Q&A on bowel cancer surgery

November's Dear Doctor Q&A will be led by Mr Matthew Hanson, a leading consultant in general and colorectal surgery.

View Mr Matthew Hanson's full consultant profile.

Do I have a hernia and do I need surgery?

Hernias are usually noticed as lumps or swellings that can cause discomfort and pain. There are lots of different types of hernias, but the most common are in the groin (inguinal and femoral) and abdominal wall such as belly button (umbilical), upper abdomen (epigastric) and at the site of a previous surgical scar (incisional).

They occur due to a weakness in the abdominal wall, which allows the abdominal contents such as fat and bowel to push outwards. They often get bigger when straining or standing and can completely disappear when lying flat. Hernias that don’t disappear or cannot be pushed back are called irreducible hernias and are more serious.

With a few exceptions, surgery is recommended to repair the hernia weakness. Hernia repairs can be performed through open incisions or keyhole (laparoscopic) surgery as day case procedures. The use of various types of mesh implants to reinforce the repair and reduce recurrence rates is now commonplace. The various options should be discussed at consultation.

What are gallstones and what symptoms may I get?

Gallstones are seen as a disease of middle aged women but they can occur in any age or sex. They form in the gallbladder, an organ attached to the lower edge of the liver. The gallbladder stores liver enzymes before they are used for digesting food. During storage these juices are concentrated and solid stones can precipitate out. They can cause pain in the upper right side of the abdomen below the ribcage. Pain from here can travel around the right side of the ribcage into the back.

Gallstones can cause pain after eating a meal, particularly fatty meals as the gallbladder is stimulated to contract. If the pain comes in waves this is called biliary colic. Constant pain with a temperature can indicate cholecystitis (inflammation of the gallbladder) requiring antibiotics and is a very common reason for hospital admissions and subsequent operation.

An ultrasound scan can confirm the presence of gallstones. Surgery should be considered for all symptomatic gallstones and is most commonly performed through keyhole (laparoscopic) surgery, which allows surgery to be done as a day case procedure.

I have some bleeding when I go to the toilet. Do I have haemorrhoids/piles or bowel cancer?

Haemorrhoids or piles can cause bleeding after opening the bowels. Bleeding will be bright red similar to that from a simple cut. Usually it is noticed on the toilet paper after wiping but they can bleed more heavily and even drip into the toilet bowl. Another common symptom is itching which can be eased by creams available from the chemist. As haemorrhoids enlarge lumps may also be felt around the bottom on wiping.

Haemorrhoids can be fully assessed in clinic with a short telescope inserted into the rectum. This also allows treatment in the form of injections or bands to be performed at the same time. Larger haemorrhoids may require surgery if particularly symptomatic.

Rectal bleeding is a major cause of worry and many people have seen the national awareness campaign regarding persistent rectal bleeding and being checked for bowel cancer. At consultation, the requirement for a camera test into the bowel known as a colonoscopy should be assessed and organised if required.

My mother had bowel cancer. Does it mean I will get it?

Most bowel cancer occurs sporadically, that is without any family link. As it is one of the most common cancers, it is possible for an older family member to have had bowel cancer that does not have a genetic link or increase your personal risk. There are however a proportion of bowel cancers that have a familial tendency and an even smaller group that do indeed have a significant genetic link.

In general, the more close relatives who have had bowel cancer and the younger the age of diagnosis the higher the possible risk to you. If you are concerned over your family history, even if you have no symptoms, a consultation may help to decide if further tests such as a colonoscopy are appropriate.

What is keyhole surgery and can I have it?

Keyhole surgery is known medically as laparoscopic surgery. It uses smaller incisions to allow the introduction of a long thin camera and instruments to perform the operation. The benefits Include less pain, smaller scars, less wound infections and quicker return to normal activities. Many procedures are now possible with keyhole surgery.

To book an appointment or to find out more information call 0208 709 7878.

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