There’s a health awareness advertisement out there that maybe you’ve seen. It reads like this:
“The early warning signs of colon cancer: You feel great. You have a healthy appetite and get lots of exercise. You’re only 50.”
Well, that ad described me perfectly. Maybe it describes you too.
I came about as close to a major health catastrophe as possible because, like a many people, the test for colon cancer sounded like a real pain that I didn’t want or need. After all, like the ad said, I felt great.
Then I started seeing the blood in the bathroom. Inside I wasn’t so “great” and when my doctor later told me that had I delayed my subsequent colonoscopy by just a few months I would have developed colon cancer, well, I didn’t want to believe him. I mean how can anyone really predict specific medical problems I would encounter in the future?
But Dr. Nemec, an internal medicine specialist who practices at Winchester Medical Center, sees a lot of cases. Some, like mine, are caught before a diagnosis of cancer while others end in a less welcome outcome. I was the typical American male who often develops colorectal cancer, an awful and often fatal disease, because I never believed that it could happen to me.
I was lucky so I am sharing my story so that you can be lucky too.
While Dr. Nemec did discover three growths in my colon, known as adenomatous polyps with a known propensity to become cancerous if not removed, and another during a colonoscopy just18 months later, the experience sent me a wake-up call about how close I came to disaster.
I’m sharing my story so that others can avoid what has happened in my family, two cases of colon cancer and a long-ago death of a grandfather that now appears attributable to the disease but was not understood until recent genetic testing indicated that his life-ending appendicitis likely resulted from colon cancer.
To help tell my story I’ve chosen to share some information that most of us keep private. Because people seldom talk about colorectal cancer or colonoscopy, the procedure for preventing it, ignorance can easily metastasizes into pain, suffering and even death due to inaction. I believe that by breaking the uncomfortable silence whenever possible, talking just may be able save lives.
My long-overdue colonoscopy certainly saved me a lot of misery and may likely have saved my life. To be completely honest, I put off my first colonoscopy because the thought of the procedure nearly scared me to death.
Who Needs to be Checked?
The first, and most important, question about colorectal cancer is how to determine if you should be checked?
The answer could not be simpler.
According to the American Cancer Society the short answer is that if you are 50 years of age or older, talk to your doctor as soon as possible and get the procedure scheduled for next week if you can. You have a family history of colorectal cancer talk to your doctor before you turn 50.
It really IS that important.
Of course, if you’re like me and have never had a serious medical problem, you can always rationalize the many reasons for why the colorectal cancer health statistics don’t apply in your case. I used irrational thinking, rooted in my fear of the unknown, to put off what my brain kept telling me needed to be done.
This year the American Cancer Society estimates that there will be 101,700 new cases of colon cancer and 39,510 new cases of rectal cancer in the United States. Overall, the lifetime risk of developing colorectal cancer is about 1 in 20 (5.1%). This risk is slightly lower in women than in men.
Despite the clear statistical risks attached to doing nothing, it was always easier to convince myself that my schedule was too busy to take a day off to see a doctor rather than doing what I knew was best for my health. Although the exact cause of colon cancer isn’t understood, scientists have figured out that certain factors increase a person’s risk of developing the disease. I had nearly all of the colorectal cancer risk factors but never took the time to realize it despite easy availability to the information:
- Being 50 or older – Yep
- Having colorectal polyps — typically non-cancerous growths that develop on the colon’s inner wall – Yep, I had three but didn’t know it
- Having other people in your family who have had colorectal cancer, or having had cancer yourself – Yep, three family members that I now know of
- Having certain genetic abnormalities – Yep, I’ve got Lynch Syndrome, a genetic condition that makes colorectal cancer almost a certainty if preventive steps aren’t taken
- Eating a high-fat diet – Yep, greasy food is part of my southern cultural heritage
- Being a smoker – Glad to answer “no” to this risk factor
My inaction nearly added me to the colorectal statistics, a notoriety that I hope never to achieve.
That Procedure Just Has to Hurt!
It wasn’t until I began seeing blood in my stool, a tell-tale sign of potentially serious gastrointestinal problems, that I reluctantly decided that it was time to see a doctor. For many following the same poor logic that I used, by the time a colonoscopy is performed, cancer is often already present. Fortunately my doctor insisted that I immediately schedule a colonoscopy. To my relief, I soon discovered that the “dreaded” colonoscopy procedure used to detect the colorectal problems is both painless and forgettable.
