ASC Patient Education

Direct view of hemorrhoid seen on sigmoidoscopy

Hemorrhoids are actually the anatomical term for "'Cushions of tissue filled with blood vessels at the junction of the rectum and the anus." However, the term has come into common usage to indicate the condition described herein. Perianal hematoma are sometimes misdiagnosed and mislabled as hemorrhoids, when in fact they have different causes and treatments.

How do I know if I have haemorrhoids?
People with Hemorrhoids may experience the following symptoms:

Itchiness around the anal canal
Bleeding, usually bright red, ranging from light staining of toilet paper to profuse hemorrhaging
Mucous discharge
Pain, mainly in thrombosed hemorrhoids
Palpable Lump/mass in prolapsed hemorrhoids .

Rubber band ligation
Elastic bands are applied onto an internal hemorrhoid to cut off its blood supply.Within several days, the withered hemorrhoid is sloughed off during normal bowel movement.

Sclerotherapy (injection therapy)
Sclerosant or hardening agent is injected into hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up.

Laser, infrared or BICAP coagulation laser, Infrared beam, or electricity is used to cauterize the affected tissues. Lasers are now much less popular. Infrared coagulation has been studied in comparison with RBL and found to be as effective in hemorrhoids up to grade III. These are the most readily available non-surgical procedures in the US.

Hemorrhoidectomy
A true surgical procedure to excise and remove hemorrhoids. Has possible correlation with incontinence issues later in life; in addition, many patients complain that pain during recovery is severe. For this reason is often now recommended only for severe (grade IV) hemorrhoids.

Stapled Hemorrhoidectomy
Also called the procedure for prolapse and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the blood flow to the hemorrhoids. It is generally less painful than complete removal of hemorrhoids and also allows for faster recovery times. It's meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions.

Breast cancer is a cancer that starts in the cells of the breast. Worldwide, breast cancer is the second most common type of cancer after lung cancer and the fifth most common cause of cancer death. However, among women worldwide, breast

Mastectomy specimen containing a very large cancer of the breast (in this case, an invasive ductal carcinoma).

cancer is by far the most common cause of cancer, both in incidence anddeath.

In Singapore, 1 in 5 cancers occurred in women is breast cancer. 1100 new cases of breast cancer are diagnosed every year. The incidence is highest in women aged 55 and above.

Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males. Incidences of breast cancer in men are approximately 100 times less common than in women, but men with breast cancer are considered to have the same statistical survival rates as women.

Usually, there is no pain and other symptoms in early stages of breast cancer. As the cancer grows, the folling signs and symptoms could accur:

a dimpling and puckering of the skin
some discharges seen from the nipple
nipple retracted
the size or shape of the breast changed
a persistent lump or thickening felt in the breast or armpit area

Do I need to go for breast cancer screening if I don’t have any symptoms ?

for age 20 and above, do breast self-examination once every month
for age 40 and above, go for a clinical breast examination once a year, do a mammogram every two years
for age 50 and above, do a mammogram every year

Stomach cancer is often asymptomatic or causes only nonspecific symptoms in its early stages. By the time symptoms occur, the cancer has generally spreaded to other parts of the body, one of the main reasons for its poor prognosis. Stomach cancer can cause the following signs and symptoms:

Gastroscopy is also named Oesophagogastroduodenoscopy (OGD). It is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract up to the duodenum. It is considered a minimally invasive procedure. It is usually done with light sedation with little discomfort to the patient. It is an accurate procedure and can identify abnormalities and do biopsies if necessary. Complications from OGD are rare. Diagnostic gastroscopy is done usually less than 5 mins.

Common oesophageal diseases (e.g. reflux oeophagitis, oesophageal cancer, stricture and foreign body) and stomach diseases (e.g. gastric cancer and peptic ulcer) can be visualised by a diagnostic endoscopic procedure.

Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a camera on a flexible tube passed through the anus. In most cases, the endoscope is advanced to the caecum (end of colon) in under 10 minutes.

It provides a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy or removal of suspected lesions such as cancer. Colonoscopy can remove polyps smaller than one millimeter. Once polyps are removed, they can be sent for histology to determine if they are precancerous or not.

Indications for colonoscopy include gastrointestinal hemorrhage, unexplained changes in bowel habit, family history of colon cancer or suspicion of malignancy. Colonoscopies are used to diagnose colon cancer and other pathologies like inflammatory and ischemic bowel disease.
Due to the high mortality associated with colon cancer and the high effectivity and low risks associated with colonoscopy, it is recommended routine screening test for people 50 years of age or older.

This procedure is usually done under sedation with minimal discomfort. There is occasional pain when junctions are negotiated. There is also occasional abdominal distension after the procedure. This is due to air insufflation.

Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, keyhole surgery, or pinhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional surgical procedures. Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.

What are the advantages of laparoscopic surgery?
There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:

reduced blood loss, which reduces the risk of needing a blood transfusion.
smaller incision, which reduces pain and shortens recovery time.
less pain, leading to less pain medication needed.
hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.

Surgery cures by cutting and removing the cancer completely.it is most likely achievable in
Early cancer which is still localized and has not spread. Lymph nodes in the region of the cancer are included in the resection. More advanced cancer may require more extensive resection. When advanced cancer has spread to distant organs (stage 4), cure is usually not possible with few exception eg isolated spread to liver or lung in colorectal cancer are sometime cured after further surgical resection.

In incurable cancer, surgery could stall have a role as palliation e.g. restore food intake or stop bleeding or remove odstruction in advanced oesophageal, gastric or colorctal cancer.

Varicose veins are veins that have become dilated, elongated and tortuous irrespective of size. It usually occur in the leg. Veins have leaflet valves to prevent blood from flowing backwards (retrograde). Leg muscles pump the veins to return blood to the heart. When veins become enlarged, the leaflets of the valves no longer meet properly, and the valves don't work. One cause of valve failure is Deep Vein Thrombosis (DVT), which can cause permanent damage to the valves.

The blood collects in the veins and they enlarge even more. Varicose veins are common in the superficial veins of the legs, which are subject to high pressure when standing. Besides cosmetic problems, varicose veins are often painful, especially when standing or walking. They often itch, and scratching them can cause ulcers. Serious complications are rare. Non-surgical treatments include sclerotherapy, elastic stockings, elevating the legs, and exercise. The traditional surgical treatment has been vein stripping to remove the affected veins. Newer surgical treatments are less invasive (see radiofrequency ablation) and are slowly replacing traditional surgical treatments. Since most of the blood in the legs is returned by the deep veins, and the superficial veins only return about 10%, they can be removed or ablated without serious harm. Varicose veins are distinguished from reticular veins (blue veins) and telangiectasias (spider veins) which also involve valvular insufficiency, by the size and location of the veins.

Spider veins and varicose veins are abnormally swollen or enlarged blood vessels in he vein’s wall. Apart from being cosmetically unpleasant, varicose veins in their advance stages can be harmful to a patient’s health, because they may be associated with the development of one or more of the following conditions: inflamed tender vein, blood clot in the vein and skin ulcers.