Any Bowel Cancer Consultants out there?
Discussion
Basically, my father has just been told he needs a serious operation to remove part of his rectum. The consultant was discussing the TEMs option also, but he was doing his best to discount this option. But I got the feeling he has only just learnt this procedure! He even admitted he was only on a course about it last week.
Therefore, I think a second opinion is needed. How would we go about this without pi**ing off the consultant (afterall the major op might need to be carried out)
Any advice would be greatful, thanks.
Therefore, I think a second opinion is needed. How would we go about this without pi**ing off the consultant (afterall the major op might need to be carried out)
Any advice would be greatful, thanks.
Hi I am not a colorectal surgeon but a plastic surgeon and I think I can speak for the majority of surgeons (of all specialties) I would have no problem with a patient going for a 2nd opinion, especially when a major operation is on the cards. If the surgeon is any good he will be confident in his management plan and have no qualms about you going for an opinion from someone else.
I recently went with my daughter to see an ophthalmic surgeon regarding possible surgery and he actively encouraged us to seek a second opinion !
Hope things go well,
Drfrank
I recently went with my daughter to see an ophthalmic surgeon regarding possible surgery and he actively encouraged us to seek a second opinion !
Hope things go well,
Drfrank
audi321 said:
How do I go about a second opinion? Discuss with the original consultant?
yes, and he should organise it for you. It will all be very professional and offence will not be taken.GP can also help, but you want things to move quickly now and the hospital route is better.
I'm not a giblet surgeon either, carpentry is me.
audi321 said:
Basically, my father has just been told he needs a serious operation to remove part of his rectum. The consultant was discussing the TEMs option also, but he was doing his best to discount this option. But I got the feeling he has only just learnt this procedure! He even admitted he was only on a course about it last week.
Therefore, I think a second opinion is needed. How would we go about this without pi**ing off the consultant (afterall the major op might need to be carried out)
Any advice would be greatful, thanks.
Hi sorry to hear this. Therefore, I think a second opinion is needed. How would we go about this without pi**ing off the consultant (afterall the major op might need to be carried out)
Any advice would be greatful, thanks.
TME is now the gold standard operation. As has already been said, I would highly recommend a second opinion, which either your surgeon or GP should arrange (and actively encourage!)
Dont confuse TEM with TME.
"A more advanced technique for removing tumours without making a surgical incision is a technique called transanal endoscopic microsurgery (TEM) and is used for tumours high up in the rectum. This involves the surgeon inserting a specially designed endoscope into your anus to remove the tumour from the wall of the rectum. This technique is only performed by surgeons with special training, equipment and experience.
There are, however, occasions when it is necessary to perform an operation via an incision in your abdomen.
The ‘gold standard’ operation for rectal cancer is a technique called total mesorectal excision (TME). This procedure involves the careful removal of the whole of the rectum as well as the fatty tissue around the rectum (which contains the lymph nodes). Research has shown that TME is more effective than other types of surgery at reducing the chance of the cancer coming back.
Depending upon the position of the tumour in the rectum, its size, and how far it is from the anal sphincter (the muscle which keeps the anus closed and prevents stool leakage), your surgeon will perform the operation using the TME technique in the following way:
* Low anterior resection: The surgeon removes the tumour without affecting the anus; your colon will be attached to the remaining part of the rectum and you will be able to continue to move your bowels in the usual way after surgery, although a temporary stoma may be formed for a short period (e.g. 8-10 weeks)."
I have had the anterior resection--please contact me if you want to know about this .
John Bowen.
"A more advanced technique for removing tumours without making a surgical incision is a technique called transanal endoscopic microsurgery (TEM) and is used for tumours high up in the rectum. This involves the surgeon inserting a specially designed endoscope into your anus to remove the tumour from the wall of the rectum. This technique is only performed by surgeons with special training, equipment and experience.
There are, however, occasions when it is necessary to perform an operation via an incision in your abdomen.
The ‘gold standard’ operation for rectal cancer is a technique called total mesorectal excision (TME). This procedure involves the careful removal of the whole of the rectum as well as the fatty tissue around the rectum (which contains the lymph nodes). Research has shown that TME is more effective than other types of surgery at reducing the chance of the cancer coming back.
Depending upon the position of the tumour in the rectum, its size, and how far it is from the anal sphincter (the muscle which keeps the anus closed and prevents stool leakage), your surgeon will perform the operation using the TME technique in the following way:
* Low anterior resection: The surgeon removes the tumour without affecting the anus; your colon will be attached to the remaining part of the rectum and you will be able to continue to move your bowels in the usual way after surgery, although a temporary stoma may be formed for a short period (e.g. 8-10 weeks)."
I have had the anterior resection--please contact me if you want to know about this .
John Bowen.