People can use fear as either a motivator or an inhibitor. In my case, the prospect of the colonoscopy procedure helped me rationalize that I wasn’t likely to get the disease and therefore didn’t need the recommended examine even though I had already turned 50 and my family had a history of the disease (both a parent and a sibling are colon-cancer survivors and both contracted the disease in their late forties.)
But the sad fact is that many people put off having a colonoscopy even though the disease is so easily preventable when detected early. Although most colon polyps are harmless, some become cancerous over time. Importantly, colon polyps usually don’t cause symptoms and that’s why regular screening is so important. Colon polyps that are found in the early stages usually can be removed safely and completely during the colonoscopy procedure.
In my case, the early detection and removal of polyps, small cell clumps that form on the lining of the colon, was key to preventing the colorectal cancer indicated in my family medical history.
I later learned that in addition to rectal bleeding or blood in the stool, other signs and symptoms of colon cancer include:
- A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool for more than a couple of weeks
- Persistent abdominal discomfort, such as cramps, gas or pain
- A feeling that your bowel doesn’t empty completely
- Weakness or fatigue
- Unexplained weight loss
If you have observed any of these signs, see a doctor immediately. The sooner you act, the more likely your chances for survival if, in fact, you do have the disease. But while new cancer detection methods are evolving all of the time, medical specialists still rely on the colonoscopy as the definitive initial approach for detecting colorectal cancer.
Unfortunately, a little information can sometimes do more harm than good, especially when it comes to a colonoscopy. It may be hard to believe, but contrary to what you may have heard, the procedure causes little or no pain either before or after it is administered.
A Painless Procedure
While the risk of injury is low, bleeding and puncture of the large intestine are possible but uncommon complications of colonoscopy. “There’s no free lunch” Dr. Nemec told me as we discussed my risk just before I was sedated for a recent colonoscopy procedure.
During a colonoscopy, the patient lies on their left side on an examination table. The doctor inserts a long, flexible, lighted tube, called a colonoscope, into the anus and slowly guides it through the rectum and into the colon. The scope inflates the large intestine with carbon dioxide gas to give the doctor a better view. A small camera mounted on the scope transmits a video image from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. The doctor may ask the patient to move periodically so the scope can be adjusted for better viewing.
Once the scope has reached the opening to the small intestine, it is slowly withdrawn and the lining of the large intestine is carefully examined again. Any polyps discovered during the process can be removed with the colonscope by the doctor.
If you’re like I was, at this point in the description you’re thinking “How can that NOT hurt?”
Believe me, I get your question. But here’s what surprised me about the two colonoscopies that I have had; I don’t remember anything at all about either of the actual procedures.
That’s right, nothing. Nada. Zip.
If there was any pain, I never felt it. In fact, I never felt anything. After being wheeled into the procedure room, a nurse instructed me to turn onto my left side. She then added a drug called “Versed” to the intravenous drip attached to my arm.
“You may feel a slight sting as the medicine reaches your bloodstream” she said.
The next thing I knew I was back in my recovery room an hour or so later.
Painless. Nothing to it at all. Honest.
My lack of memory of either colonoscopy isn’t just some fluke, the six milligrams of a Versed, also known as Midazolam, causes drowsiness, relieve anxiety, and prevents any memory of the event.
Believe me, the stuff really works.
In fact, a lesser publicized side-effect of Versed is that it offers comic relief for the family member or friend designated to drive the patient home after the procedure.
“You asked me a dozen times on the way home whether or not the doctor had removed any polyps” my designated driver laughed once the drug had worn off and I had regained my bearings. My first memory after the procedure, which takes less than an hour, was having a piece of pizza at Mario’s in Berryville later that afternoon.
As many people attest, the preparatory process for a colonoscopy is more difficult than the actual procedure itself. I, personally, agree that this is true. But that said, there is good news for the colonoscopy neophyte.
The preparatory process has gotten easier in the last two years.
Prior to my first colonoscopy, I was instructed to prepare by fasting with clear broth and liquids for 24 hours and taking Dulcolax, a mild laxative, along with drinking a gallon of Colyte liquid in two-cup increments every 20 minutes the evening before the process.
