Rectal cancer is easy neither on the surgeon nor on the patient. For the latter especially, the fight continues even after a surgeon has done his job, says Dr. Patta Radhakrishna, during an interview with our writer, Shali Ittaman.

Operating on a patient with rectal cancer can often leave many surgeons with sweaty palms. For valid reasons too, says Dr. Patta Radhakrishna, an eminent gastrointestinal oncologist and surgeon at the SIMS Hospital in Chennai.

The rectum, he explains, is bound deep within the hip casing, or the pelvis. It is also set tightly against other organs, including the urinary and reproductive structures. For a surgeon to wade past all those to reach the rectum, is by no means an easy task. Also, given its position, the chances of cancer from the rectum spreading to the other organs always remain high — which, when it happens, puts the surgeon in a further bind.

However, for surgeons such as Dr Patta, who are skilled in open, laparoscopic and robotic surgeries, the operation itself is not always the biggest challenge. For them, the point of pain is in getting the patient to say yes to a surgery, once having given him a preview of what life could look like post-surgery.

Ostomate colostomy: The hanging shit bag

The rectum forms the fag end of the large intestine. From here, the remnants of the food eaten, or the excreta, exit the human body. During a cancer surgery the rectum from the anus upwards is cut and removed. Thereafter, the hanging end of the intestine is channeled through a hole made in the abdomen, which then becomes the new passage for the faeces leaving the body.

If the patient is a man of means, he would pay to have an ostomate colostomy bag — a shit holder — stitched to his tummy; a kind of mobile loo to carry around with him as he goes about his daily life. If he is of lesser means, he would probably make do with used milk pouches, or even cloth rags.

Of course, at this stage the patient is effectively free of cancer. However, he would now be contending with the shit coming out of the new hole in his stomach!

The North-east experience

Dr. Patta, who was serving in the north-east region of India for a part of his career, has seen several cases of rectal cancer emerge from there. (The north-east is a place where the cancer load has always been on the higher side.) He still remembers how, many of them would refuse surgery when presented with the prospect of having to live with a shit bag clinging to their person. “Women, specially so…”

The hesitation

It is not that people haven’t learnt to live with the bag tied to their bellies. Many have! (There is now even a ostomates' club — bag wearer’s club — in India, where people out of rectal cancer surgery meet, socialise, share experiences and even find mates and life partners for themselves and for each other.)

For those, however, being seeded with the idea of a post-surgery life, there are, and genuinely so, causes for conflict.

“Many of them are wondering how their love life would unfold with a shit bag tied to their stomach. Others, especially the obese among them, are brooding on how they would function with a bag hanging under their ballooned tummies. Still others are trying to contend with the idea of going to work with the potty bag around their waists,” say Dr. Patta. 

He says a surgeon’s biggest challenge is to reason out with such people, and persuade them to go ahead with the life saving surgery.

(Shali Ittaman has been an editor at the Times of India and at the Hindustan Times in New Delhi. He has also been the head of the new media division at the Press Trust of India.)

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