After rectal cancer surgery, men may have difficulty in getting an erection or ejaculation, and women may have sequelae such as sexual frigidity and vaginal dryness.
Whether the sexual function can be preserved after surgery depends on the attention of both doctors and patients
If the patient is over 80 years old and already has the first signs of incontinence, it may be better to preserve the anus than to cut it.
Compared to foreigners who suffer more from colon cancer, Chinese people are more “miserable”: the prevalence of rectal cancer exceeds that of colon cancer patients. “This is very troublesome because the rectum is located closer to the anus, which means that the anus may not be preserved; it also means that the ejaculatory nerve and erectile nerve of men may be damaged if the operation is not done properly, making it difficult or impossible to ejaculate after the operation; women are also affected, and there are many people who are sexually frigid after the operation. Clinical observation shows that more than 40% of patients have different degrees of ‘discounted’ sexual function after surgery.” Professor Lan Ping, vice president of the Sixth Hospital of Sun Yat-sen University, said that Chinese patients are often too subtle and never remind doctors of this; and many doctors do not pay attention to the quality of the patient’s post-operative sexual life, often everything about the tumor.
Experts remind: if the patient is over 80 years old and has the aura of urinary and fecal incontinence, it may be better to insist on anal preservation than anal cutting.
Rectal cancer patients: sexual function may die with the tumor
”Chinese patients are very reclusive, and they don’t say anything if doctors don’t ask. In fact, in recent years, as tumor is defined as a chronic disease and the clinical cure rate is getting higher, patients’ post-operative quality of life is being paid more and more attention. But just because doctors are not too attentive and patients don’t actively mention it, the sexual function and feelings of many rectal cancer patients just pass away quietly with the tumor being cut.” When it comes to this point, Lan Ping is very regretful: “You know, many rectal cancer patients are young adults in their 30s and 40s, and there are decades of long life waiting for them later.”
Lamping explained that many of the nerves that govern male and female sexual function and sexual sensation co-exist in the pelvic cavity together with the rectum, and surgical operations to remove the tumor, if not very precise, may damage these nerves, resulting in post-operative sequelae such as difficulty in erection and inability to ejaculate in men, and sexual frigidity and lack of vaginal discharge in women.
”About more than 40% of clinical patients with rectal cancer will unfortunately experience sexual impairment. Our hospital takes this issue more seriously, so we have narrowed down the range of patients with impairment to about 10 percent. It really depends critically on whether the doctor and patient pay attention to it.” Lan Ping suggested that it would be better for patients to take the initiative to remind doctors before surgery to help preserve their sexual function as much as possible, because after all, not every doctor will pay special attention to this area, more energy is definitely still focused on whether the tumor can be removed cleanly, but if the patient requests it, doctors are bound to handle it more carefully.
He revealed that they are currently working on a related topic: studying whether the neural stem cells that have been damaged after surgery can be reconnected to restore the patient’s sexual function, but it will take a long time for this to happen.
”Patients will be able to feel how their sexual function status is after the surgery during the hospitalization period, because although they cannot have sex at this time, the physiological reactions that should be there will certainly still be there.” In addition, he reminded that sexual life can start only after about one month after surgery, and before that, rest and recuperation should also be the main focus.
Anal preservation is not always effective in elderly patients
”Anal preservation” is one of the hottest keywords in the field of rectal cancer treatment in recent years, and many patients will cry out to their doctors at first: “I must preserve my anus! I’d rather die than preserve my anus!”
Lan Ping said he understands patients’ feelings: “Not only is it physiologically inconvenient, but it also involves patients’ self-esteem, and removing the anus is equivalent to a disability in their eyes.” He said, at present, the level of anal preservation technology is developing well in China, and a considerable proportion of patients can achieve anal preservation as they wish, but it still varies from person to person, whether anal preservation can be achieved mainly depends on the size and location of the tumor and the degree of invasion of the intestinal wall. “In the past, it was thought that the tumor could be preserved when it was 7 cm away from the anus, but now it can still be preserved when it has developed to 5 cm or even 2 cm distance individually, but this is not an absolute standard, and it depends on the specific situation of individual patients.”
Lan Ping also pointed out that many elderly patients in their eighties, in fact, have already appeared incontinence aura, if at this time still insist on requesting anal preservation, even if successful, may also have poor results. “The elderly are not as compensated as young people, the anus is already more relaxed, and surgery will further damage the muscles around the anus, resulting in further deterioration of the sphincter function, and it is likely that life will be difficult to take care of itself after surgery.”
He said that such cases if not anal preservation is actually better, because after cutting the anal outlet will become in the lumbar abdomen, anal pouch as long as attention to care, replacement, is possible to keep the body fresh and odorless, the degree of convenience is rather greater than forced anal preservation.
Medical outlook.
More than 50% of rectal cancer patients may not do chemotherapy in the future
As we all know, most tumor patients have to go through a trilogy of surgery, radiotherapy and chemotherapy. But Lan Ping told reporters: in fact, more than half of the rectal cancer chemotherapy patients are just spending money on “white practice”, without any effect, but will hurt their bodies, leading to the decline of immunity.
”It is not that hospitals and doctors want to pit patients’ money, but the current means to screen out which patients are sensitive to chemotherapy and which are not, so for insurance purposes, they all have chemotherapy.” He introduced the survey data: 60% of rectal cancer patients can live for a long time without chemotherapy after surgery; 75% of patients who have chemotherapy can survive for a long time. In other words, the difference between doing it and not doing it is only 15 percent, and more than half of the patients actually live well without it, and a small number of patients who do it do not improve their survival rate.
”So we are now in contact with international experts and want to try to establish a research network for individualized tumors in the hope that in the future we can discover more sensitive and insensitive markers for colorectal cancer so that we can effectively distinguish between various types of patients in the face of treatment. For example, patients are told: You have 90% possibility to live long term without chemotherapy, do you see if you still need it? This way the treatment can be targeted, but also save the patient’s medical costs and avoid some unnecessary medical harm.” Lan Ping said.
In addition, he said, the intended research also hopes to discover more accurate molecular markers to predict the likelihood of tumors in healthy people in the future, and to “calculate” the probability of cancer in combination with their family genetic background and their own situation, which will help high-risk people to be more vigilant and have regular checkups to achieve early detection and treatment. It can help high-risk people to be more alert and have regular checkups for early detection and treatment.