The consultant has said that the tumor is around 12cm up the rectum. He said it is higher than he would like to do via TEMs (despite what I've read on other sites). In addition he said the cancer may have gone into the bowel wall futher than is possible than to remove with TEMs. He has agreed to do another test next week which will determine the depth into the bowel wall and will help him decide further.
He wants to do TME as my father is fit and well (for aged 74) and as you've said is the Gold Standard. For obvious reasons, my father would rather go for the TEMs procedure. The problems with the TME is 2 fold.
1. My father is very worried about the seriousness of the operation (i.e. 5% mortality rate from the operation alone!), 3-6 months recouperation period, stoma for 3 months min, maybe permanent.
2. My mother isn't too healthy either and would struggle to manage without Dad caring for her, and I would doubt she could care for him during the recouperation period.
My initial thoughts are that the consultant is inexperienced in TEMs (he said he was on a course about it 2 weeks ago) and he is verging on refusing to do it this way. The benefits of the TEMs route (i.e. No recouperation period, no stoma, no chance of dying on the operation table) are outwaying the comparably low 60% success rate of TEMs, but the issue is how do I tackle the consultant about it.
Does anyone have experience to advise me either way?
He wants to do TME as my father is fit and well (for aged 74) and as you've said is the Gold Standard. For obvious reasons, my father would rather go for the TEMs procedure. The problems with the TME is 2 fold.
1. My father is very worried about the seriousness of the operation (i.e. 5% mortality rate from the operation alone!), 3-6 months recouperation period, stoma for 3 months min, maybe permanent.
2. My mother isn't too healthy either and would struggle to manage without Dad caring for her, and I would doubt she could care for him during the recouperation period.
My initial thoughts are that the consultant is inexperienced in TEMs (he said he was on a course about it 2 weeks ago) and he is verging on refusing to do it this way. The benefits of the TEMs route (i.e. No recouperation period, no stoma, no chance of dying on the operation table) are outwaying the comparably low 60% success rate of TEMs, but the issue is how do I tackle the consultant about it.
Does anyone have experience to advise me either way?
As I said in my previous post,I have had the anterior resection which is the TME operation.
Don't really want to discuss all the details in public,so if you want to know more about this then PM me.
If he is fit then shouldn't be too much of a problem.
Had a stoma for eleven months--it is not a major problem.
Don't really want to discuss all the details in public,so if you want to know more about this then PM me.
If he is fit then shouldn't be too much of a problem.
Had a stoma for eleven months--it is not a major problem.
audi321 said:
The problems with the TME is 2 fold.
1. My father is very worried about the seriousness of the operation (i.e. 5% mortality rate from the operation alone!), 3-6 months recouperation period, stoma for 3 months min, maybe permanent.
2. My mother isn't too healthy either and would struggle to manage without Dad caring for her, and I would doubt she could care for him during the recouperation period.
1. While it is a major operation, for a fit healthy man I'd be *hugely* surprised if the mortality was as high as 5% for an elective anterior or AP resection; where have those figures come from? From the surgeon in question, or elsewhere? (Your surgeon should be able to give you an idea of his personal complication and mortality rates.)1. My father is very worried about the seriousness of the operation (i.e. 5% mortality rate from the operation alone!), 3-6 months recouperation period, stoma for 3 months min, maybe permanent.
2. My mother isn't too healthy either and would struggle to manage without Dad caring for her, and I would doubt she could care for him during the recouperation period.
2. While I appreciate that's a concern, that's in the short-term. If he makes the wrong decision, it could significantly affect his chance of *being around* to care for her in the longer term. If he did push for (what could turn out to be) the wrong operation, how well would your Mum cope with caring for a terminally-ill husband?
mft said:
audi321 said:
The problems with the TME is 2 fold.
1. My father is very worried about the seriousness of the operation (i.e. 5% mortality rate from the operation alone!), 3-6 months recouperation period, stoma for 3 months min, maybe permanent.
2. My mother isn't too healthy either and would struggle to manage without Dad caring for her, and I would doubt she could care for him during the recouperation period.
1. While it is a major operation, for a fit healthy man I'd be *hugely* surprised if the mortality was as high as 5% for an elective anterior or AP resection; where have those figures come from? From the surgeon in question, or elsewhere? (Your surgeon should be able to give you an idea of his personal complication and mortality rates.)1. My father is very worried about the seriousness of the operation (i.e. 5% mortality rate from the operation alone!), 3-6 months recouperation period, stoma for 3 months min, maybe permanent.
2. My mother isn't too healthy either and would struggle to manage without Dad caring for her, and I would doubt she could care for him during the recouperation period.
2. While I appreciate that's a concern, that's in the short-term. If he makes the wrong decision, it could significantly affect his chance of *being around* to care for her in the longer term. If he did push for (what could turn out to be) the wrong operation, how well would your Mum cope with caring for a terminally-ill husband?
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