Partial Colectomy with UC

Hi, I'm looking to see if anyone has any information they can share about partial colectomies in patients with UC.

My background: I've had UC since 2013, and was in rough shape until I started taking Entyvio in 2015. Things got better fast but plateaued quickly, and Entyvio never quite got me to remission. I started taking CBD oil in 2017, and that helped quite a bit with my remaining symptoms. For about the past two years, I've been going 4-6 times a day, mostly in the AM, with formed or mostly formed stool and no blood or mucus. Other than going more than normal, my only symptom is some urgency in the first couple BMs of the day.

In January of this year I had a colonoscopy. My doctor initially told me that I still had some active UC, but that things looked greatly improved since my last scope. Then the pathology came back - he told me that I had some abnormal cells, and that I would have to have another scope in 6 months. Here's what the pathology report from that colonoscopy says:

Ascending colon: Essentially normal colonic mucosa.

Transverse colon: Essentially normal colonic mucosa.

Descending colon: Fragments of colonic glandular mucosa showing small stromal lymphoid aggregates and one fragment showing low grade glandular dysplasia in a background of minimal chronic inflammation. No evidence of high-grade dysplasia or malignancy is identified.

Sigmoid colon @ 30cm: Colitis, moderate, with reactive glandular changes.

Sigmoid colon @ 20cm: Colitis, mild, nonspecific, with reactive glandular changes noted.

Rectum: Colonic glandular mucosa showing fragments of mixed hyperplastic and adenomatous polyp, with erosion, granulation tissue and background chronic inflammation noted. No evidence of high-grade dysplasia or malignancy is identified as sampled.

Fast-forward to last week, I had my follow-up colonoscopy, and my doctor found an 8mm mass. He called yesterday and told me the pathology identified it as a slow-growing neuroendocrine tumor, and said I would have to see a colorectal surgeon for a partial colectomy. I do not have a written copy of the pathology report yet.

I haven't been able to find any information online about partial colectomies specifically in patients with UC. Are they done often? Or does UC preclude that as an option in many/most cases? Any information is greatly appreciated.

Thank you!

I haven't either. I'm so sorry to hear they found a mass and that you will need surgery. Let us know how the consult with the surgeon goes. They should be able to give you more information regarding partial versus total colectomy with UC.

I have been thinking a lot about that, and...I guess I need to keep thinking about it.

My father’s friend has UC but about 25 years ago he had a rupture from diverticulitis and they did a resection leaving part of his colon.

He tells me that he still has bad days. I think his UC was never as bad as mine was when I had my colon.

I’d ask what’s the likelihood that the tumor/cancer would return to the remaining colon.

I looked into this matter a lot when my condition was severe. The reason they don't tend to do bowel resection with UC patients is that once they reconnect the bowel, the UC just starts up in the healthy section. For example if you removed just the rectum and then reattached the colon to the anus to form a new rectum, UC would start there again. However, if the whole colon is removed, then UC never returns, so they usually do it all in one shot.

Also, surgeries are very taxing on the body and the more surgeries you get the higher the risk of each subsequent surgery. This is because of scar tissue. They'll do it with Crohn's patients because there is really no choice, but multiple surgeries are to be avoided. Surgery is traumatic injury to the body.

It may be that if the primary need for the surgery is uncontrollable UC, then taking only part of the colon is the wrong move. But, it may also be that when the primary reason for the surgery is a tumor mass, that following the standard of care, resection, is the same as non-UC patients.

IT is possible that if future surgery for UC seems likely, then doing the whole colon now might be efficient. But you pathology does not look so bad. It is not clear that you will eventually need colon removed for UC. IF the colon-rectal surgeon is recommending only resection, then that might be seriously considered.

good luck.

Well it confirms cancerous mass in sigmoid, and some pre-cancerous hyperplastic changes in one of the descending colon polyps.

I wonder if a partial resection would remove just part of the sigmoid or also include the portion of the descending colon where the pre-cancerous polyp was found.

good luck at your appointment.

My mother had colon cancer in her 70s. I don't know the exact details except that the surgery only removed the cancerous section and some surrounding tissue -- she never had even a partial colectomy. She's now 93 so survival of colon cancer without a complete removal of the colon is possible. It depends on many factors. Talk with your doc and get a second opinion if needed.

The only time I've heard of partial colectomy being done in UC patients is when the patient is in remission (usually long term remission) but has developed cancer low down.

If you do decide to keep part of your colon, I'd look into Xeljanz, since Entyvio isn't getting you in remission.

Good luck, let us know how it goes. We have a number of knowledgeable posters who've undergone colectomy and are great resources as you heal.