PALLIATION IN THE MANAGEMENT OF CARCINOMA OF THE COLON AND RECTUM.

Palliative treatment is necessary in approximately 67 per cent of patients in whom a diagnosis of carcinoma of the colon or rectum is made. Extending the scope of surgery will not improve this figure. Decreasing the current 80 per cent delay in the diagnosis of the disease should increase the number of patients surviving five years. Before palliative measures are instituted it must be definitely determined that a curative procedure still could not be done. In case of doubt exploratory celiotomy is indicated. When the patient is beyond the curative stage there is still much that can be done if the physician takes an active interest and assumes a positive approach to the problem. The results are often rewarding with survivals beyond 5 years not uncommon. Four things can be accomplished by palliation: relief of pain, relief or prevention of obstruction, prolongation of a useful life, and support of the patient's morale. Before the patient is subjected to possible additional suffering from any palliative measure, the possibility of accomplishing these objectives should be weighed carefully. Palliative exenterations and similar radical palliative procedures have little to offer in prolonging the patient's life and relieving his pain. A "preventive" colostomy should not be established in the expectation that obstruction might develop at some time in the future. A "preventive" colotsomy is an unnecessary colostomy. When properly and sensibly employed, drugs, diet, radiation, fulguration, hypnosis, and surgery have much to offer as palliative measures in the management of carcinoma of the colon and rectum. [ABSTRACT FROM AUTHOR]

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