Hitoshi Matsumoto Reveals Colon Cancer Surgery—Experts Explain the Treatment and Prognosis That May Follow

“My bloody stools wouldn’t stop. When I went to the hospital, they told me, ‘You’ve got a hell of a lot of cancer.’”

Matsumoto Hitoshi (62) of the comedy duo Downtown appeared on a livestream of “DOWNTOWN+,” a platform featuring original content from the duo. Over two consecutive days, he revealed that he had been diagnosed with colorectal cancer, sparking considerable public attention.

Speaking about the treatment he underwent, Matsumoto also revealed that he had a stoma (an artificial opening for waste) created, saying, “My intestines are sticking out from the side of my abdomen.” He also discussed his treatment, saying, “I’m scheduled to have surgery in a few months to put my intestines back.”

Following his revelations, various speculations began circulating online, including comments such as, “If he has a stoma, doesn’t that mean the cancer was quite advanced?” and “If he didn’t undergo chemotherapy, does that mean it was caught early?”

We asked Dr. Yoshimasa Goto, director of Goryokai Clinic Shirokanetakanawa, who has performed more than 10,000 endoscopic examinations, about the possible treatment and prognosis based on the information that has been made public. (The statements below are Dr. Goto’s.)

Reconstructing the intestine after removing the cancer

Dr. Goto emphasized that it is impossible to determine the severity of the disease based solely on the fact that a stoma was created, and explained:

“Having a stoma does not necessarily mean that the cancer was advanced or terminal.

In cases of colorectal cancer, after the cancer is removed, the two ends of the intestine are reconnected. However, when surgery is performed in a location close to the anus, such as the rectum, there is a risk of an anastomotic leak, in which the surgical connection can open because stool passes through the healing area. For that reason, a temporary stoma may be created.

A temporary stoma is generally created using the small intestine (ileum) in the lower abdomen. Once it has been confirmed that the intestinal connection has healed properly, another operation is performed to close the stoma. In other words, whether a stoma is created is not determined solely by the stage of the cancer. In many cases, it is created to allow surgery to be performed safely and reduce the risk of postoperative complications.”

If the cancer has spread as far as the anal sphincter, a permanent stoma may also be necessary.

Since Matsumoto said that he is scheduled to have surgery in a few months to put it back, it is reasonable to think that his stoma is temporary. However, the details of his actual surgery have not been made public, so this cannot be stated with certainty.

Some have speculated that Matsumoto has early-stage cancer because he has not mentioned undergoing chemotherapy. However, Dr. Goto takes a cautious view on this as well.

“Not every patient with colorectal cancer undergoes chemotherapy. Generally speaking, in cases of early-stage colorectal cancer—stage 0 (where the cancer remains confined to the mucosa) or stage I (where it remains within the intestinal wall)—treatment can often be completed with endoscopic treatment or surgery alone, without the need for chemotherapy.

Even in stage II (where the cancer has spread beyond the intestinal wall), if there is no lymph-node or distant metastasis and the cancer can be completely removed through surgery, there are many patients who are monitored without chemotherapy after their risk of recurrence has been assessed.

However, even in stage II cases, chemotherapy may be considered when the risk of recurrence is judged to be high—for example, when the cancer has spread extensively beyond the intestinal wall, or when it has caused an intestinal obstruction or perforation (a hole in the intestine).”

Generally speaking, stage III colorectal cancer involves lymph-node metastasis, so chemotherapy after surgery to prevent recurrence is routinely considered. In stage IV cases, where there is distant metastasis to organs such as the liver or lungs, treatment is determined primarily around chemotherapy, combined where appropriate with surgery to remove metastatic tumors, radiation therapy, and other approaches.

“However, these are only general guidelines. Treatment decisions vary depending on the patient’s age, overall health, pathology results, and other factors. It is therefore impossible to say that ‘stage X always means this treatment.’”

In other words, concluding that not undergoing chemotherapy means the cancer was caught early would be premature.

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

Prognosis can vary greatly depending on Pathology Results

Prognosis varies greatly depending on the final stage and the results of pathological testing. Treatment for colorectal cancer has advanced considerably, and many patients can expect long-term survival when there is no metastasis and surgery is performed at an appropriate stage. On the other hand, when the risk of recurrence is high, patients undergo regular examinations and may receive additional chemotherapy or other treatment when necessary.

Some speculation has also appeared online suggesting that stress from the scandal involving a woman that led to his suspension from entertainment activities may have caused his colorectal cancer or that his illness is karmic retribution. Dr. Goto rejects these claims.

“Cancer is neither a punishment nor karmic retribution. It is a disease that develops through a combination of many factors, including aging, genetic factors, lifestyle, environmental factors, and genetic mutations that occur by chance. There is no medical basis for connecting someone’s past actions with their illness, and such thinking can also hurt patients and families who are dealing with the same disease.”

Drawing on his experience as an internist treating a wide range of illnesses, Dr. Goto continued:

“I have treated many different illnesses as an internist, from cancer and lifestyle-related diseases such as diabetes to mental health conditions. What I have come to feel through that experience is that, in a sense, illness is equal in its reach. Regardless of how distinguished someone’s position may be, or how carefully they may have lived, anyone can become ill.

Of course, there are diseases that can be detected early through screening, and there are diseases for which the risk of developing them can be reduced by improving lifestyle habits. The value of prevention and screening should never be underestimated. But that is entirely different from saying that people who did not take care of themselves become ill. I do not believe that becoming ill itself should be portrayed as the result of a person’s way of life or character.”

During his livestream, Matsumoto said, “There are many people in the world who have stomas, so I want more people to know about them.”

Even while discussing a serious illness, his ability to speak about it in his own words, occasionally with humor, revealed the pride he carries as a comedian. One can only hope that Matsumoto’s disclosure will help increase public understanding of colorectal cancer and stomas.

This article explains general considerations regarding colorectal cancer based on publicly available information. It does not provide a diagnosis, cancer stage, or prognosis regarding Hitoshi Matsumoto personally. For symptoms and treatment decisions, please consult your treating physician.

Medical supervision: Yoshimasa Goto, M.D. — Director of Goryokai Clinic Shirokanetakanawa. Graduate of the National Defense Medical College.