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Fighting colorectal cancer

Steven Mills, MD, with assistant and patient
Paul R. Kennedy
Dr. Steven Mills, center, performs minimally invasive rectal cancer surgery.

Minimally invasive laparoscopy is now the gold standard for treating colorectal cancer

Although deaths from colorectal cancer are decreasing about 2 percent a year in the United States, about 57,000 people still die annually from the disease, which is one of the most preventable of all cancers.

"This type of malignancy typically begins as a small, benign growth in the lining of the colon," says UC Irvine colorectal surgeon Dr. Steven Mills.

The growths, called polyps, can become cancerous over a period of five to 10 years. They can be detected by a colonoscopy — a procedure using a lighted, flexible tube to examine the inner lining of the rectum and colon. "These growths can be removed simply and painlessly during the exam, stopping cancer in its tracks," Mills says. 

For people who aren’t tested, however, colorectal polyps may develop for years until they become malignant.

At this point, the key to survival is highly specialized surgical treatment, often supplemented by radiation and chemotherapy. Specialists at the H.H. Chao Comprehensive Digestive Disease Center at UC Irvine Medical Center are nationally recognized experts in the treatment of colorectal cancer.

Particularly challenging are cancers affecting the rectum. The gold standard for rectal cancer surgery is a procedure known as total mesorectal excision (TME). Until recently, this operation was always performed using conventional methods. Now Mills and colleague Dr. Michael Stamos are among only a handful of colorectal surgeons in the United States with enough experience to perform TME using minimally invasive techniques.

"For patients, a laparoscopic (minimally invasive) TME results in less blood loss, decreased pain, a shorter hospitalization and a faster return to normal activities," says Mills.

Technically challenging

Considered one of the most technically challenging operations performed for any type of cancer, laparoscopic TME requires superb surgical skills. Not only must surgeons work within the tight confines of the pelvic bones, but they also must avoid the tiny nerves governing sexual, bladder and bowel functions that are also located in this cramped space.

During the procedure, the surgeon removes the cancerous portion of the rectum, as well as any involved lymph nodes and blood vessels. "Special care is given to preserving the anal sphincter—the ring of muscles that governs bowel control," Mills says. "If the sphincter is damaged, it can lead to a permanent colostomy."

This life-altering procedure involves a surgical opening in the abdomen that allows waste to pass out of the body into a bag. "Advanced techniques are used to protect pelvic nerves, resulting in a high preservation rate for bowel, urinary and sexual function," he adds. "TME reduces the recurrence of local rectal cancer to under 10 percent."

At UC Irvine Medical Center, about 40 percent of cases involving the partial or complete removal of the colon and affected lymph nodes are now performed through a single, small incision hidden deep within the navel, making the procedure virtually scarless. The new approach has a significant learning curve and requires extensive experience. For this reason, it is only available at select medical institutions across the United States.

Radiation and chemotherapy also play critical roles in the care of colorectal patients. Individuals with this disease have ready access to a team of nationally renowned experts housed at the Chao Family Comprehensive Cancer Center.

"Quality of life is a major focus of the colorectal program," Mills says. "From diagnosis through treatment, our goal is to achieve a high cure rate. At the same time, we want to attain outcomes that provide our patients with a good body image so they can look forward with confidence to the rest of their lives."

For referral to a UC Irvine Health colorectal surgeon, call 888.717.GIMD.