This is cancer that begins in your colon or rectum. Often, it may start as a polyp which is a growth of abnormal tissue on the lining of the colon or rectum. Most people will not have symptoms of colorectal cancer until the disease is at a fairly advanced stage. Then they may experience symptoms such as: change in bowel habit that lasts for more than a few days blood in the stool stomach pain. Tests used to confirm a diagnosis of colorectal cancer include: stool blood test – a sample of stool is tested for traces of blood sigmoidoscopy colonoscopy barium enema – a chalky white substance (barium) and air are pumped into the colon and x-rays are taken biopsy – a small piece of tissue is removed for examination under a microscope. Stool blood tests, sigmoidoscopy, colonoscopy and barium enemas are also used as screening tests to look for colorectal cancer in people without symptoms. If these tests find cancers at an early stage, the chances of successful treatment are much higher than when the cancers are further advanced. Screening tests can also involve the removal of polyps that may become cancerous in the future. Treatment The choice of treatment depends on your overall health as well as how far advanced the cancer is. This is determined in a process known as ‘staging’ in which the tumour size, lymph node involvement and spread to other organs is assessed. The three main forms of treatment for colorectal cancer are: Surgery – the most common treatment. Surgery may involve ‘Open Surgery’ in which a large incision (cut) is made in your abdomen or ‘Laparoscopic Surgery’ in which several much smaller incisions are made. The section of the colon or rectum with the cancer is removed and the two ends are reconnected. In some cases, a temporary or permanent colostomy may be required to remove body wastes. Chemotherapy – anticancer medicines, either taken by mouth (oral) or injected into a vein (intravenous), can destroy cancer cells and slow tumour growth. Chemotherapy is useful to treat cancers that have spread to other parts of the body and may also be used before or after surgery or in combination with radiation therapy. Radiation Therapy – high energy x-rays are used to destroy cancer cells or shrink tumours. It is often used together with surgery, in some cases to shrink the tumour before surgery, or to destroy any cells that may be left behind after surgery.

There are two types of IBD, ulcerative colitis and Crohn’s disease. In these conditions, the immune system attacks the lining of the colon causing inflammation and ulceration, bleeding and diarrhoea. In ulcerative colitis this only involves the large intestine, whereas in Crohn’s disease areas within the entire intestine can be involved. Both diseases are chronic (long term) with symptoms coming (relapse) and going (remission) over a number of years. Symptoms depend on what part of the intestine is involved but include: o abdominal pain o diarrhoea with bleeding o tiredness o fevers o infections around the anus (bottom) o weight loss can occur if the condition has been present for some time. Diagnosis is made when the symptoms, examination and blood tests suggest inflammatory bowel disease, infection is ruled out, and you undergo a colonoscopy with biopsy. Treatment depends on the severity of the symptoms and what part of the intestine is affected. Medication is aimed at suppressing the immune system, which is harming the lining of the bowel. This is done via oral or intravenous medication as well as medication given as an enema (via the bottom). Other treatments include changes in the diet to optimise nutrition and health. Treatment in some cases requires surgery to remove affected parts of the bowel. For more information see www.crohnsandcolitis.org.nz

Conditions of the gut dealt with by general surgery include disorders of the oesophagus, stomach, small bowel, large bowel and anus. These range from complex conditions such as ulceration or cancer in the bowel through to fairly minor conditions such as haemorrhoids. Many of the more major conditions such as bowel cancer will require surgery, or sometimes treatment with medication, chemotherapy or radiotherapy. Haemorrhoids are a condition where the veins under the lining of the anus are congested and enlarged. Less severe haemorrhoids can be managed with simple treatments such as injection or banding which can be performed in the clinic while larger ones will require surgery.

Haemorrhoids are a condition where the veins under the lining of the anus are congested and enlarged. Less severe haemorrhoids can be managed with simple treatments such as injection or banding which can be performed in the clinic while larger ones will require surgery. Haemorrhoid Removal Haemorrhoidectomy: each haemorrhoid or pile is tied off and then cut away. Stapled Haemorrhoidectomy: a circular stapling device is used to pull the haemorrhoid tissue back into its normal position.

Colonoscopy is the examination of your colon (large bowel) using a colonoscope (long, flexible tube with a camera on the end). The colonoscope is passed into your rectum (bottom) and then moved slowly along the entire colon, while images from the camera are displayed on a television monitor. The procedure takes from 10 minutes to an hour. Sometimes a small tissue sample (biopsy) will need to be taken during the procedure for later examination at a laboratory. A colonoscopy may help diagnose conditions such as polyps (small growths of tissue projecting into the bowel), tumours, ulcerative colitis (inflammation of the colon) and diverticulitis (inflammation of sacs that form on the walls of the colon). Colonoscopy may also be used to remove polyps in the colon. Risks of a colonoscopy are rare but include: bleeding if a biopsy is performed; allergic reaction to the sedative; perforation (tearing) of the bowel wall. What to expect It is important that the bowel is completely empty before the procedure takes place. This means that you will only be able to have liquids on the day before, and will probably have to take some oral laxative medication (to make you go to the toilet more). When you are ready for the procedure, you will be given medication (a sedative) to make you go into a light sleep. This will be given by an injection into a vein in your arm or hand. The colonoscopy will usually take 15 – 30 minutes, but you will probably sleep for another 30 minutes. Because you have been sedated (given medication to make you sleep) it is important that you arrange for someone else to drive you home. Some patients may experience discomfort after the procedure, due to air remaining in the colon.

A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall in some way.

General surgery covers some disorders of the liver and biliary system. The most common of these is pain caused by gallstones. These are formed if the gallbladder is not working properly, and the standard treatment is to remove the gallbladder (cholecystectomy). This procedure is usually performed using a laparoscopic (keyhole) approach.