utilizes the concept of Multidisciplinary Team Approach (MDT) with constant evaluation of treatment outcomes. MDT is the current management trend especially for colorectal cancer. It involves the combination of treatment modalities and collaboration with other healthcare professionals to ensure a thorough and holistic care for patients.
Our practice aims to provide the highest standard of care and we strive to improve outcomes of procedures and treatments through systematic quality of care audits, research, education, and training. We benchmark with International Standards in colorectal surgery. All our surgeons are board-certified Fellows of the Philippine Society of Colorectal Surgeons.

What are the Main Treatment Options for Colorectal Cancer?


Surgery is the mainstay of treatment for colon or rectal cancer.

This entails removing the segment of the colon involved by the cancer as well as the lymph nodes draining via the mesentery. If the cancer is small and early, minimally-invasive laparoscopic surgery can be done, with smaller incisions, less pain, and faster recovery. 

Additional treatment in the form of chemotherapy or radiation may provide additional benefit and this may be best discussed with your specialists.

How is Colon Cancer Diagnosed?

Colon cancer is best detected early, when there are still no symptoms. Screening for individuals with no risk factors to develop colon or rectal cancer starts at 50 years old. For those individuals with inherited risks such as those with significant family history, screening should start earlier. This is achieved through screening tests such as colonoscopy, fecal occult blood test with flexible sigmoidoscopy, barium enema and CT virtual colonoscopy.

On the other hand, if you are experiencing the typical symptoms of colon cancer or polyps, a colonoscopy would be the most appropriate test for you. If a polyp is found, it can be completely removed and sent to the laboratory to check for early malignancy. Removal of a benign adenomatous polyp prevents its progression to cancer. However, if a tumor is found instead under colonoscopy, a biopsy can be done quickly and safely to determine if it is malignant.

What Happens if You have Colon Cancer?

Colon cancer first begins as a tumor in the lining of the colon. Early symptoms maybe bleeding, abnormal fecal discharge, or unexplained anemia. As the tumor grows, it may begin to obstruct the flow of feces causing abdominal colic and changes in bowel habits. If the obstruction is left to progress, eventually the flow of feces and gas will be completely blocked, resulting in abdominal enlargement, pain and vomiting. Perforation of the large intestine with intra-abdominal infection is another complication of advanced tumors.

Aside from its effect on the intestines, colon cancer also spreads through the lymph nodes and affects other organs away from the colon. The most sites of metastasis are the liver, lung, and peritoneum (inner lining of the abdomen).

Colon cancer is staged according to severity:

Stage I - cancer does not go beyond the wall of the colon.

Stage II -  cancer goes beyond the wall of the colon.

Stage III - the cancer has spread to the lymph nodes  around  the colon.

Stage IV - the cancer has spread to other organs.



At the Forefront of Colorectal Care in the Philippines

Stage 4 Colon and Rectal Cancer                      

*Note: There is No More Stage 5

There are various stories about colon cancer being detected at a terminal stage. Christine, 44 years old, never had any symptoms – no pain, no weakness and fatigue, now weight loss, not even a streak of blood during bowel movement. But one day, she just bled profusely in the toilet. The verdict was Stage 4 colon cancer.

Fred, 45 years old, did not ignore his symptoms. He had abdominal pain and bouts of constipation and diarrhea for several months. He was diagnosed with amoebiasis. When bleeding started, he underwent flexible sigmoidoscopy and barium enema. Both exams were normal. No one suggested a colonoscopy. Fourteen months from the onset of his symptoms, his colon was completely obstructed by cancer. He had  to undergo emergency surgery.  At the time of surgery, his doctors noted his liver to full of tumor as well.  Stage 4.

Margie has 2 siblings who were survivors of colon cancer.  She was advised to undergo screening colonoscopy. She declined.  She eventually noted blood from her stools.  During work-up, she was diagnosed to have rectal cancer that has spread to her lungs.  Stage 4.

Most colon and rectal cancers are caught in later stages. This is because symptoms usually take time to manifest.  More often, symptoms are dismissed as hemorrhoids, stomach flu or other inflammatory bowel diseases. Also, there is a common disregard for the importance of colorectal cancer screening.


There are certain symptoms that may indicate the presence of colon and rectal cancer. These include: recent changes in bowel habits, such as diarrhea or constipation; blood in the stool; persistent abdominal discomfort, such as cramps or gas pain; a feeling that bowel doesn’t empty completely; unexplained anemia, weakness or fatigue; and weight loss with no known reason.


Colon and rectal cancer, which is cancer of the large intestine or the lowest part of the digestive system, may be associated with a diet low in fiber and high in fat, calories, red meat, and processed foods. Other risk factors are a sedentary lifestyle, obesity, smoking, alcohol, diabetes, as well as a personal or family history of colon polyps or colorectal cancer. Age is also a risk factor. “About 90 percent of people diagnosed with colon cancer are older than 50,” says Dr. Manuel Francisco T. Roxas, a leading colorectal specialist, “although it can also occur in younger people, but much less frequently.” Thus, Dr. Roxas strongly recommends regular screening for those 50 years old and above.


In Stage 4 colon and rectal cancer, which is the final stage, the disease has spread to other parts of the body such as liver or lungs. Treatment for Stage 4 colon cancer entails a careful evaluation from experts to ensure correct staging. Then, a combination of treatment modalities can be applied such as chemotherapy, radiation and surgery (a surgeon removes the section of the colon affected by the tumor and joins the remaining healthy sections together).


A multidisciplinary teamwork approach is applied in the management of colorectal cancer. The team is composed of specialists from the field of Colorectal Surgery, Medical Oncology, Radiation Oncology, Pathology, Psychiatry and Enterostomal Nursing.  The objective is to ensure that the best available care is provided the patient. 

Colon and rectal cancer is best detected early, when it is most curable, before the development of symptoms. This is achieved through screening tests, particularly colonoscopy, which views the entire colon. At the same time, the surgeon can already remove any visible polyps (small, benign tissue which may eventually develop into colon or rectal cancer).


Various options for colorectal cancer screening are available. Routine screening is highly recommended, as follows: 1) fecal occult blood test yearly with flexible sigmoidoscopy every three years, or 2) colonoscopy every five to ten years, or 3) virtual CT colonography every three to five years. 


Colorectal Specialists provides comprehensive, advanced, and efficient care to wide range of colorectal conditions. Its expertise is in the surgical management of colorectal cancer, diverticulitis, inflammatory bowel diseases, and other benign disorders like hemorrhoids, fissures, fistulae, polyps, constipation, fecal incontinence, sexually transmitted anorectal diseases, and other colorectal problems. It always strives to provide comfort, privacy and total quality service to its clienteles.

This specialist clinic is located at the 3rd Floor, Medicard Lifestyle Center, #51 Paseo de Roxas Cor. Sen. Gil Puyat (Buendia) Ave., Makati City, with Tel. No. 555-0832, Cell phone No. 09266305759. The clinic is open from Mondays to Fridays - 1:00 PM to 7:00 PM, and on Saturdays - 9:00 AM to 3:00 PM. Also, please visit or