As a society, we don’t much like talking about medical problems related to the colon and rectum. But it’s important to be aware of what’s going on down below. Although it’s certainly not the only…
As a society, we don’t much like talking about medical problems related to the colon and rectum. But it’s important to be aware of what’s going on down below. Although it’s certainly not the only disease that can arise in the colon or rectum, cancer is a big problem in this region of the body. The American Cancer Society reports that colorectal cancer is the third leading cause of cancer-related deaths in men and women in the United States, one that’s expected to cause 50,630 deaths in 2018.
If you’ve been diagnosed with colorectal cancer, you’ll likely need to see a colorectal surgeon. But cancer isn’t the only disease these highly trained specialists treat. They can also help patients with various diseases of the small intestine, colon, rectum, anus and perianal area, says Dr. Christopher Buzas, a colorectal surgeon with Geisinger in Danville, Pennsylvania. “The most common conditions a colorectal surgeon treats are colon, rectal and anal cancer. But we can also take care of inflammatory bowel disease — so that’s Crohn’s disease and ulcerative colitis — diverticulitis, and then the full gamut of anal-rectal problems such as hemorrhoids, anal fissures and anal fistulas.” They can also treat constipation and fecal incontinence.
A colorectal surgeon’s area of specialty may also include organs and tissues related to intestinal disease, such as the liver and urinary tract and female reproductive system. This means these doctors may overlap with some other specialists, including urologists, gastroenterologists and gynecologists in certain cases.
It may be time to see a colorectal surgeon if you develop problems such as bloody stool, increasing constipation or other changes. “Any change in bowel habits that’s not normal or short-lived” is worth getting checked out, says Dr. Martin R. Weiser, a surgical oncologist specializing in colorectal surgery at Memorial Sloan Kettering Cancer Center in New York. “Of course, everybody gets changes related to gastroenteritis, either from viruses or food,” from time to time, he says, “but things that persist should be worked up and not assumed to be benign.”
When it comes time to meet with a colorectal surgeon to address whichever problem you might be dealing with, you should ask a few questions to make sure you’re working with the right doctor for your particular situation.
1. What is your experience?
Weiser says the most important question a patient can ask a colorectal surgeon is how much experience he or she has with a particular disease or procedure. “If someone doesn’t bring it up, I’ll bring it up,” Weiser says, because it’s a big piece of the puzzle to know how many procedures the surgeon has completed and what the outcomes were.
He says many of his patients will bring in journal articles or studies and ask specific questions about advances in the field. “I think most surgeons would talk about that,” but if the doctor seems uncomfortable or dismissive, that might mean it’s time to find someone else to work with. He says you may also want to get a second opinion after any visit with a colorectal surgeon. “Any surgeon who gets upset [about second opinions] is probably not someone you should see. I think it’s reasonable to go for second opinions.”
Buzas adds that it’s important to consider how recently a physician has performed a certain procedure, as there’s a practice element at work. “Don’t just ask how many of these they’ve done over their career but how many have they done recently. You don’t want somebody who hasn’t done something in 5 or 10 years.”
Like many other specialist physicians, colorectal surgeons can have areas of expertise, such as inflammatory bowel disease or cancer. Therefore, finding a doctor who focuses just on your specific problem may be a good approach.
2. Are you board-certified?
Buzas says board certification is also a critical component of determining who the best doctor is for your situation, as it can be a strong indicator of a physician’s qualifications. The American Board of Colon and Rectal Surgery offers certification for colorectal surgeons. You can search for your surgeon’s certification on the board’s website. To achieve certification, physicians must complete five years of general surgical training and one year in colon and rectal surgery and pass rigorous examinations. They must also stay up-to-date on new technologies, treatments and surgical approaches and take a recertification examination every 10 years while also meeting other maintenance-of-certification requirements at regular intervals.
3. Have my medical records been sent over?
“Especially if you were being seen in another hospital or facility, bring all your medical records and all your imaging studies with you,” Buzas says. Better yet, have them sent over in advance so that your new doctor can review everything that’s already been done. “That way the doctor will have a chance to look over that stuff initially and instead of going through all the lab reports and previous progress notes or studies, you could just have a dialogue during the visit time.”
