Wednesday, April 29, 2009
This is the first of a series of annual plugs—call them “Bum Plugs,” if you will—addressing the importance of colon cancer screening that I intend to post every April 29th as a birthday gift to my Mom who died November 28th, 1976.
Had she lived, my mother would have turned 80 today. She died at the young age of 47, leaving behind my Dad and eight children. Diagnosed with cancer in the spring of 1976, she underwent a vaginal hysterectomy which we were told “got it all.” So why was it that she was back in the hospital by October for removal of part of her bowel and dead by the end of November?
Being only nineteen at the time, I accepted the explanation, that she had cancer of the womb that had spread to her bowel and liver. It was not until my sister was diagnosed with breast cancer twenty years later at the age of 36, that I started doing some research on cancer and asking questions. From my reading, I learned that no two cancers are the same (i.e., breast cancer cells are different from lung cancer cells, uterine cancer cells are different from cervical cancer cells, etc.) and that if breast cancer spreads to your lungs you do not now have lung cancer but you have breast cancer with metastases in the lung. I also learned that you can have two different cancers at the same time, that there were no screening tests to detect cancer of the uterus, and that the pap test only detected cervical cancer.
The fact that my mother was diagnosed after having a pap test meant that she must of had cervical cancer, not uterine cancer, as I had always believed. I needed to know more. Was it possible that she may have had both cervical cancer as well as bowel cancer? After an unsuccessful attempt, due to a twenty year time span, to gain access to her medical records through her doctor’s office, I wrote to the VG Hospital in Halifax (now The QE 11) and was able to obtain copies of her hospital medical reports.
As it turned out, she did have “Carcinoma in situ” of the cervix, and medical and biopsy reports showed that the cancer was removed with no evidence of invasion. With instructions for post op check ups every four months for the first two years, every six months for the next two years and annually thereafter, she was sent home to recover. Optimistic for her complete recovery, we were devastated when, just seven months later, she was back in the hospital and diagnosed with colon cancer with several metastases in the liver and omentum. One month later she was gone.
But now we know!
So, what does this mean for me?
Power! Although I often joke that “Ignorance is Bliss—the less you know, the less you miss,” knowledge is a powerful tool. Knowing my mother’s medical history (as well as her Dad’s who died of bowel cancer at age 50) allows me to take control of at least one aspect of my health and well-being. My family history means I have a much greater risk for colon cancer than the general population, but through lifestyle changes and routine screening I can greatly reduce my chances of dying due to colon cancer. Lifestyle changes such as regular exercise, reducing consumption of red meat and fats (while substituting them with good fats from fish, olive oil, avocado and flax etc.), reducing consumption of processed “convenience” foods, and increasing the fiber in my diet through grains, fruits and vegetables can be beneficial.
Not only reducing my risk for colon cancer, lifestyle changes reduce my risk for heart disease, stroke, diabetes, and numerous other diseases, as well as help control my weight. It’s a win- win situation. Although one cannot foresee what lies ahead . . . I might get hit by a truck tomorrow . . . I feel very confident colon cancer will not be in my future.
Anyone is at risk for bowel cancer. There are usually no symptoms until the cancer is advanced so early screening is important. Anyone 50 years (I personally feel 40 is not too young) should speak to their doctor about having a colonoscopy or sigmoidoscopy done. Anyone with a family history of colon cancer should start screening 10 years before the earliest colon cancer diagnosed in a first degree relative.
Don’t let embarrassment dissuade you from getting tested. I’ve had two colonoscopies to date and they are not that bad. I think women are more open than men about speaking to their doctors about this issue partly because they are more in tune with their health, and partly because after childbirth and years of pap tests they have lost a lot of their inhibitions. So, for all you men breaking into a
sweat at the thought of having
a scope up your ass. . .
“BUCK UP BUTTERCUP.” Do yourself a favour . . . GET TESTED!
SOME FACTS ABOUT COLON CANCER
Diet and colon cancer
Diets high in fat are believed to predispose humans to colorectal cancer. In countries with high colorectal cancer rates, the fat intake by the population is much higher than in countries with low cancer rates. It is believed that the breakdown products of fat metabolism lead to the formation of cancer-causing chemicals (carcinogens). Diets high in vegetables and high-fiber foods such as whole-grain breads and cereals may rid the bowel of these carcinogens and help reduce the risk of cancer.
Colon polyps and colon cancer
Doctors believe that most colon cancers develop in colon polyps. Therefore, removing benign colon polyps can prevent colorectal cancer. Colon polyps develop when chromosome damage occurs in cells of the inner lining of the colon. Chromosomes contain genetic information inherited from each parent. Normally, healthy chromosomes control the growth of cells in an orderly manner. When chromosomes are damaged, cell growth becomes uncontrolled, resulting in masses of extra tissue (polyps). Colon polyps are initially benign. Over years, benign colon polyps can acquire additional chromosome damage to become cancerous.
Ulcerative colitis and colon cancer
Chronic ulcerative colitis causes inflammation of the inner lining of the colon. Colon cancer is a recognized complication of chronic ulcerative colitis. The risk for cancer begins to rise after eight to 10 years of colitis. The risk of developing colon cancer in a patient with ulcerative colitis also is related to the location and the extent of his or her disease.
Genetics and colon cancer
A person's genetic background is an important factor in colon cancer risk. Among first-degree relatives of colon cancer patients, the lifetime risk of developing colon cancer is 18% (a threefold increase over the general population in the United States).
Even though family history of colon cancer is an important risk factor, majority (80%) of colon cancers occur sporadically in patients with no family history of colon cancer. Approximately 20% of cancers are associated with a family history of colon cancer. And 5% of colon cancers are due to hereditary colon cancer syndromes. FAP (familial adenomatous polyposis) is a hereditary colon cancer syndrome where the affected family members will develop countless numbers (hundreds, sometimes thousands) of colon polyps starting during the teens. Unless the condition is detected and treated (treatment involves removal of the colon) early, a person affected by familial polyposis syndrome is almost sure to develop colon cancer from these polyps. Cancers usually develop in the 40s. These patients are also at risk of developing other cancers, such as cancers in the thyroid gland, stomach, and the ampulla (the part where the bile ducts drain into the duodenum just beyond the stomach).
AFAP (attenuated familial adenomatous polyposis) is a milder version of FAP. Affected members develop less than 100 colon polyps. Nevertheless, they are still at very high risk of developing colon cancers at young ages. They are also at risk of having gastric polyps and duodenal polyps.
HNPCC (hereditary nonpolyposis colon cancer) is a hereditary colon cancer syndrome where affected family members can develop colon polyps and cancers, usually in the right colon, in their 30s to 40s. Certain HNPCC patients are also at risk of developing uterine cancer, stomach cancer, ovarian cancer, and cancers of the ureters (the tubes that connect the kidneys to the bladder), and the biliary tract (the ducts that drain bile from the liver to the intestines).
MYH polyposis syndrome is a recently discovered hereditary colon cancer syndrome. Affected members typically develop 10-100 polyps occurring at around 40 years of age, and are at high risk of developing colon cancer.
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