Wednesday, March 31, 2010

Colorectal Screening Saves Lives

Seven years ago, 27-year-old Aleksandra Nowak lived in constant fear of death. Her mother, grandmother, uncle and aunt all died before the age of 40 from colon cancer. Doctors in her native Poland told her to prepare for the inevitable.

Then, she came to America, earned her college degree, and unexpectedly, she fell in love.

"It was always my dream to come to America and get an education, but I never thought I would meet someone," explained Nowak.

Knowing there is a strong genetic link to developing colon cancer; she warned her then-boyfriend about her likely prognosis and tried to dissuade him from seeking a future together.

"I said, 'Don’t fall in love with me -- I will probably die at a very young age,'" says Nowak. And that would have been very likely, had her boyfriend not persuaded her to get a colonoscopy. The test revealed more than 400 polyps stretching from her appendix to her rectum.

"I was devastated. I thought this is it ... this is the end," said Nowak.

Nowak shares her story to stress the importance of colorectal screenings. According to the American Cancer Society, colorectal cancer is the third most common cancer diagnosed in men and women in the United States and is the third leading cause of cancer death. Yet it is also preventable.

Colorectal Screening Saves Lives

When found early, colorectal cancer is treatable and beatable. According to the Massachusetts Department of Public Health, however, only an estimated 64 percent of Massachusetts residents aged 50 or older get screened. If everyone aged 50 or older had a screening test, as many as 90 percent of deaths from colorectal cancer could be prevented.

That's because if detected early asymptomatic colorectal cancer is usually curable with surgery. If precancerous polyps in the colon or rectum are found and removed during a screening colonoscopy, many cancers can be prevented.

"Family histories of colon polyps or colon cancer are the main factors in determining whether someone faces an increased risk of colon cancer," says Michael Thiim, MD, a gastroenterologist at Mass General and Nowak's doctor. But other risk factors include: inflammatory bowel disease and genetic syndromes such as familial adenematous polyposis or hereditary nonpolyposis colorectal cancer. No one is immune. Anyone, even those without risk factors, can get colorectal cancer. That's why everyone should have their first colonoscopy at age 50 and then once every 10 years if the exam is normal.

The Exam

During a colonoscopy, a thin, flexible tube with a camera on the tip is inserted into the anus and takes pictures of the colon and rectum. With this technique biopsies can be taken and polyps can be removed.

"Patients often find the most unpleasant thing is the bowel preparation the day before the exam," said Thiim. Various methods can be used to help cleanse the bowel. Most commonly, patients are instructed to drink a liquid preparation designed to stimulate bowel movements the night before.

In addition to colonoscopy, there is CT colonography, also known as 'virtual colonoscopy,' where a CT [computerized tomography] scan is used to examine the colon. The advantage of CT colonography is that it is less invasive. President Barack Obama had a virtual colonoscopy performed as part of his routine physical exam. However, both procedures require a cleansing of the bowels the day before. Furthermore, if an abnormality is found during a CT colonography, the patient would then have to undergo a traditional colonoscopy.

In Sickness and In Health

It may not sound like it, but Nowak was fortunate. Her upper intestine and abdomen were free of disease. But the large number of polyps found in her colon required drastic measures. Thiim told her they could prevent her from ever developing colon cancer by removing her colon.

With her now-husband at her side, Nowak agreed. The surgery was performed two days before the new year and allowed her to ring in 2010 with hope for the future. Today she is almost 100 percent back to normal.

"You can't give up. If they find something at an early stage, they can remove it and you can be perfectly fine. You have to hope for the best," said Nowak.

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