By Dr. W. Gifford Jones
"Why in the name of Heaven do I subject myself to this indignity and inconvenience every five years?" I ask. The answer is always the same. I prefer not to have a colostomy or die from cancer of the large bowel. Undergoing colonoscopy is the only way to prevent it. That is, unless I decide to live in Uganda?
This year 170,000 North Americans will develop colon and rectal cancer. Sixty-five thousand will die from it. The great tragedy is that practically all of these deaths can be prevented.
This makes cancer of the large bowel the number one cancer killer of men who don't smoke and the second cancer killer of women.
Dr. Basil Morson, a pathologist in London, England, is the world's leading expert on colon cancer. Dr. Morson claims that "all colon cancers come for polyps". In effect, you don't develop a cancer of the large bowel unless you first grow a polyp.
These soft, fleshy, growths arise from the inside lining of the bowel. It's estimated that about one person in three over the age of 50 has one or more colonic polyps.
Dr. Warren Rudd, Director of the Rudd Clinic for Colon and Rectal Cancer, in Toronto, author of the book " " has found colon polyps in one-third of his patients.
But how many of these polyps become cancers? A report from The Mayo Clinic shows that after five years 2.5 percent become malignant. Ten years later the figure jumps to 10 percent and in 20 years to 24 percent.
It's mandatory to diagnose polyps early. Waiting for symptoms of cancer such as bright red bleeding with bowel movements, a change in bowel habits such as increasing constipation or alternating constipation and diarrhea are signs that cancer may have spread beyond control.
Polyps may be shaped like a wart, a cauliflower, mushroom or look like a marble. Some are flat and sit on the bowel wall like a floor mat on broadloom attached over a wide area. Others are attached by a long thin stem, like a cherry on a stalk.
Polyps may grow slowly or quickly. In general the larger the polyp the greater the risk of malignancy.
Large bowel polyps can be found by a barium enema. But this procedure may miss small polyps and it also exposes the patient to radiation. Besides, this method means the polyp can neither be biopsied nor removed.
A sigmoidoscope is a rigid instrument that is able to explore the sigmoid portion of the large bowel. But it misses polyps in other parts of the colon as it cannot travel as far.
The gold standard for the diagnosis of precancerous polyps is the "video colonoscope". It consists of a T.V. camera, the size of your little finger, inside the tip of the scope. This sends a colour T.V. picture from inside the colon to a nearby T.V. screen.
Another advantage of this technique is its ability to remove polyps on sight, thus avoiding a surgical incision.
Colonoscopy is not a procedure you want done every Monday morning! And you become very acquainted with your bathroom for several hours before the procedure.
The bowel must be scrupulously cleaned by laxatives the night before the examination. No food may be eaten for many hours and copious amounts of water must be drunk to flush out the colon.
Prior to the procedure most patients are given a mild sedative. They should also be told that the risk of bowel perforation is about one in 4,000 cases. Looking at the total picture including discomfort, risk and embarrassment some patients refuse colonoscopy.
But before deciding against it consider the facts. Patients who seek a doctor because of symptoms have usually developed advanced cancer by this time. Their five year survival rate is only 10 to 20 percent.
But if a cancer is found before symptoms occur the five year survival rate after surgery is 85 to 90 percent. Discovery of a premalignant polyp increases the rate to 100 percent. That's why I suffer the inconvenience every five years.
Is there any way I could have circumvented this procedure? It's a little late now. But I could have moved to Uganda at an early age. In this country, and many other underdeveloped nations, colon cancer is practically unheard of.
Ugandans consume huge amounts of fiber which makes the stools soft. This eliminates constipation and quickly removes cancer causing chemicals from the large bowel.
It's prudent to have a colonoscopy by 40 years of age and then repeat one every five years. Write to me if this column prompts you to have a colonoscopy which discovers a potentially malignant polyp. These statistics would be helpful.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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