Putting aside the stigma of colorectal cancer
Wednesday, November 4, 1998BY SUE MacDONALD
The Cincinnati Enquirer
Dr. Janice Rafferty finds a bit of irony in the newfound focus on colon and rectal cancer in this era of the Kenneth Starr report.
"Isn't it strange in this day and in this society that we're so willing to go into minute detail about sex, but people will not talk about changes that involve the bowel?" asks Dr. Rafferty, a colon - rectal surgeon at the University of Cincinnati Medical Center.
People's squeamishness is natural, she says, because most people are embarrassed to talk about bowels, bowel movements, bodily wastes and tests that involve sticking tubes into the rectum and intestines.
Yet screening tests for colorectal cancer are among the best for catching early tumors and preventing the spread of the disease.
"Colorectal cancer screening is so important and so effective," Dr.Rafferty says. "It's just embarrassing. I guess the question is are you willing to live with the embarrassment, or are you willing to live with the cancer? You have to get past the embarrassment and just do it."
A few facts about colorectal cancer:
Colorectal cancer is two different cancers. Tumors or polyps can develop in the colon (the 5 feet of tissue that makes up the large intestine) or it can develop in the rectum (the last 6-8 inches of the large intestine). Treatment varies, depending on where the cancer is, how far it's invaded tissue and whether it has spread to surrounding lymph nodes. Sometimes doctors can remove just the tumors or polyps; sometimes they need to remove parts of the colon - rectum.
Colorectal cancer often grows without notice. In early stages, it usually involves polyps, or growths, that appear on the lining of the walls of the rectum and intestine. Over time, about 5 percent to 10 percent turn cancerous; if the cancer spreads, it usually affects the liver and lungs.
Having colorectal cancer doesn't mean someone will have to have a colostomy, an operation that routes the colon out of the body so that bowel wastes collect in an external pouch. In fact, newer treatments that shrink polyps and tumors before surgery lessen the chance of colostomy, Dr. Rafferty says, and most patients don't need such drastic treatment.
If surgery is recommended, chances increase for quicker recovery, less surgery and less drastic surgery if you choose a doctor who's specially trained in colorectal surgery rather than a general surgeon, according to a study from the American Society of Colon & Rectal Surgeons.
Higher survival rate
A Los Angeles study found patients operated on by ASCRS members had a three-year survival rate 39 percent higher than patients treated by non-members, a figure attributed to better training and higher volume, meaning doctors get better the more surgeries they do.
A second Cleveland Clinic study found that bowel surgeries by ASCRS-trained physicians resulted in fewer patient complications and 12 percent to 35 percent lower costs, or about $6,000 per surgery.
For rectal surgery, in particular, Dr. Rafferty says most surgeons prefer "preoperative staging," a series of tests that determine where the rectal cancer is, how far it's invaded tissue and how far it's spread.
Radiating the tumors before surgery can sometimes shrink them, saving the rectum from drastic surgery and reducing from 30 percent to 4 percent the chance that the cancer will spread to the pelvis, she says. Some doctors prefer radiation after surgery, and it remains an area under study.
Like most cancers, the earlier colorectal cancer is caught, the easier it is to treat, which is why doctors encourage people over 50 -- and those younger who have a family history of colorectal cancer -- to get screened regularly.
Dr. Rafferty recommends that you:
- Pay attention to your bowels, digestion and bowel movements.
- Don't automatically blame blood in the stool on hemorrhoids.
- Get checked by a doctor if symptoms are new, worry you and are pain-free.
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