Patients who have surgery for rectal cancer often have an ileostomy (stoma bag). After the bowel containing the cancer is removed, there will be a join in the bowel and whilst this join is healing the stoma stops stool passing through it. Once this join has healed the stoma can be closed. However, bowel function may not return to normal and some people suffer with diarrhoea which has a great impact on their lives. We think that diarrhoea may be caused by a lack of healthy bacteria in the bowel. This could be improved through faecal microbiota transplantation (FMT).
These are the research projects that BDRF have funded.
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How do surgeons decide when to avoid or defunction a rectal anastomosis? Building a theory of how surgeon and organizational factors affect decision-making.
The project aims to build a theory of how surgeons weigh up different factors within the decision making process prior to deciding whether an individual patient gets a join in the bowel or a bag.
This study hopes to develop a method of collecting cancer samples from patients before treatment to ensure that genetic tests can be done accurately and reliably. The results of these will then help doctors advise each patient on the best treatment plan for them and their individual cancer. This project will lay the foundation for the next step which will be working out which genetic tests help best determine response to treatment.
The role of risk of recurrence, bowel function and avoidance of a permanent stoma in patient preferences for treatment for rectal cancer.
This research examines which factors are most important to people in making a decision about which rectal cancer treatments to have: reducing their risk of recurrence, avoiding a permanent stoma, having good bowel function. This research will also be able to see what level of (poor) bowel function people will put up with in order to avoid needing a permanent stoma and whether this varies by age, gender or disease stage at diagnosis, and will help inform health care professionals about what factors patients find important in making decisions about their treatment.
Emergency Laparotomy and Frailty; A national multicentre prospective cohort study of older surgical patients (ELF study).
Improving outcomes of emergency abdominal surgery for elderly and frail people
Devising a test to understand the origins of rectal cancer tumours, in order to fast track patients to the most effective treatment
Changes in circulating biomarkers of metastatic colorectal cancer when targeting platelet tumour cell interactions with anti-platelet therapy
The project will further understanding into how colorectal cancer cells spread and demonstrate how anti-platelet drugs could reduce this. The way the disease markers change in response to anti-platelet therapy would provide evidence for further investigation in larger clinical trials, potentially benefitting a huge number of patients.
A significant proportion of patients diagnosed with a rectal (final segment of the large intestine) cancer will present with a tumour that is unlikely to be completely removed with surgery alone. Many of these patients will be offered chemotherapy and radiotherapy prior to surgery. There is currently no reliable way to accurately predict which of these patients will respond to treatment, i.e. which cancers will shrink or completely disappear, or which will continue to grow despite treatment.
An investigation of transcutaneous vagal nerve stimulation (tVNS) on return of bowel function and inflammatory cytokine response after colorectal surgery
Surgery on the bowel often leads to postoperative ileus (POI) - a condition in which the bowel “goes to sleep”. In most patients, the bowel soon returns to normal, but in 12% of patients POI is prolonged. This delays recovery and increases the risk of vomiting, constipation, breathing difficulties, and blood clots in the legs and lungs. A new device, GammaCore®, aims to minimise the occurrence of POI by stimulating the nerves to the bowel and reducing the time taken for return of normal bowel function. It is easy to use, has no known serious side-effects and the device can be used at home or in hospital.
We are conducting work on a protein found in abundance in colorectal tumours (Nrf2) which could be used to test for tumours which are likely to be more sensitive to radiation treatment, or indeed manipulated to increase the sensitivity of tumours to radiation treatment