A Cautionary Tale About Colon Cancer

In 2002, a vivacious and relatively young (only 44) Arlington wife and mother got some unexpected news—she had metastatic colon cancer. It was a cruel blow for a woman who didn’t have any symptoms or family history of the disease. She had only had a colonoscopy because her husband—10 years her senior—had been putting off his, so she offered to go along for morale support. He got a clean bill of health. She started the battle for her life—and lost it just four months after her 49th birthday and two months shy of her daughter's sixth grade graduation. Five years of surgery, chemotherapy, organic diets, clinical trials, and homeopathic treatment for colon cancer couldn't change the outcome.  Her colon cancer had been found too late.

Colon cancer is the second highest occurring cancer among both men and women after lung cancer. After the age of forty, you have a one in four chance of developing colon cancer during your lifetime. This year, 143,460 men and women will be diagnosed with the disease, and 26,470 men and 25,220 women are expected to die from it. But the numbers would certainly be much higher without the growing acceptance and practice of early detection measures—beginning with a simple rectal exam during your annual checkup. “If your doctor isn’t doing an annual rectal exam, you need to find another doctor,” says Ronald S. Kline, M.D., F.A.C.S., a board-certified colon and rectal surgeon. “Colon cancer is preventable, treatable and beatable. But you’ve got to be vigilant.”

Dr. Kline recommends that everyone begin having an annual digital rectal exam (DRE) at age 40, along with a fecal occult blood test. By age 50, you should begin having a colonoscopy every five years—unless colon cancer runs in your family or you have other predisposing factors. If so, bump it up 10 years and have your first colonoscopy at age 40. Of course, if you notice any of the warning signs—rectal bleeding, change in bowel habits, mucoid discharge, decrease in stool diameter, unexplained weight loss, abdominal pain or bloating, anemia—see your doctor right away.

Although all rectal bleeding is abnormal, it can be caused by several conditions besides cancer—hemorrhoids, diverticulosis, colitis, ulcers may be the culprits, but your physician will most likely want you to undergo a colonoscopy to look for suspicious polyps or tumors that may be the cause of the bleeding.

While many people are anxious about having a colonoscopy and hate the pre-procedure prep, undergoing a colonoscopy is easier than undergoing treatment for colon cancer. Done under anesthesia, there isn’t any pain and most people have no recollection of the actual procedure—which involves inserting a small-diameter, flexible tube with a viewing lens into the rectum and snaking it through the colon. New prep liquids have reduced the amount of fluid required to flush the colon clean. And for patients who don’t want to chug gallons of a chalky tasting drink, there is a new pill prep. “Patients take 32 pills—four every 15 minutes, and they can wash down the pills with any drink they want,” Dr. Kline says.

Virtual colonoscopies—in essence a CAT scan of the colon—are generating enthusiasm, but they still require the same prep as a traditional colonoscopy and there are some disadvantages. First, virtual colonoscopies are considered experimental by insurance companies. Secondly, because they are conducted in radiology, patients don’t receive sedation. While a tube isn’t inserted into the rectum and snaked through the colon, air is still pumped into the body to help make the area more visible, so there is discomfort. “If the radiologist sees something suspicious during a virtual colonoscopy, he or she can’t tell if it is a tumor or a piece of stool,” Dr. Kline notes. “If the radiologist does see a polyp or something suspicious, the patient will still need to undergo a traditional colonoscopy to confirm the finding and to remove the polyp or biopsy the tumor.”

What happens if your colonoscopy reveals a polyp or tumor? The colorectal surgeon will either remove it or get a tissue sample and send it to a lab for a biopsy. If it is determined that the growth is malignant, a CT scan will be ordered to look at all the internal organs to see if the colon cancer has spread. Depending on the results of the CT scan, an individualized course of treatment for colon cancer will be prescribed. Because colon cancer is slow growing, regular colonoscopies are your best defense against the disease. “It takes about three years for a polyp to become large enough for us to see,” Dr. Kline says. “There is something that triggers the cells to start growing. We don’t really know why. What we do know, is that people who have a polyp removed have a 10 percent higher chance of having a polyp again, so it’s important to have routine colonoscopies so we can catch suspicious growths early.”   

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