Fall 2002

Small rectal cancers can be resected transanally if confined to the mucosa and submucosa (Tis or T1 tumors). Deep rectal cancers or tumors with nodal involvement should have pre-operative chemoradiation. Identifying which tumors meet these criteria can be problematic. Very small and very large tumors can be readily evaluated by the experienced digital rectal examination. Tumors that are small but deep, or large and bulky but feel mobile are more problematic. With these digital examination is more difficult. Endoscopy adds no further information, and CT scan cannot distinguish the depth of invasion, merely the total wall thickness. MRI cannot separate the depth of invasion either, though it is superior to CT at finding perirectal lymph nodes. Trans-rectal ultrasound (TRUS) can visualize the layers of the rectal wall and demonstrate the depth of tumor invasion. Enlarged lymph nodes are readily seen, and if needed, biopsy can be undertaken. Patients with superficial lesions can be offered an appropriate trans-rectal local excision; while more advanced lesions can be treated more aggressively.

Trans-rectal ultrasound can also be used to follow rectal cancer patients postoperatively. The majority of local recurrences are extraluminal, and are often not palpable. TRUS can examine extraluminal tissues and identify recurrence before other modalities, allowing earlier intervention. Recent studies have shown a higher rate of resectability and increased survival with TRUS post-operative follow up. TRUS may also be beneficial for

 follow up of anal canal cancers but that data is still being collected.

TRUS is also quite helpful in patients with fecal incontinence. In many patients the history and examination are convincing that a sphincter defect is present and repair of the anal sphincter can be appropriately offered. In others, particularly those who have had previous anorectal surgery, or perhaps have some neurological condition, anatomical study of the sphincters is needed to properly guide therapy. If the sphincters are intact, no surgery is indicated.

For evaluation of sphincters, the procedure is often done in conjunction with anorectal manometry (also now available at HMH) while the patient is awake. Sedation is used for evaluation of rectal cancers.

The TRUS procedure takes about ten minutes. A bowel prep of two Fleet’s enema’s is required prior to the procedure. The patient may experience gas shortly after the procedure if injecting air into the colon was necessary to properly position the probe. There are no medical conditions that can make TRUS unsafe or hazardous except for the usual precautions if the procedure is done under sedation. TRUS is covered by Medicare.


KITSAP COLORECTAL SURGERY HAS A NEW HOME!
To better serve our patients, referring physicians, and business associates, we have relocated our office to the Eastwood Building at 2528 Wheaton Way, #103, Bremerton, WA 98310. Our phone (360) 377-4717 and fax (360) 377-4134 numbers remain unchanged.

Medicare will now cover a screening colonoscopy
every ten years for average risk patients

Kitsap ColoRectal Surgery, Johnny B. Green, MD, FACS, FASCRS
Eastwood Building, 2528 Wheaton Way, #103, Bremerton, WA 98310
(360) 377-4717 -- (360) 377-4134 fax
www.kitsapcolorectal.com