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Don't ignore this part of the body
Regular screenings are still the best way to avoid colon cancer

By Diana Reynolds Roome

Most of us would prefer not to be aware of our digestive tract. In fact, the less we notice it, the more we tend to assume it's functioning alright.

Yet, as one family found out, there are good reasons not to neglect it, especially that crucial five feet of tubing called the colon that stores unabsorbed food products and eliminates waste.

Two years ago, Los Altos resident Janet Bailey (who has withheld her real name for reasons of confidentiality) had a pain in her left abdomen. When she told her doctor about the pain, he examined her and told her it was nothing to worry about. Six weeks went by, and Bailey was feeling worse and worse. She couldn't eat and the pain wouldn't quit. A physician's assistant told her to take blood pressure medications.

"My problem is I'm a happy person. I look good, I sound well," said Bailey, who wishes she had stopped smiling and demanded treatment. "But this time I knew I was sick."

One night, Bailey started vomiting. A doctor sent her to the emergency room at El Camino Hospital. There, she was told she probably had acid reflux disease. At this point, Bailey was desperate. Her daughter took her back to the hospital, put her in a wheelchair, and told her to describe the pain as it truly was. Within hours she was in surgery for an intestinal obstruction that could have killed her if treatment had been delayed much longer.

"When I woke up they told me I had colon cancer," said Bailey. "I was in shock and I thought I was going to die. My stomach was cut right open from top to bottom and they took 18 inches of colon and eight lymph nodes."

As Bailey later discovered, by the time colon cancer starts to cause obvious symptoms, such as pain, blood in the stool, bloating or a change in bowel habits (all of which may also have other causes), it is often advanced. In Bailey's case, the cancer had already spread to her lymph nodes and liver. She had another operation, this time on her liver, and underwent hundreds of hours of chemotherapy.

Many years before, Bailey's sister had died of colon cancer, which progressed to a point that it spread to her brain. This meant Bailey herself was at higher risk, though she did not then realize the importance of getting screened.

"Once you have a first-degree relative with colon cancer, risk increases threefold," said Dr. Samuel Marcus, a gastroenterologist at El Camino Hospital, who also teaches at Stanford University Medical Center. "You should start screening at 10 years younger than the age when the relative developed cancer, or at age 40, whichever comes first. For example, if your father had cancer at 45, you should start looking at 35."

But as Marcus also points out, this knowledge is good news. "Colon cancer is very common, but 95 percent of cases are avoidable if patients go for colonoscopy screening, which is still the most accurate and practical way of looking at the large intestine."

Colonoscopy is an outpatient procedure that takes under an hour, though preparation involves fasting and the ingesting of enema preparations that clean out the bowel and require you to stay very near a bathroom for a day. During the exam, the patient is sedated, and the gastroenterologist passes a scope through the rectum into the bowel. The colon is carefully examined, and if there are any polyps (small tumors), they are removed then and there because they can be precursors to cancer. These are later checked for signs of cancer.

During the procedure there may be some cramping, but generally there is little pain and minimal risk. (Other less invasive tests are available, but may not be as effective.) Nobody pretends it's fun, but it is necessary, especially for people over 50.

Outlook improving

Colon cancer is the No. 2 cancer killer of both men and women in the U.S., second only to lung cancer in men and breast cancer in women. It is expected to strike nearly 150,000 people in 2006, according to the American Cancer Society. However, the odds are improving.

"When people do develop colon cancer, the outlook is so much better than five years ago," said Dr. Shyamali Mallick Singhal, a surgical oncologist at El Camino Hospital. "If you had liver metastases over five years ago, you might have five months to live. Now there are a lot of new treatments for metastatic colon cancer, and you could potentially live five years, and live well."

Experts say that although more Americans have been getting the message about preventive screening, not enough people go for the tests, even when their doctor has ordered one.

"Screenings can identify colon cancer earlier, and chances are that it will be more treatable then, but people are very resistant," said Singhal. According to Marcus, some of his patients delay for years before they pluck up courage to come in for a screening.

Meanwhile, it's important to be aware of risk factors.

"Red meat increases the risk, especially the fat in meat and particularly when it's barbecued and well-done," said Marcus.

A mixed diet with plenty of fresh fruits, vegetables and whole grains is the best way to keep things moving in the digestive tract, and prevent constipation -- which is also a risk factor for colon cancer. Exercise, too, helps keep people regular.

"Besides your responsibility to yourself, you have to look at the bigger picture," said Marcus. "A colonoscopy is cheap compared to missing an early colon polyp that becomes cancerous, and the ramifications of that for your family and loved ones."

In a strange way, Bailey's cancer was a blessing in disguise to her two sons and their young families. Her illness drove Bailey's grown-up children to go for screenings. These picked up early signs of cancer in one son, and polyps in the other son that, over a period of months or years, would have developed into cancer, Marcus said. Bailey's daughter also had polyps removed. Today, they are all healthy and cancer-free because their tumors were treated before they caused serious trouble.

INFORMATION:

Although March is Colorectal Cancer Awareness Month, El Camino Hospital is offering a free community lecture in May on colon cancer prevention and the importance of routine screening. The lecture, the first in a series, is scheduled for May 17 from 7-8 p.m. in the hospital's ground-floor cafeteria. Call (800) 216-5556 for more information.

To learn more about colon cancer, visit the American Cancer Society at www.cancer.org, or call (800) 227-2345. More information is also provided by Camino Medical Group at caminomedical.org