By the time I gulped down my last cupful of the wretched tasting Colyte on the morning of the procedure, I was gagging on both the taste and texture of the thick, stale smelling elixir. But a new prep-drink is quickly gaining prominence with gastroenterologists. Prior to my second colonoscopy I took four Dulcolax tablets with 8 oz of water at 2:00p.m., just like before. But this time I mixed a powdered substance called “Miralax” (purchased over-the-counter at the drugstore) with 64-ounces of Gatorade at around 4:00 pm.
By 7:00pm I was done with my colonoscopy cocktail.
The result of both prep-processes is the same so plan to stay very close to a restroom while the medication cleans your intestinal tract. That said, the Gatorade-concoction is much easier to drink. So if possible, ask your doctor to consider letting you use Miralax rather than Colyte. (If it helps at all, you also get to pick your favorite Gatorade flavor.)
The other uncomfortable aspect of the colonoscopy preparation is fasting. Plan to go at least 24-hours without eating depending on the time your procedure is scheduled for. By the time I went to bed on the night before the procedure I was hungry but otherwise prepared.
On the day of my colonoscopy I downed one final cup of Gatorade-Miralax, made a quick trip to the bathroom, and headed to the Winchester Medical Center with my designated driver. After “checking-in” at 11:00 am, I was wheeled into the procedure room at noon, in recovery by 1:00pm and eating my first meal in more than 36-hours by 4:00 pm.
It was just that simple. No pain, other than wanting something to eat, and no side effects other than a four-hour memory lapse (and perhaps a strange craving for more blue Gatorade.)
If your colonoscopy is “clear”, as it is for many people, you may not need another procedure for several years. In my case however, the presence of several polyps indicated that I would need to return in two years for a repeat procedure.
“Not too terrible” I thought to myself after Dr. Nemec gave me the news later. But the two year schedule was not to be thanks to a genetic trait that had silently and secretly attached itself to my family tree generations in the past.
Just a year after my first colonoscopy, at the age of 52, I unexpectedly received a medical warning sign that changed not only my life, but my four children’s lives as well, and convinced me that my doctor had been correct after all in warning me that my seemingly benign polyps had the likelihood to morph into cancer and might very well of ended my life had I not acted when I did.
A Family’s History
Americans have always tended to keep their medical histories private and my family was no exception. To the best of my knowledge, no one in the family had ever had colon cancer until one of my parents developed the disease some 30-years ago. Fortunately, my parent survived the disease and remains cancer-free today.
At least I thought that colon cancer was new to my family.
In actuality, it turns out that my family was not very open when it comes to issues like colon cancer. I now think back to the deaths of several family members when I was a child and suspect colon cancer may have been the killer. Given the passage of time, the truth will now likely remain a secret but my guess is that the actual cause of death just wasn’t discussed. But when a sibling of mine was diagnosed with the disease at age 49, the attending physician suspected a possible genetic link due to our parent’s colon cancer of 30 years ago.
Following the doctor’s orders, my sibling sought genetic testing and soon learned that a deleterious genetic “variant”, known as Lynch Syndrome and which increases the carrier’s risk for developing certain forms of cancer, especially colorectal, by up to a startling 82%, was clandestinely being passed from one family generation of our family to the next. Additional testing confirmed that my parent and I also have the genetic variant. The knowledge that I, too, am a probable colon cancer recipient removed any uncertainty that I had about the need for future screening and regular checkups. Unless I took an active role in preempting the disease, the implications of the diagnosis on me and future generations of my family was extraordinary. I would also later discover that Lynch Syndrome can reveal nearly as much information about past family generations as it does for the living. This is because our genes hold not only important information about our future health, but also can unlock mysteries about the health of our ancestors. The reason for this is that each child born in successive family generations inherits a genetic makeup contributed by both parents. Each parent has a fifty percent probability of contributing any particular gene to its child. This genetic randomization accounts for why members of the same family can have similar traits while also exhibiting vastly different characteristics in hair color, physique and other body traits. I have four children. Therefore, each of my children has a 50% chance of inheriting the Lynch Syndrome gene from me.
