Colon and rectal, or colorectal, diseases encompass a wide range of conditions and disorders, which can have mild to life-threatening consequences. Like many other diseases, especially cancer, early detection through screenings has the potential to significantly improve quality of life, treatment outcomes, and even overall survival rates among patients. Yet, many patients are too embarrassed or remain uninformed about alarming symptoms and the benefits of early detection and treatment of colorectal diseases, which delays or even prevents them from seeking treatment. Common colorectal disorders include the following:
Colorectal cancer
According to the American Cancer Society (ACS), it is the third most commonly diagnosed cancer as well as the third leading cause of cancer-related deaths in both men and women in the US. The ACS also recommends adults at average risk for colon cancer commence regular screening at the age of 45.
Hemorrhoids
They represent swollen veins near or around the anus and rectum, and by age 50, almost half of all adults will have experienced symptoms (pain, itching, bleeding, and/or sensitive lumps) of this very common ailment.
Inflammatory bowel disease (IBD)
This is comprised of ulcerative colitis and Crohn’s disease. Ulcerative colitis effects the colon (large bowel), while Crohn’s disease can technically occur anywhere between the mouth and the anus. Medications may control IBD, but there are patients that require surgical management of their disease.
Irritable bowel syndrome (IBS)
Classic symptoms with this ailment include abdominal pain, bloating, and cramping accompanied by either diarrhea or constipation. Stress may make the disease worse.
Diverticular disease
Results in pockets (diverticula) in the wall of the colon, which can get infected intermittently and cause diverticulitis. This disease is typically a consequence of aging.
Anal fissures
Represents a small tear in the lining of the anus and can be quite painful, especially when having a bowel movement. The majority of fissures heal on their own with no need for surgery.
Bowel incontinence
Mild cases may be managed non-operatively, but moderate to severe cases may require injection of a bulking agent in the anus, placement of a nerve stimulator, or surgical intervention.
As there is much overlap with symptoms of colorectal diseases, as well as the probability of misdiagnosis/mistreatment, you should always be evaluated by a colorectal surgeon if you are experiencing these types of symptoms. This type of surgeon is an expert in the surgical and non-surgical treatment of colorectal ailments. One such expert is Karen Zaghiyan, MD, a board-certified colorectal surgeon who practices minimally-invasive colorectal surgery in Los Angeles at La Peer Health Systems. We sat down with Dr. Zaghiyan for a Q&A session to learn more about her process and how she helps La Peer patients.
Q: What first sparked your interest in the colorectal field?
A: Colorectal cancer runs in my family. So, while in college, I became interested in learning about the gastrointestinal tract and how it works, and while in medical school, I spent some time in the lab researching colon cancer. It wasn’t until surgical residency, however, that I discovered how rewarding colorectal surgery was. During residency, I was exposed to the vastly different subspecialties of surgery and found immense satisfaction in doing a major colorectal operation to cure cancer or inflammatory bowel disease one day, and the next, I could do a hemorrhoidectomy or anal fistula surgery and restore the one part of the body nobody wants to talk or think about. I found great satisfaction in the powerful doctor-patient connection when a patient trusts you with their BUTT—literally!
Q: What are some of the most common reasons patients come to you in need of colorectal surgery?
A: Hemorrhoids, anal fissures, and anal fistulae are some of the most common colorectal conditions for which patients seek my expertise. Almost 4.5% of the population seeks medical advice for hemorrhoids alone, so by sheer numbers, I see many patients with hemorrhoids every week. Thankfully, I can often help these patients with office treatments alone and only a few will actually need surgery. I also see many patients needing surgery for colorectal cancer, Crohn’s disease or ulcerative colitis, rectal prolapse, and fecal incontinence.
Q: Is there a new or innovative colorectal procedure that you would like to highlight?
A: Transanal total mesorectal excision (TaTME) is one of the most cutting-edge operations in colorectal surgery right now. TaTME is performed for rectal cancer and ulcerative colitis, which allows the rectum to be removed without an abdominal wound and helps patients recover faster with less pain and better results. I am proud to say I have one of the largest experiences in this technique in the country and am one of the only surgeons on the West Coast currently performing this surgery.
The other “new” procedure is sacral nerve stimulation (SNS) for fecal incontinence (or bowel leakage problems). This procedure is actually not all that new, but for some reason, many patients and doctors don’t know it exists. SNS is a safe and simple outpatient procedure that can give patients suffering from bowel leakage their life back, and I am proud to be one of few doctors in the Los Angeles area treating fecal incontinence with SNS.
Q: Can you talk a bit about your time spent in Singapore?
A: During the end of my fellowship training in colorectal surgery, I went to Singapore to learn from masters in colorectal surgery from all around the world. It was a phenomenal experience that opened my eyes to the rapid growth and innovation of our field and what can be achieved if we think outside the box, learn from each other, and are open to change. I came back to the U.S. eager to apply what I had learned and push the limits to continue to advance our field with new techniques.
Q: Is there a particularly memorable patient success story that you would like to share?
A: Seeing young patients get sick hurts my soul. I guess because “it’s not supposed to happen.” One of my favorite stories of hope I love to tell is that of a 35 year-old young mom with rectal cancer. I diagnosed her four years ago after she had been told over and over that her rectal bleeding was from hemorrhoids. I placed one finger inside her anus and knew what it was, nobody had checked before that. She was my age at the time and had young kids, like I did. To make it worse, the cancer had spread to her liver (Stage IV). After chemotherapy, radiation, a combined rectal resection (done by me) and liver surgery (done by a liver surgeon), then more chemotherapy, she was cancer-free. Four years have passed . . . I just did her colonoscopy and computed tomography (CT) scans . . . she remains cancer-free.
As you can see, colorectal disease is a diverse collection of conditions with a multitude of treatments. A colorectal specialist should be your guide on this treatment journey, and La Peer is grateful to have such a talented colorectal surgeon as Dr. Zaghiyan providing state-of-the-art care to our patients.
