Abdominoperineal resection (APR) is a type of a surgery in which the anus, rectum, and sigmoid colon are removed through small cuts in the belly. It is a surgical procedure done primarily to remove the cancer of the rectum. Typically, abdominoperineal resection (AP) is conducted as an elective procedure. This procedure is most often used to treat rectum cancer if it is located very low in the rectum or in the anus, close to the sphincter muscles.

Nowadays, advanced surgical techniques and other treatment modalities have brought an increase in the rate of sphincter-sparing operations. However, APR surgery is still necessary in selected cases, especially if the patient has distal tumors or poor sphincter function.  AP resection is a major operation. During perineal resection, the rectum, distal colon, and anal sphincter complex are completely removed using both anterior abdominal and perineal incisions. Once the anus and rectum are removed, a permanent colostomy is needed to complete the procedure.

Colostomy brings the colon to an opening at the surface of the skin, which allows the waste to pass out of the body. This new opening is called stoma and usually measures from one to one-and-a-half inches in diameter. A pouch, or a stoma appliance, is needed to be worn at all times. The stoma has no sphincter muscles, so there is no conscious control over the elimination of waste products from the body after the procedure.

• Overconsumption of animal protein, saturated fats, and calories
• Low dietary fibre intake
• Overconsumption of alcohol
• Excessive smoking
• Family history of colorectal cancer
• Obesity
• Physical inactivity

Colorectal cancer is the second most common cancer in the world. It can metastasize and spread to other body parts. Colorectal cancer is dangerous and can be life-threatening. But death rate from colorectal cancer has dropped in the recent years, thanks to advance screening techniques and better colorectal treatment options.

What is colon cancer?

Colorectal cancer is also known as bowel cancer, colon cancer, or rectal cancer. Colorectal cancer begins as an abnormal growth of cells in the inner lining of the colon or rectum. This abnormal growth is called a polyp.

Some types of polyps can change into cancer over the course of several years. But it does not mean that all polyps have the tendency to become cancerous. The chance of changing a polyp into colorectal cancer depends on the type of polyp that grows. 

Colorectal cancer can affect men and women equally. However, studies have proven that men might develop it at a younger age.

What causes colon cancer?

There is no definite cause of colorectal cancer, but old age and certain lifestyle factors can increase colorectal cancer risk. Some of these colorectal cancer risk factors include the following:

Types of Colorectal Cancer

A majority of colorectal cancers are adenocarcinoma. If you have been diagnosed with colorectal cancer, there are 95 percent chances that it is an adenocarcinoma. But there are some other types of colorectal cancer such as carcinoid, gastrointestinal stromal, lymphomas, and sarcomas.

Colorectal Cancer Symptoms

There are no early signs of colorectal cancer, but once it grows, the patients may experience the following colon cancer symptoms:

• Fatigue, weakness, and shortness of breath
• Change in bowel habits, including diarrhoea or constipation
• Blood in stool
• Abdominal discomforts such as cramps, bolting or pain
• Dramatic weight loss

A liver transplant surgery is conducted to remove the diseased liver and replace it with a healthy liver donated by either a living or a deceased donor. There are a huge number of people who are listed on the waiting list for a liver transplant because the availability of donated liver is limited. This is the reason why a liver transplant is an expensive procedure and is conducted only in rare cases.

Qualifications for Liver Transplant Recipient

A healthy liver plays an important role in the human body. It plays a key role in the absorption and storage of key nutrients and medications and also helps eliminate bacteria and toxins from the blood.

However, a healthy liver may get diseased over a period of time due to many reasons. Patients with the following liver-related conditions are considered for the liver transplant procedure:

• Acute liver failure triggered by drug-induced liver injury among other reasons
• Chronic liver failure or end-stage liver disease due to liver cirrhosis
• Hepatic tumour or cancer
• Nonalcoholic fatty liver disease (NAFLD)
• Alcoholic liver disease
• Chronic viral hepatitis
• Diseases causing liver failure
Some of the leading reasons that contribute to liver cirrhosis include the following:
• Diseased bile ducts that carry the bile juice from the liver and small intestine to the gall bladder
• Hemochromatosis, which is a genetic problem where the liver tends to build up iron undesirably
• Wilson’s disease wherein the liver accumulates copper by itself
• Biliary atresia in children, a condition wherein an infant is born without the bile ducts or has the ducts blocked or damaged
• Liver cancers such as cholangiocarcinoma, hepatoblastoma, or hepatocellular carcinoma

