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 patient is more likely to develop cancer. About 20 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 patient's health.
Patients have several surgical options, each of which has advantages and disadvantages.
The surgeon and patient must decide on the best individual 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 patient empties the pouch periodically. The proctocolectomy with continent ileostomy is an alternative to the standard ileostomy. In this operation, the surgeon creates a pouch out of the ileum inside the wall of the lower abdomen.