What do these famous people have one thing in common: Filipino president Corazon C. Aquino, entertainer Steve Allen, former evangelist Tammy Faye Bakker, poet Donald Hall, American president Ronald Reagan, actress Audrey Hepburn, professional golfer Ben Hogan, philanthropist Albert Lasker, and NBC commentator Jay Monahan.
They were afflicted with colon cancer, one the least talked about diseases. In the Philippines, it is the fourth most common form of cancer – after breast, lung and liver cancers.
“Among cancers, colon cancer stands out as a disease that can be largely prevented, but few people believe it will happen to them,” said Dr. Atenodoro Ruiz, Jr., a gastroenterology consultant at The Medical City and a diplomate of the American Board of Internal Medicine in Gastroenterology and of the Philippine College of Physicians in Internal Medicine.
One cannot talk about colon without mentioning the rectum, too. Thus, colorectal cancer (CRC) came into existence. “Almost all colorectal cancers are adenocarcinomas, which develop from the lining of the large intestine and rectum,” notes The Merck Manual of Medical Information.
Both colon and rectal cancers begin in the digestive system, which processes food for energy, and the last part of it absorbs fluid to form solid waste (stool) that then passes from the body.
The American Cancer Society (ACS) shares this information on how the digestive system works: “After food is chewed and swallowed, it travels to the stomach. There it is partly broken down and sent to the small intestine.” The small intestine is the longest part of the digestive system – about 20 feet.
“The small intestine also breaks down the food and absorbs most of the nutrients. It leads to the large intestine (also called the large bowel or colon),” the ACS explains. “The colon absorbs water and nutrients from the food and also serves as a storage place for waste matter. The waste matter moves from the colon into the rectum, the last 6 inches of the digestive system. From there, the waste passes out of the body.”
In the past, CRC has been referred to as “a disease of the rich.” But such is not the case anymore. “(CRC) is more common in richer countries, but its incidence is rising in some developing countries,” the Geneva-based World Health Organization (WHO) reports. “The risk of developing those cancers that are typical of higher socioeconomic groups – cancers of the breast, colon, and rectum – can be expected to increase with economic development.”
Until now, no one knows what causes CRC. “Epidemiologic, human case-control, and animal studies support a strong association between colon cancer and a diet that has high-fat (usually saturated fat), low fiber, and high red meat consumption,” Dr. Ruiz said.
Risk factors that predispose a person to develop colon and rectal cancer include age, personal history of adenoma or carcinoma, family history of CRC, and pre-existing diseases, like inflammatory bowel disease.
“Age 50 is the most common risk factor for CRC as 90% of cancers occur after the age of 50,” said Dr. Ruiz.
Like most cancers, many cases of colon cancer have no symptoms. But the Johns Hopkins Colon Cancer Center in Baltimore, Maryland says the following symptoms could indicate colon cancer:
Change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days; feeling that you need to have a bowel movement that is not relieved by doing so; rectal bleeding or blood in the stool; cramping or steady abdominal (stomach area) pain; decreased appetite; weakness and fatigue; and jaundice (yellow-green discoloration of the skin and white part of the eyes).
“Painful bowel movement and a feeling that the rectum has not been completely emptied are other symptoms of rectal cancer,” the Merck manual adds. “Sitting may be painful, but otherwise the person usually feels no pain from the cancer itself unless it spreads to tissue outside the rectum.”
Reading those symptoms, I was totally alarmed. I am now 56 years old and lately I had been experiencing the narrowing of the stool for few weeks already. I also had this feeling of not completely emptying my stomach after going to the comfort room.
I was reminded of the words of Dr. Ruiz. “Among cancers, colon cancer stands out as a disease that can be largely prevented, but few people believe it will happen to them,” he once told me.
If discovered early, colon cancer is preventable and treatable. “If it is early stage and localized within the colon, the cure is 100 percent,” said Dr. Ruiz. “If it had spread to lymph nodes or distant organs, the 5-year survival rate is much lower.”
Dr. Aaron I. Velasco, an internist and gastroenterologist who works in various hospitals in Davao City, said the 5-year survival rate of those diagnosed with stage 1 colon cancer is 92%. It goes down to 63-80% for those with stage 2 and 50% with stage 3. The chance of survival of those diagnosed with stage 4 is very minimal: 11%.
Dr. Velasco suggested that once a person reaches the age of 50, he should undergo a colonoscopy, which should be every 10 years after the first screening. Fearing that I may have colon cancer, I decided to undergo colonoscopy.
“In colonoscopy,” he explained, “we use a tube with a tiny camera to look at the whole colon and rectum. We don’t only find tumors early, but the test can also prevent colorectal cancer by removing polyps.”
The test usually takes 30 to 45 minutes, Dr. Velasco said. But in some instances, it may take longer, depending upon what is found and what is done during the test.
One day before the procedure, he told me to take general liquids all throughout the day. “You must consume 3-4 liters of fluids like water and juices,” he said. “For breakfast, you can eat porridge. Lunch is all noodles and dinner will only be just soup.”
That’s not all. I had to drink an oral solution laxative twice: at 8 am and then at 3 pm. At 8 in the evening, I took four tables of Senokot. After two in the morning the following day, he advised me not to take anything.
On the day of my colonoscopy, I took two Dulcolax tablets at 5 am. An hour later, I had my anti-hypertensive medicine. Both tablets were taken with only a small sip of water.
I had my schedule at 9:30 in the morning so together with my sister, Evangeline T. Capuno, we went to the hospital an hour earlier. There was one ahead of us at the hospital endoscopy unit. When the nurse saw me, she asked me to go to a room where I could change my clothes for the screening. After that, she had me lied down in a bed and placed a dextrose in my right hand.
It was past 10 when I was finally inside the screening room. They placed some devices all over my body. My blood pressure was also monitored. Then, Dr. Philip Valencia, the anesthesiologist, told me, “Sir, I have to let you sleep now.” After saying so, he injected the chemicals into the dextrose.
All the while, I thought I can witnessed and felt the procedure myself. But I didn’t – I was sleeping throughout the procedure. After 30 minutes or so, I was awakened by Dr. Valencia. “Sir, wake up,” he told me. “It’s done.”
Colonoscopy is very safe but some doctors caution there is a slight chance for problems from a colonoscopy. The scope or a small tool may tear the lining of the colon or cause bleeding. This must be the reason why WebMd.com suggests that those who undergo colonoscopy should call their doctor immediately if, after the test, they: have heavy rectal bleeding, have severe belly pain, develop a fever, are very dizzy, are vomiting, and have a swollen and firm belly.
Aside from colonoscopy, other screening tests for colon cancer include barium enema X-rays, sigmoidoscopy, stool tests, and computed tomographic colonography. Which screening test you choose depends on your risk, your preference, and your doctor. “Be sure to talk to your doctor about what puts you at risk and what test is best for you,” Dr. Velasco reminds.
If you are wondering what the result of my colonoscopy was, here’s the report: “The procedure was done under IV sedation with no untoward complication. Greenish, watery fecal material was seen over the sigmoid colon and the descending colon, which was removed by saline flushing and suctioning. The cecal pole was reached; unremarkable mucosa from the cecum/ileocecal valve down to the rectosigmoid colon save for few, diminutive polyps seen over the rectum/distal sigmoid, removed by cold biopsy forceps. Incidental finding of dilated venous columns above the dentate line.”
In simpler terms, it’s negative!
