I Would Like to Introduce You to Sandra, My Patient for Over Six Years Diagnosed with Colorectal Cancer
Sandra is 51 years old and has been a patient of mine for years. Coming in for her yearly Well- Woman appointments, she always seemed very content with her life, her job and her family. But two years ago, this all changed. She no longer had that happy smile. Instead her face was filled with a look of fear and dread. She had been diagnosed with colorectal cancer. Her name has been changed to preserve anonymity.
March is National Colorectal Cancer Awareness Month
This is the first article in a three (3) part series that will address symptoms and initial evaluation in Part 1, Part 2 will focus on Diagnosis, and Part 3 will look at Treatment.
Colorectal Cancer is as real as it gets. Excluding skin cancers, colorectal cancer is the third most diagnosed cancer among white men and women in the US today. For women, the leading diagnosed cancer is breast cancer, followed by lung cancer. For men, prostate cancer is the most diagnosed type of cancer followed by lung cancer.
But Sandra is only 51 years old! Most people don’t think that someone so young and healthy could get colorectal cancer? Sandra certainly didn’t think about it as a possibility. Let’s take a look at the statistics. For 2017, The American Cancer Society’s estimates for the number of colorectal cancer cases in the US to be:
- 95,520 new cases of colon cancer
- 39,910 new cases of rectal cancer – that’s over 135,000 cases in this year!
- Expected number of deaths due to colorectal cancer – 50,260 in 2017
- The lifetime risk of developing colorectal cancer is 1 in 21 (4.7%) for men, 1 in 23 (4.4%) for women
Sandra’s Story (It could also be your story or the story of someone you care about, too)
In January 2015, Sandra noticed a change in her bowel movements. Some days, she had bouts of diarrhea and other days she suffered from constipation. She recently had traveled to a foreign country and thought that maybe she had picked up some type of gastrointestinal virus. Over the next few months, she continued to have diarrhea and constipation and now her belly felt bloated, more gas and she noticed pain on her left lower side of her abdomen. In late July 2015, after a week- long episode of bright red blood with bowel movements and increasing pain, her sister brought her into the ER for evaluation.
A CT scan showed a lemon-sized mass in her distal sigmoid colon ( see diagram) and the surrounding lymph nodes were enlarged. At first, it was thought that this might be an infection of part of her colon, known as diverticulitis. Antibiotics were given and she was scheduled for more testing. She had a consult with the gastroenterologist who immediately scheduled a colonoscopy.
What is a Colonoscopy & How Does it Find Cancer?
A colonoscopy is a procedure which uses a flexible scope to look at parts of large intestine. Biopsies can also be performed at the same time to determine if any areas in the colon look suspicious for cancer. For Sandra, unfortunately, the biopsies came back showing adenocarcinoma, the most common type of cancer of the colon/rectum.
Fortunately, over the past 20-30 years, the death rate (calculated by number of deaths/100,000 people/year) from colon cancer has been declining in both men and women. Reasons to explain this drop in deaths include more frequent screening, earlier removal of polyps (which can turn into cancer) and earlier diagnosis. As a result, there are over 1 million colorectal survivors in the United States today.
Many of the following symptoms for colon cancer can be seen with other conditions that are benign and not cancerous. These include infection (diverticulitis), hemorrhoids, irritable bowel syndrome or inflammatory bowel disease.
As you may notice, Sandra experienced many of these same symptoms.
- A change in bowel movements (diarrhea, constipation, narrowing of the stool) that last for more than 2-3 days
- A feeling like you haven’t really emptied your bowels completely after having a bowel movement.
- Rectal bleeding.
- Dark, tarry stools or blood in the stool
- Cramping or belly pain
- Fatigue and weakness
- Loss of weight even with trying to eat normally
If you or anyone you know is experiencing these symptoms, most likely it won’t be cancer. Yet to be safe, it is always best to have a consult with your physician or a gastroenterologist (a doctor who specialized in the health of your intestinal tract). A screening test, like a colonoscopy, might be ordered for you.
In Part 2, we will delve deeper in the risk factors for colon cancer, the different types of screening tests as well as go over the pros and cons of each. Stay tuned for more on Sandra’s story…
In Health & Wellness,