Wednesday, March 7, 2012

Colon Cancer Awareness Month: Get your ass screened. We mean it.

Don't want this growing in your colon?
Get screened. Via Wikimedia Commons.
It started a few months after I had my second son. A pain. Sharp, unrelenting, abdominal. Occasional blood from a place where blood isn't supposed to appear: the rectum. There. Got the R-word out of the way.

After I had laparoscopy for presumed endometrial scarring as the cause of the pain, the pain nevertheless persisted. So, I was referred to a gastrointestinal (GI) specialist, or gastroenterologist. The GI doc I saw first was a man who, I later, discovered, was the GI doctor for my uncle and my father. They loved him. There probably was a sort of "hail fellow well met" male camaraderie between doctor and patient there that made them sympatico. Me, not so much. He looked at me, looked at my age (36), and decided that all I needed was to take some ibuprofen. He literally sent me home with instructions to take some ibuprofen a few times a day and call him, not in the morning, but maybe in a couple of weeks.

Two years later, after more episodes of blood in the toilet, continued pain, and, pardon me, but I think this information is important, a whole lot of mucus coming out of there, I went to another GI doctor. For whatever reason--even though my symptoms weren't necessarily a match for colon cancer, even though I didn't, to my knowledge, have any risk factors for colon cancer, even though I was still quite young to have colon cancer--he decided to do a colonoscopy.

As I emerged from the anesthesia after the procedure, I saw my GI doctor talking with my husband. "How did it go?" I asked, groggy. He sort of smiled at me and said, "You're not going to remember any of this, but those symptoms you had saved your life." Unbeknownst to him, amnesia meds don't work on me--I've had ample subsequent opportunities to test that hypothesis--and I did remember it.

How did it save my life? 
What they found in my colon, near where it meets my lower small intestine, was a large, flat growth, about two inches (5 cm) by one inch (2.5 cm). In GI parlance, it was a large, flat (sessile) polyp, which is not a good kind of polyp. Closer analysis of the thing after my GI doctor deftly removed it during a second procedure revealed it to be a tubulovillous adenoma with cancerous tendencies. In fact, my medical records from that doctor now say the word "cancer" on them. 

Adenomas, the type of tumor this was, are "of greatest concern" in the colon. They come in three types: tubular, tubulovillous, and villous. The larger the size, the greater the cancer risk. Mine was large and on its way to becoming cancer. According to my GI doctor, I'd've been dead in another 5 years had I not had that colonoscopy and appropriate intervention. 

In other words, if I'd waited until the recommended age for a first colon cancer screening--age 50--I'd have already been dead for seven years. In fact, I would have died this year from colon cancer.

My mind was saying, "This would have been It. This would have been the thing, in a different time, that would have killed me. My potential death was growing inside of me, and I managed to put a stop to it." 

It's true: Colon cancer can be prevented
Finding and removing polyps in the colon can prevent colon cancer from developing. But first, you have to have the screening. Because more than 90% of cases of colorectal cancer happen in people ages 50 or older, the starting age for screening is currently set at age 50. 

If you have symptoms like the following, though, don't delay. If a GI doctor dismisses you as my first one did--that polyp of mine was probably growing in there for a few years--get a second opinion.

  • Blood in or on the stool (as I had)
  • Stomach pain or aches that do not go away (as I had)
  • Unexplained weight loss
  • A change in bowel habits (diarrhea, constipation, frequency)
  • A feeling of incomplete emptying


Colon cancer is associated with some risk factors. These include

  • Age 
  • Having previously had colon polyps or colorectal cancer yourself
  • A family history of polyps or colorectal cancer
  • A history of having inflammatory bowel disease (Crohn's or ulcerative colitis; not to be confused with irritable bowel syndrome or IBS)
  • A family history of inherited disorders related to polyps of the colon
Of these factors, I thought going into my GI doctors that I had none. Only later did I learn that my father also had had some polyps found and removed, although of the more typical and less-threatening variety and at a later age (in his 50s). In addition, in the past year, my octogenarian maternal grandmother had a large colorectal cancer removed that had likely begun its evolution from a polyp years ago, but she had never undergone screening. I cannot stress enough how important it is for a family to share health history so that these risks can be known and for anyone to have appropriate screening either at the recommended age or in the presence of symptoms.

Speaking of family, there is my own. My having been diagnosed with a precancerous growth at age 38 means that my first-degree relatives--siblings, parents, children--should have screening at least by that age and preferably years before.

There is some understandable reluctance to have a colonoscopy. Outside of the obvious ignominy of having someone shove a tube up your rectum while you lie anesthetized (I woke up during my second--yep, there's a tube in there), there is the preparation for it. I've done just about every prep known to modern medicine, having now had five colonoscopies--all my follow-ups have been clear, and I don't need another for four years now (!). Yes, they're unpleasant, and they take quite a bit of willpower. You have to drink what they tell you, take the pills that they tell you, not eat when they tell you, and consume only what they say is OK. You'll never want to see Jell-O or Gatorade again, and I can't stare down a bowl of clear bouillon any more without feeling a tad nauseated. 

But the goal of a prep is a completely clean colon. The cleaner you get it, the more accurate your findings will be and the less likely you'll have to do it again simply because you conducted--pardon me--a  crappy prep. 

March is Colon Cancer Awareness month. Be aware and embrace the reality that polyps happen and that so far, finding them requires this daylong unpleasantness. But also embrace the fact that the prep won't kill you. Instead, it will help you prevent a cancer that does, in fact, kill 50,000 people a year in the United States alone. 

This year, five years after that first colonoscopy would have been the year I'd've been one of those people. Thanks to that procedure, I am instead alive and well enough to tell you about it, and my three young sons still have their mother. I'd starve for a week and drink Gatorade until I puked to make sure of that outcome.
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By Emily Willingham, DXS Managing Editor

1 comment:

  1. Sorry for the late comment, but, Emily, this is such an important post. I just had my first colonoscopy a few weeks ago. Believe me, after all the procedures, operations, and treatments I've had over the last year for breast cancer, I didn't relish going in for it. But it was much easier than I had thought it would be, even though, as you say, the prep is definitely not fun. (There's a great Dave Barry piece about it, which is fun.) It was a huge relief to find out that everything looked fine. But it's also reassuring to know that even when the results aren't fine, as in your case, this procedure usually allows you to prevent much worse trouble. I'm really glad you paid attention to your symptoms and found the right GI doctor.

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