INSTRUCTIONS TO CANDIDATE

Mr Tom North has colorectal cancer and requires surgical resection. Please consent
him for a colectomy.

After 6 minutes you will be asked questions.

Domain Consent for colectomy Marks
Introduction Introduction, clarifies position 1
Consent  Consents procedure 2
Checks patient’s name, age, occupation and briefly presenting complaint (to ensure
correct person is being consented)
 Ensures patient is acting voluntarily and explain that if they consent to the
procedure, they can withdraw their consent at any time
 Checks patient understands English (if they have answered the above questions with
no trouble, this can be assumed)
General  The part of the bowel affected by the cancer will be removed 1
description  Some of the surrounding bowel & tissues (lymph nodes) will also be removed to
reduce the chance of the cancer recurring
 The bowel ends are then joined together
 A temporary or permanent colostomy may be performed – Surgeon brings part
of the bowel up to the skin
 Draws diagram 1
Benefit of  If the cancer is completely removed and there is no distant spread, the cure rate 1
surgery is very high. Depends on the stage of the cancer
Before  Usually admitted to hospital the day before surgery 2
 Do not eat or drink anything (even water) at least 8 hours before surgery
o Ask your doctor which medications should be stopped and which should
continue to be taken
o If your medications need to be taken, take them with a small sip of water
 The evening before, the bowel is cleansed using a bowel preparation solution
 Some tests may be performed before the surgery
o Colonoscopy, physical examination, blood tests
 A catheter may be placed for urine, as well as several IV lines for fluids
During  Anaesthetist gives you a general anaesthetic so you go to sleep 3
 A tube is placed into your throat to assist breathing
 Open surgery: Midline incision is made (about 15-20 cm); or laparoscopic
surgery: several small incisions through which instruments and cameras are
inserted, abdomen filled with gas to expand it to make it easier to see inside
 The tumour is localised and other organs may be inspected for spread of the
tumour
 The tumour is then removed, together with surrounding bowel & glands that
cancer cells may have affected
 If there is enough healthy bowel remaining, both bowel ends are stitched
together
 Estimation of duration: 2 hours
 Estimation of pain/discomfort: will be unconscious during operation
After  You will wake up in the recovery room and be transferred to the ward 3
 You may feel drowsy, nauseated and may have a sore throat due to the tube
 You may feel pain
o Patient controlled analgesia (PCA) – you control the amount of
medication given
o Pethidine injections, suppositories, IV medication
 Your intestines need to recover from the surgery
o No food is given for 4-5 days
o IV infusions will provide you with fluids and minerals your body needs
 Once you have passed flatus, you can drink
 Once the intestines resume their normal function, liquid food is given for the
first few days before you can have solids
 While recovering, you may be given heparin or anticoagulants to stop clots from
 forming in your legs
o These can travel to your lungs and cause problems
 A stoma nurse or physiotherapist may also visit you to help improve your
recovery
Risks Common risks: 1
 Anaesthesia – Risk is very small
o Allergic reaction
o Breathing problems
 Surgery
o Blood clots in the legs that may travel to the lungs
o Breathing problems, heart attack or stroke during the surgery
o Infection
o Bleeding
Specific risks
 Damage to nearby organs 1
 Wound infections – treated with antibiotics
 Bleeding inside your abdomen
 Incisional hernia – Bulging tissue through the incision site
 Adhesions – Scar tissue may form in your bowel which can cause blockage of
your intestines
 Recurrence of the cancer, which may occur locally
Risks of not doing the procedure
 The risk of not undergoing the procedure is the spread of the cancer 1
 Colorectal cancer can spread to nearby glands, and most commonly spreads to
the liver
 When cancer spreads to other organs, the cure rate decreases
Recovery and During your recovery 3
follow up  Avoid lifting heavy objects
 Follow a high-fibre diet
 Ensure care of the colostomy to prevent infections
Follow up
 You will need to have regular colonoscopies to ensure the cancer does not recur
o 3 months after surgery
o 1 year after surgery
o Every 3 years after first 2
 Regular stool occult blood tests every year
 Tumour marker screening
o CEA is a protein found normally in small quantities the blood
o It is present in increased amounts in people with colon cancer
o Should be measured before colon cancer surgery & then at intervals of 2-3
months
Patient Gives adequate opportunity for questions 1
Questions
Rapport Communication skills, patient feels comfortable 1

Examiner’s Questions
Are there any Chemotherapy 2
alternatives to o Can be used for patients unsuitable for surgery or in patients with cancer
a colectomy? that has spread. Have many side effects
Radiation therapy
o Only indicated in rectal cancers
Both chemotherapy & radiation therapy may be used after surgery to reduce the risk
of spread
Total 25
Fail ☐ Borderline ☐ Pass ☐ Clear Pass ☐

Colostomy
Temporary
A temporary colostomy may be performed to give the bowel enough time to rest
and recover
The bowel is brought up and through the abdominal wall to the skin
The edges of the bowel are stitched to the surface of the skin
A stoma bag is secured around the opening to allow stool to drain
Once your body has fully recovered, another surgery is performed to close up the
stoma & reattach large bowel
This is usually done after about 12 weeks, if there are nor complications

Permanent
Sometimes, if there is not enough bowel remaining to stitch together, a permanent
colostomy may be performed
A permanent colostomy is where the healthy end of the bowel is brought through
the abdominal wall to the skin
A stoma bag is secured around the opening to allow stool to drain
The other end is stitched up
 A few days following the surgery, there may be mucous discharge from the
anus
 This is normal and due to normal secretions
People with colostomies usually can do activities that normal people can do