Dr Misha Kabir

Decisions, decisions, decisions! Sound familiar? If you’re a potential pouchee one of the biggest decisions you may have to face is whether to have surgery after a bout of dysplasia -pre-cancerous cell changes that can lead to cancer if they are not removed.

In most cases dysplasia can be taken out during a colonoscopy (an examination of the large bowel and part of the small one using a flexible tube known as an endoscope). If this process doesn’t work, most medical professionals recommend surgery to remove the large bowel and the fitting of fit a pouch or stoma.

In a recent St Mark’s Hospital survey, which polled 113 responses, (see the December 2018 Roar!page 14) almost two-thirds of patients (64%) diagnosed with dysplasia opted to have surgery while 36% decided not to do so and have regular monitoring instead.

However, 35% of those who had never been diagnosed with dysplasia chose the surgical option, while 30% preferred regular monitoring and a further 35% were uncertain about what they would decide to do.

The reasons respondents gave when considering treatment are shown in Box 1 (below):

Survey leader Dr Misha Kabir, Clinical Research Fellow in IBD and Endoscopy at St Mark’s Hospital, told Roar!: “The respondents who preferred surgery were more likely to think that dysplasia progressed to cancer within a year and that colonoscopy surveillance alone would probably not prevent cancer developing in the future.

“Three-quarters of the 47 respondents who had previously been diagnosed with dysplasia felt well informed by their medical teams about the risk of cancer associated with a dysplasia diagnosis and the management options available to them.

“The majority also did not regret the final decision they made to have surgery – or not – for the dysplasia. They also completed a quality-of-life score which on average was the same for the patients who had surgery and those who had not done so.”

The reasons for not feeling well informed are highlighted in Box 2 below:

Dr Kabir added: “We hope to address the issues raised in Box 2 and to improve the information and the support we give to patients making these decisions in the future. As always we are grateful for the invaluable role that support groups like Red Lion Group continue to provide to patients making decisions about surgery.”