I love my career in medicine. There are so many facets of my job that are awesome. I enjoy teaching my patients how to be healthy. I love building relationships with my patients and their families. I love getting a hug from a grateful patient who I have helped to feel better. However, there are some parts of my job that are not as enjoyable. One of the worst parts of my job is delivering bad news. We actually had classes during medical school including role playing on how to deliver a diagnosis of cancer, of HIV, or some other fatal disease. Unfortunately I’ve had to be the bearer of bad news on many occasions, and I can tell you it never gets any easier.
One of the worst of these occasions was a few years ago, and involved one of my favorite patients. She was a lovely, vibrant, intelligent woman. She led an exemplary life from a health standpoint. She exercised, practiced yoga, and ate a very healthy diet including mostly organic foods and local meats and produce. She was also mentally and spiritually healthy, and had a great sense of humor. She did have an interest in complementary and alternative medicines, often seeking out treatment with herbal supplements, homeopathic remedies, and acupuncture. Because of this she would often question some of our traditional western medicine practices. We had many spirited discussions regarding recommendations like screening mammograms, colonoscopies, and cholesterol treatment! We had a great mutual respect, and I always enjoyed seeing her. One day, she came to see me with complaints of profound fatigue. This was highly unusual for her, as she typically was very energetic. I decided to run some routine bloodwork to see if we could determine a cause for her fatigue. Unfortunately, these tests were grossly abnormal. She was very anemic (low blood counts and low iron) and her liver function testing was also abnormal. This was very worrisome, and so I ordered additional testing including an ultrasound of her liver. I was completely dismayed to get the results of her ultrasound. This revealed multiple tumors throughout her liver. Because of the appearance of these, it was most likely that they were metastatic, meaning they had spread from another cancer somewhere else in her body. The most common type of cancer that spreads to the liver is colon cancer, and this would pull the whole picture together, as that is a common cause of iron deficiency anemia. I asked her to come into my office so that I could talk to her in person, and we could review the results. I will never forget that day, and I will never forget the look on her face when I told her about the tumors on her liver, and the likely diagnosis. Together, we made a plan for further testing. The results did ultimately confirm that she had a large tumor in her colon, which had spread to her liver. This does not carry a good prognosis. Stage 4 colon cancer at best can be treated with chemotherapy to buy time, but there is no cure. She consulted with oncologists and other cancer specialists. She started a chemotherapy regimen and also pursued other alternative treatments in conjunction. Unfortunately for my patient, none of these were effective, and within 9 months she had passed away.
There are many things that bother me about this story, but the thing that bothers me the most is that I could never convince her to have a screening colonoscopy done, despite our many discussions on the topic. She was 58 at the time of her diagnosis. If she had a colonoscopy at age 50 as is recommended, her tumor likely would have been found at a much earlier stage, she would have been able to receive curative treatment, and she would still be alive today. It makes me angry, and it makes me sad, because this situation was entirely preventable.
I decided to share this story, because March is Colon Cancer Awareness month. Colon Cancer is the third leading cause of cancer death in the United States. It is one of the cancers that we have good screening for, and good treatments if diagnosed early on. However, only about 60 percent of adults have had the recommended screening. All adults over the age of 50 should talk to their doctor about colon cancer screening. Most of the time we recommend a screening colonoscopy, but there are some other screening tests available. If there is a family history of colon cancer screening may need to start at a younger age, ask your doctor. It doesn’t matter how healthy you think you may be, cancer does not discriminate! I think most people put this off, because colonoscopy testing is not that pleasant, let’s face it. But I can assure you that as scary as a colonoscopy is, colon cancer is much scarier! All of my patients who have colonoscopy done come back and tell me it was not as bad as they thought!
Bottom line, get your colon cancer screening done! Ask your loved ones if they have had their screening! It may save a life! For more information, go to the American Cancer Society website at www.cancer.org.