Learning that you have a high probability for developing colorectal cancer, as I did, is never welcome news. But for my family, the good news is that each of my children now has the knowledge that will allow them to be tested for the variant gene and to take active steps to prevent the disease from progressing. The other good news in my case is that my immediate family and I learned of our colorectal cancer risk before the disease progressed into what, nationwide, is the second leading cause of cancer-related death in the United States for men and women. At the same time, my genetic testing helped to revealed previously unknown information about one long-deceased ancestor; my grandfather.
Sadly, the genetic knowledge came decades too late to help him and other earlier generations of my family avoid colon cancer.
The medical detective work that revealed that my grandfather’s death was likely caused by colon cancer demonstrates the diagnostic power of modern genetic testing. It had long been said in my family that my grandfather, who died at the age of 45 when my parent was just seven years old, was the victim of a ruptured appendix. However, the new found presence of Lynch Syndrome in my family tree shed a different light on the underlying cause of his death in rural western Kentucky more than 75 years ago. While my grandfather’s appendix did rupture and the resulting infection caused his early death, the cause of the appendicitis was likely caused by colon cancer according to medical professionals familiar with my family’s medical history and Lynch Syndrome.
Here’s how his diagnosis was unraveled in the absence of any documented medical information about his death; Genetic researchers know with certainty that because my parent has the Lynch Syndrome gene, it had to have been passed on by one of my grandparents. Unlike my grandfather who died at 45 years of age, my grandmother lived to be 100 years old. Given her long life, had my grandmother had the Lynch Syndrome gene, her probability of developing cancer at some point in her life was nearly very high. Yet she remained cancer-free her entire life.
Back to my grandfather; a ruptured appendix is a common complication of advanced colon cancer. According to my geneticist, it is almost certain that my grandfather was the Lynch Syndrome carrier who passed on my family’s predisposition for colon cancer. If that is true, he too had a very high statistical probability for developing cancer. While it cannot be proven medically due to the lack of information about his condition at the time, he almost surely had a form of colorectal cancer which caused a ruptured appendix that ultimately took his life. Sadly for him, and others of his generation, colon cancer prevention and treatment were nascent in rural America in the 1940’s.
But although my grandfather’s generation lived at the mercy of diseases like colorectal cancer, today’s generation has more knowledge and options for avoiding its peril. Statistics indicate that people today are benefiting from modern cancer research by taking colon cancer screening seriously. The American Cancer Society says colorectal cancer incidence rates have been declining in the U.S. since the mid-1980s. Since 1998, rates have been declining by 3.0% per year in men and by 2.3% per year in women. The acceleration in the decline in the past decade has largely been attributed to the detection and removal of precancerous polyps as a result of colorectal cancer screening.
Easy Steps To Prevent Colon Cancer
Cancer researchers now believe that lifestyle may play a role in the disease and its prevention. While it’s not always easy to change your lifestyle, experts say that making several relatively simple lifestyle modifications may significantly lower your risk of developing colorectal cancer. Professionals at The Colon Cancer Prevention Center at Hackensack University Medical Center recommend the following:
EXERCISE REGULARLY AND MAINTAIN A HEALTHY BODY WEIGHT: Controlling your weight can reduce your risk. Try to exercise at least 30 minutes on most days. Staying active stimulates movement through your bowel, reducing the time it may be exposed to harmful substances that may cause cancer.
LIMIT FAT: High-fat diets increase one’s risk of colon cancer. Limit foods from animal sources that are high in fat, especially saturated fat, such as red meat, milk, cheese, ice cream, and coconut and palm oil. Restrict fat intake to less than 30 percent of daily calories.
EAT FOODS RICH IN FIBER: Dietary fiber may provide protection from colon and other cancers. Fiber reduces constipation, which irritates the inside wall of the colon. Try to get 25 to 35 grams of fiber in your daily diet.
EAT PLENTY OF FRUITS AND VEGETABLES: These contain vitamins, minerals, fibers, and antioxidants, which may protect you from cancer.
But while genetic testing and better understanding of the environmental factors that may cause cancer hold hope for reducing the disease in future generations, today’s best defense against one type of cancer, colorectal, remains physical screening and a mandatory colonoscopy by age fifty.
Colon cancer is easy to prevent but you have to take the first step. Make the call today, you’ll be glad that you did.
It may just save your life.