 Liver Disease Symptoms

The patients with liver disease may experience the following symptoms:

• Fatigue and weakness
• Nausea and loss of appetite
• Muscle and weight loss
• Black stools and vomiting
• Jaundice
• Problems with blood clotting
• Confusion and forgetfulness
• Build up of fluids in the abdomen

Stomach cancer, also known as gastric cancer, is the fifth most common cancer worldwide. This disease is a result of the growth of cancerous and malignant cells in the inner lining of the stomach.

Stomach cancer does not grow overnight as this disease usually grows slowly over many years. Some pre-cancerous changes take place before true cancer actually develops. But these early changes rarely result in any symptoms and therefore, often go undetected in the early stage when it is most easy to treat it.

Gastric cancer can grow through the wall of the stomach and invade nearby organs. It can easily spread to the lymph vessels and lymph nodes. In an advanced stage, it can travel through the bloodstream and spread or metastasize to organs such as the liver, lungs, and bones. Usually, people diagnosed with stomach cancer have either experienced metastasis already or eventually develop it.

Types of Stomach Cancer

Stomach cancer should not be confused with other cancers in the abdomen or esophageal cancer. Some other cancer can also occur in the abdomen, including cancer of the large and small intestine, liver or pancreas. These cancers may have different symptoms, outlook, and options for treatment.

Some of the common types of gastric cancer include:

• Adenocarcinoma: It is the most common form of stomach cancer and about 90 to 95 percent of stomach cancers are This form of cancer develops from the cells that form the innermost lining (mucosa) of the stomach.
• Lymphoma: This is a rare form of stomach cancer and only about four percent of stomach cancers are lymphomas. These are cancers of the immune system tissue, sometimes found in the wall of the stomach.
• Gastrointestinal stromal tumor (GIST): It is a rare kind of tumor that starts in very early forms of cells in the wall of the stomach calledinterstitial cells of Cajal. GISTs can be found anywhere in the digestive tract.
• Carcinoid tumour: It is also a rare form of stomach cancer and about three percent of stomach cancers are carcinoid tumors. Carcinoid tumors start in cells of the stomach that produced hormones.

Some other types of stomach cancers include squamous and small cell carcinoma and leiomyosarcoma. These cancers are very rare.

Stomach Cancer Causes

There is no single, definite cause behind stomach cancer. However, several stomach cancer risk factors have been identified that could potentially lead to the formation to a tumor in the stomach. Some of these stomach cancer causes or risk factors include:

• Inflammation of the gut called gastritis
• Infection with common bacteria called Helicobacter pylori
• Long-lasting anaemia
• Growth in stomach called polyps
• Smoking
• Obesity
• Excessive consumption of smoked, pickled or salty foods
• A-type blood group
• Epstein-Barr virus infection
• Certain genes (family history of disease)

Stomach Cancer Symptoms

There can be several early stomach cancer symptoms. However, the signs of stomach cancer could be present because of some other underlying condition as well. Unfortunately, this is the main reason why it is difficult to make stomach cancer diagnosis at an early stage.

Some of the early stomach cancer symptoms may include:

• Heartburn
• Regular indigestion
• Slight nausea
• Loss of appetite
• Frequent burping
• Feeling bloated

But just experiencing indigestion or heartburn after a meal does not really mean that you have cancer. Although, if you experience these symptoms a lot, talk to your doctor, who can decide whether to conduct further tests or not.

As advanced gastric cancer grow, you may experience more serious signs of stomach cancer, including the following:

• Frequent stomach ache or pain in the sternum
• Frequent heartburns
• Vomiting containing blood
• Dysphagia (swallowing difficulties)
• Loss of appetite, accompanied by sudden weight loss
• Blood in stools
• Excessive fatigue
• Yellowish eyes or skin