Buzas recommends writing down all your questions before you get to the doctor’s office so you don’t forget anything important you wanted to talk about. He says many patients feel nervous about the examination and “you’re going to be asked some difficult questions. If it has to do with a complex problem like rectal cancer or Crohn’s disease, you might forget the questions you had before you got into the office.” Writing them all down ahead of time can help you make sure you don’t miss anything.
He also recommends bringing a family member or friend with you to the appointment. “Especially when it comes to more complex things that would require a large operation, it’s important to bring someone else with you. You’re going to get a lot of information, and especially if you hear the word cancer, a lot of times the patient just shuts down,” and misses a lot of important information. A loved one can act as a second set of ears and your advocate if the appointment becomes too overwhelming.
There’s more than one way to skin a cat, as the saying goes, so “it’s very reasonable to ask your surgeon, ‘what’s your preferred way to do this and how many have you done,'” Weiser says. Particularly when it comes to deciding between having an open procedure or minimally invasive surgery, finding out the surgeon’s preference and experience can help guide your decision. “What you want to avoid is saying, ‘I have this problem and I want it to be treated this way,’ because some surgeons may say that they’ll do it that way even though maybe they’re not fully comfortable with that,” Weiser says. Here, the doctor’s expertise can help guide you to the best possible treatment.
For some patients, depending on the condition, you may not need a surgical approach at all, and Buzas says most colorectal surgeons will seek to exhaust nonoperative methods of treating disease before moving to surgical options. “A fair amount of what we see doesn’t even need a surgical approach. You can usually treat these things medically so we can avoid surgery if possible.”
You should also ask about any side effects related to treatment so that you’ll be prepared for what to expect. And if you need to make any dietary changes, you should discuss that upfront as well.
5. What should I do before the visit?
Before you visit with a colorectal surgeon, it’s important to have a thorough understanding of your family history. “Especially when young people come in, it’s important to ask about relatives who may have had cancer because that could change things,” Weiser says. If an aunt or uncle had cancer — not necessarily just colorectal cancer — for example, that can help your physician nail down a diagnosis or guide treatment. “There’s associated cancer syndromes that could be important, so checking on family history is good,” he says.
6. Am I comfortable with this doctor?
There’s some questions you should ask yourself when looking for the right colorectal surgeon. Top among them is: Am I comfortable with this doctor?
Weiser says in many cases, the relationship between patient and colorectal surgeon can become a long-term one. “The majority of my practice is cancer, and I follow those patients for five years generally.” He also treats some patients with diverticulitis, and that may require a year-long follow-up before he sends them back to their gastroenterologist, “so it depends on the disease process,” and some care may last even longer. “For instance, there are some anal diseases where I may follow someone indefinitely. If they have premalignant disease in the anus, such as dysplasia, I may see them once or twice a year forever,” he says.
Buzas says he also sees many patients long-term, “so certainly when you initially meet with your surgeon, you want to make sure that you get along with them and that you have a good relationship. Sometimes people just don’t click, and if you’re going to be interacting with someone for that long a period of time, then you should have some sort of rapport.”
He notes that recurrence can also be a problem, so if possible, look for a doctor who isn’t close to retirement in case you need additional treatment down the line. “Sometimes these things can come back and if they do, you would want to make sure you can go back to the same person. They know what care you’ve had and they’d know what the next step would be,” Buzas says.
You should also ask about the doctor’s facilities. Part of ensuring good care means having the right set-up and equipment, such as having bathrooms in exam rooms, Weiser says. That way, if you need an enema or need to evacuate after a procedure, the facilities are right there, rather than down the hall. “Things like that make the whole enterprise that much easier,” plus less anxiety-inducing for patients.
And thinking ahead to eliminate anything that might discomfort patients is part of everyday practice for a good colorectal surgeon. “It’s a very sensitive area,” Buzas says, and the best surgeons “understand that and know that different people relate to these types of problems in different ways. Some people like to joke about it, and some people don’t like to talk about it at all. You need a surgeon who can read emotions” and tailor a communication approach to your comfort level.