However, if only the rectum and lower colon are involved, the risk of cancer is not higher than normal. Sometimes precancerous changes occur in the cells lining the colon. If the doctor finds evidence of dysplasia through endoscopic exam and biopsy, it means the individual is more likely to develop cancer. About 20 percent to 25 percent of ulcerative colitis patients eventually require surgery for removal of the colon because of massive bleeding, chronic debilitating illness, perforation of the colon, or risk of cancer. Sometimes the doctor will recommend removing the colon when medical treatment fails or the side effects of steroids or other drugs threaten the individual's health.
Individuals have several surgical options, each of which has advantages and disadvantages.
The surgeon and individual must decide on the best individual option. Again, in order to make an informed decision, ask the surgeon to fully explain the benefits, risks and costs of each option. The most common surgery is the proctocolectomy, the removal of the entire colon and rectum, with ileostomy, creation of a small opening in the abdominal wall where the tip of the lower small intestine, the ileum, is brought to the skin's surface to allow drainage of waste. A pouch is worn over the opening to collect waste and the individual empties the pouch periodically. The proctocolectomy with continent ileostomy is an alternative to the standard ileostomy.