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Hereditary Nonpolyposis Colorectal Cancer Treatment

Hereditary Colorectal Cancer Treatment

Doctors at Johns Hopkins are leading the way in research for treating hereditary nonpolyposis colorectal cancer and other colorectal conditions. We believe in staying active in current studies and promising new developments in colorectal conditions to further our understanding of these diseases. Through our continuous efforts to offer the latest treatment strategies, we continue to provide excellent patient care. Many patients choose to be part of our patient registry, which helps us gather information and learn how to take care of our patients even better in the future.

The goal for treating hereditary nonpolyposis colorectal cancer (HNPCC) is to remove the polyps and any presence of cancer. Sometimes an endoscopic approach is sufficient; other times, your doctor may recommend surgery.

Treatment for Hereditary Nonpolyposis Colorectal Cancer includes:

  • Endoscopic Treatment

  • Surgery

  • Lifestyle After Colorectal Surgery

    Comparison of proctocolectomy and colectomy surgical procedures
    Comparison of proctocolectomy and colectomy surgical procedures (Click to Enlarge)

Hereditary Colorectal Cancer Treatment: Endoscopic Treatment

If your doctor finds polyps during the examination, he or she may be able to remove them during the colonoscopy. A biopsy forceps is inserted into the colonoscope in order to see the polyps. If your doctor finds evidence of cancer, then colorectal surgery offers the best chance for a cure.

Hereditary Colorectal Cancer Treatment: Surgery

If cancer was found during the diagnosis, surgery is the first step in treatment. Removing the entire colon is the only way to treat existing cancer or prevent colon cancer from developing. There are a few different surgical options available. Your doctor will explain each one in detail and will choose the best approach to treat you.

Surgical options include:

Total Proctocolectomy with Brooke Ileostomy

During this procedure, the entire colon and rectum are removed. Your doctor will perform an ileostomy, which brings out your small intestine through the abdominal wall. Waste collects in an ileostomy bag. This procedure is generally performed when:

Technique for total proctocolectomy with Brook ileostomy (front and side views)
Technique for total proctocolectomy with Brook ileostomy (front and side views) (Click to Enlarge)

  • Invasive cancer is found in the rectum

  • The anal sphincter is not functioning normally

  • The sphincter muscle is weak

An ileostomy can be temporary or permanent.

Colectomy with Ileorectostomy

Technique for colectomy with ileorectal anastomosis (Click to Enlarge)
Technique for colectomy with ileorectal anastomosis

In this procedure, your doctor removes the colon but preserves all or most of the rectum. He or she then attaches the small intestine to the upper portion of the rectum. This is a less complicated operation than a total proctocolectomy and preserves bowel function. The main concern is that by not removing the rectum, there is potential for polyps and cancer to develop.

Restorative Proctocolectomy

Technique for restorative proctocolectomy (ileoanal pouch procedure)
Technique for restorative proctocolectomy (ileoanal pouch procedure) (Click to Enlarge)

During this procedure, the entire colon and most of or the entire rectum are removed. The end of the small intestine (ileum) is attached to the rectum with the creation of an ileal pouch. The advantage of this procedure is that you may maintain bowel continence while removing all of the at-risk large intestinal lining. The ileal pouch provides a place for rectal storage. Typically, the operation is performed in two stages:

  1. A temporary ileostomy is created.

  2. After a period of time, your doctor removes the ileostomy to direct the intestinal waste to the ileoanal pouch.

Lifestyle After Colorectal Surgery

Many patients worry about their sexual function after bowel surgery. Sexual function is not impaired after surgery or ileostomy. However, it is important that you and your partner understand the surgery and feel comfortable with it.  

A woman may be able to have a successful pregnancy following colorectal surgery. If you plan to become pregnant, you should consult your physician.

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