“A Colostomy Doesn’t Necessarily Mean ‘End-Stage'”… Experts Explain the Treatment and Prognosis Ahead for Hitoshi Matsumoto, Who Opened Up About His Colon Cancer Surgery

“The bloody stool wouldn’t stop.” “When I went to the hospital, it turned out I had cancer—big time.”

Hitoshi Matsumoto (62) of “Downtown” appeared on a live stream for “DOWNTOWN+,” a platform that broadcasts the comedy duo’s original content. For two consecutive days, he opened up about his colon cancer, sparking widespread attention.

He explained the circumstances leading to his treatment, revealing that he had undergone surgery to create a stoma (artificial anus) because “my intestine was protruding from my side,” and mentioned his treatment plan, stating, “I’m scheduled to have surgery to put the intestine back in a few months.”

In response to these revelations, various speculations are circulating online, such as, “If he has a stoma, wasn’t the cancer quite advanced?” and “Since he hasn’t undergone chemotherapy, was it detected at an early stage?”

We spoke with Dr. Yoshimasa Goto, Chairman of the Gorokai Clinic Shirokane-Takanawa—which has performed over 10,000 endoscopies—about the possible treatment methods and prognosis based on the information that has been made public (quotes below are from Dr. Goto).

Reconstructing the Intestine After Resection

Dr. Goto stated, “It is impossible to speculate on the condition based solely on the information that a stoma was created, ” and went on to say:

“Just because a stoma was created does not necessarily mean the cancer is ‘advanced’ or ‘terminal.’
In the case of colorectal cancer, the intestines are reconnected after the tumor is removed. However, when surgery is performed in areas close to the anus, such as the rectum, there is a risk of ‘anastomotic leakage,’ where the wound reopens as stool passes through the sutured area. For this reason, a temporary stoma may be created.

A temporary stoma is generally created in the lower abdomen using a section of the small intestine (ileum). Once it is confirmed that the intestinal anastomosis has healed properly, surgery is performed to close the stoma. In other words, the decision to create a stoma is not determined solely by the stage of the cancer. It is not uncommon for a stoma to be created to ensure a safe surgery and reduce the risk of postoperative complications.”

It is said that if the cancer has spread to the anal sphincter, a permanent stoma may be necessary.

Since Matsumoto mentioned that “surgery to reverse it will be performed in a few months,” it is believed to be a temporary stoma; however, as the specifics of the actual surgery have not been disclosed, this cannot be confirmed with certainty.

Since Matsumoto has not mentioned chemotherapy, some have speculated that his cancer is in an early stage, but Dr. Goto remains cautious on this point as well.

“Not all patients with colorectal cancer undergo chemotherapy. Generally speaking, in cases of early-stage colorectal cancer—Stage 0 (where the cancer is confined to the mucosa) or Stage I (where it is confined to the intestinal wall)—treatment is often completed with endoscopy or surgery alone, and chemotherapy is not necessary in many cases.

Furthermore, even in Stage II (where the cancer has spread beyond the intestinal wall), if there is no lymph node metastasis or distant metastasis and the tumor can be completely resected surgically, there are quite a few patients who, after an assessment of their risk of recurrence, are placed under observation without receiving chemotherapy.

“However, even in Stage II cases, if the cancer has spread extensively beyond the intestinal wall or has caused intestinal obstruction or perforation (a hole in the intestine)—and the risk of recurrence is therefore deemed high—chemotherapy may be considered.”

On the other hand, Stage III generally involves lymph node metastasis, so chemotherapy aimed at preventing recurrence after surgery is typically considered as the standard of care. In Stage IV cases, which involve distant metastases to organs such as the liver or lungs, the treatment plan is determined by combining chemotherapy—as the mainstay—with procedures such as resection of metastatic lesions and radiation therapy.

“However, this is merely a general guideline. Since the treatment plan varies depending on the patient’s age, overall health, and pathology test results, it is not possible to say, ‘Because it is Stage XX, this treatment is mandatory.’”

In other words, it would be premature to conclude that “not receiving chemotherapy = early-stage cancer.”

“At this point, we cannot determine the stage of Mr. Matsumoto’s colorectal cancer. The stage is determined by considering not only the size of the tumor but also how deeply the cancer has invaded the intestinal wall, whether there is lymph node metastasis or distant metastasis to organs such as the liver or lungs, and the results of the pathological examination of the tissue removed during surgery.”

The prognosis varies significantly depending on the pathology results

The prognosis varies greatly depending on the final stage and the results of the pathological examination. Treatment for colorectal cancer has advanced significantly, and many patients can expect long-term survival if there are no metastases and they undergo surgery at the appropriate time. On the other hand, if the risk of recurrence is high, patients will undergo regular checkups and, if necessary, receive additional treatments such as chemotherapy.

While some speculated that “the stress from the scandal involving a woman—which led to the suspension of his entertainment activities—might have caused the colorectal cancer” or that “the illness was a case of karma, ” Dr. Goto refutes these claims.

“Cancer is neither a punishment nor a case of ‘what goes around comes around.’ It is a disease caused by a combination of various factors, including aging, genetic factors, lifestyle habits, environmental factors, and random genetic mutations. There is no medical basis for linking past actions to the disease, and such thinking can also hurt patients and their families who are facing the same illness.”

Drawing on his experience as an internist who has treated numerous conditions, Dr. Goto continued:

“As an internist, I have treated a wide range of conditions, from cancer and lifestyle-related diseases like diabetes to mental health disorders. What I’ve come to realize through this experience is that, in a sense, illness is equal. No matter how distinguished a person’s position may be, or how carefully they’ve managed their lifestyle, illness can strike anyone.

Of course, there are diseases that can be detected early through screenings, and there are others where the risk of onset can be reduced by adopting healthy lifestyle habits. The value of prevention and screenings is by no means small. However, that is a completely different matter from the idea that ‘people who weren’t careful get sick.’ I believe we should not attribute the fact that someone has become ill to their lifestyle or character.”

During the live stream, Matsumoto said, “There are many people in the world who live with a stoma, so I want people to understand more about it.”

Even when discussing a serious illness, his ability to speak in his own words—sometimes interweaving humor—revealed his pride as a comedian. We sincerely hope that Matsumoto’s revelation will serve as a catalyst for broadening understanding of colorectal cancer and ostomies.

*This article explains general concepts regarding colorectal cancer based on publicly available information and does not discuss Hitoshi Matsumoto’s individual diagnosis, stage of the disease, or prognosis. Please be sure to consult your attending physician regarding symptoms and treatment plans.

Supervised by: Yoshimasa Goto / Chairman, Gorokai Clinic Shirokane-Takanawa. Graduate of the National Defense Medical College.