Colorectal Cancer: The Embarr... Health Article

Nobody ever died of embarrassment, or so the saying goes. But people do die of colorectal cancer, more than 56,000 every year.

What’s tragic about that fact is that people with colon or rectal cancer have a good chance of being cured if the disease is detected early. But too often, people do not tell anyone about their symptoms. Or they avoid simple screening tests. One reason is that the disease affects organs involved in the elimination of waste, a normal bodily function that many people find embarrassing.

"Distasteful" Attitude Caused Delay in Screening

This was certainly true for Patricia. Even though her doctor urged her to undergo a simple test for colorectal cancer, she delayed the test for an entire year. The reason for putting it off, she says, is that she found the test “distasteful.”

A few years ago, Patricia, who was age 52, learned that her brother, Fred, had undergone successful surgery for colon cancer. Although she was concerned to hear of Fred’s illness, she was unconcerned about herself. Now, she is very aware that having family members who have colon cancer is a red flag for high risk. “Back then,” she says, "I had never thought about colon cancer running in families. So it didn’t occur to me that I was at risk and that I should be checked.” Shortly after her brother’s surgery, Patricia’s doctor retired and she went to a new internist. The internist asked her about her medical history, and Patricia casually mentioned her brother’s cancer. That was all Patricia’s new doctor needed to hear.

“She zeroed right in on it,” Patricia says. “She wanted a stool sample. But the thought of that was so distasteful to me, I just put it off.”

The doctor gave her a take-home fecal occult blood test (FOBT) kit. The test checks stools for traces of blood, but Patricia wasn’t interested in taking it. Patricia saw the doctor every 3 months to monitor her blood pressure. At every visit, the doctor grew more insistent that Patricia be tested. Finally, after a year, Patricia overcame her distaste. She followed the directions and returned the kit to her doctor’s office. The doctor called her almost immediately with the news that there was blood in her stool that wasn’t visible to the naked eye.

Cancer Can Be Present Without Symptoms

“I couldn’t believe anything could be wrong,” Patricia says. “I felt absolutely fine.” She had not experienced any of the warning signs of colorectal cancer. She had no change in her bowel movements, such as constipation or diarrhea. She didn’t have ribbonlike-looking bowel movements, visible blood in her stool, or abdominal pain. Still, the doctor referred Patricia to a gastroenterologist, who arranged for her to have a colonoscopy.

A colonoscopy is a procedure in which the doctor uses a lubricated colonoscope. This is a flexible 4-foot-long tubular device equipped with fiber optics for viewing the inside of the colon. Patricia’s doctor found a tumor that had to be surgically removed. “I was never so shocked in my life,” Patricia recalls.

Patricia decided to have the surgery immediately. She was lucky; although the tumor turned out to be cancer and was quite large, her doctor was able to completely remove it. Pathology tests also showed that Patricia’s cancer had not spread, so she did not need chemotherapy.

After a week in the hospital, Patricia was home. Three weeks later, she was back at work. Patricia’s life has resumed and is much the way it was before. Still, having had cancer has taken its toll. “I was overjoyed that they got it all and that I didn’t have to undergo chemotherapy. But I do live with the fear it will come back,” she says.

New Outlook: Screening Is Distasteful But Life-Saving

Patricia has heeded her doctor’s advice and added fiber to her diet, a step that may help reduce the risk for colon cancer. “I’m trying to eat a lot of ‘rabbit’ food. I try to eat more fruits and vegetables, and I eat beans until they come out of my ears,” Patricia says. She also sees her doctor regularly and performs the FOBT twice a year. If her cancer does recur, she now knows it can be caught early. She looks at the FOBT differently now. “OK, so it’s distasteful. But it’s nothing compared with losing your life. Cancer is not getting a cold; cancer will kill you,” she says.

Patricia now knows much more about colorectal cancer. In fact, she is often in chat rooms on the Internet, urging people, including those who don’t have a family history of the disease, to be checked for it. She has also contacted all her siblings. “I got in touch with some of them that I am never usually in touch with, and I insisted they be checked,” she says. So far, none of them have had the disease.

Patricia is aware that the disease sometimes has no symptoms, that people who have symptoms may be reluctant to get them checked, and that screening is not done as often as it should be. She is also helping to spread the word that March is Colorectal Cancer Awareness Month, a good time for those with risk factors to be screened or for those with symptoms to see their doctor. Risk factors include being age 50 and older, having a family history of colorectal cancer or polyps, or having a personal history of ulcerative colitis or Crohn’s disease.

“It bothers me a lot that there isn’t more publicity about colorectal cancer,” she says. “Women are told to get mammograms every year and to do breast self-exams as if breast cancer was the only thing they have to worry about. There is more than breast cancer that can kill a woman.”

Patricia wants her daughter, who is age 33, to be checked when she turns age 41. That’s the age her doctor recommends because of the family history of colon cancer. Although the American Cancer Society recommends screening for colorectal cancer beginning at age 50, those with close relatives who have had the disease should be tested earlier. “My daughter doesn’t want to be checked. She finds it distasteful, too. But she will be checked,” Patricia says firmly.