Hello all. Please let me know what you think or know about this: I have what seems to be some serious cuffitis and, for a whole host of reasons, am going to try to get a pouch reversal/ileo loop. In the meantime - 3-to-4 months - should I be worried about cancer of the cuff? For some reason I don't know nor can fathom, my surgeon left me with 8-10 cm of cuff instead of the usual 2-4 cm. How would my gastro guy test for this? Thanks to all in advance for your replies.
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Test for cuffitis or the size of your cuff? Either way, both would be readily discernable on scoping. The rectal cuff visually has a different appearance. Biopsies can give specifics on the type of inflammation.
Or are you asking about cancer? Testing would be the same regardless of the size of your cuff. Biopsies.
As to why you have such a long cuff (about 75-100% of your rectum), I can only guess that it had to do with your anatomical reach (the mesenteric blood and nerve supply).
https://en.m.wikipedia.org/wiki/Rectum
The typical rectal cuff is actually 1-2cm, so yours is quite long. There are other techniques for lengthening the reach without leaving excessive rectal cuff.
Jan 
Excuse me, I didn't know you are looking to have your cuff fixed. Now I understand why you posted about getting a temp ileostomy. Do you think your surgeon doesn't want to do this operation because maybe he realizes he left too much of your rectum at the base of your j-pouch?
There have been a lot of posts lately about rectal cuff cancers, many expressing concern that is much greater than the actual risk warrants. It's reasonable to keep an eye (and a scope with biopsies) on the rectal cuff periodically, but the risk of cancer of the rectal cuff (even an inflamed one) developing and spreading in any single six-month period is simply not something that's significant enough to appropriately drive any changes at all to your health care. If you're focused on this then there is certain to be something more important you're ignoring. Yes, folks with FAP need more frequent biopsies, and it's reasonable for folks with chronic inflammation to work out an appropriate (perhaps increased) pouchoscopy frequency with their doctors.
The colon cancer risk in UC really does get pretty high, but only over the course of years, and only when there's an entire colon at risk. Once there's only a small remnant of colon that's easy to biopsy with a small scope the risk is much, much lower. Cuffitis can be miserable, and needs to be managed, but it just doesn't help to make it worse with imaginary horrors.
Scott and TE Marie - Thanks for your responses. To clarifty. I'm hoping to get a permanent ileo in the next 3-4 months at the Clevelanod Clinic. In the meantime, I do wonder about my larger than normal, inflamed cuff. I have not been scoped for at least six months, so I am concerned about what's going on with my cuff regarding cancer. Why wouldn't I want it scoped again? Btw, I had my colon out because my gastro guy found pre-cancerous polyps.
TE Marie - Not being a shrink or mind-reader, who knows what goes in my surgeon's mind. But he is the chief or surgery at his hospital and does have that ego thing going on. But I think the fact that he has never done a reversal is the main reason, which could also be a result of ego. Regardless, it's moot now. I'm going to Cleveland.
From speaking to my own GI, scoping frequency is increased if there is serious chronic inflammation or a history of dysplasia in the colon, because those two pieces of information increase the cancer risk from low to something higher than low. Unless you have these two risk factors going on, scoping frequency isn't going to matter. I am on a one year scope cycle as a result of these two risk factors, and due to my Remicade treatment, I will be on a 3 month scope cycle to determine if it works.
I had been on a 2 year scope cycle and it was changed after my GI spoke to Dr. Shen about the Cleveland Clinc study on rectal cuff cancer. See this thread:
