Fifteen years before Dallas Collins had come to see me for his first office visit before his fifty- year-old screening colonoscopy. He couldn’t understand why his primary care doctor had sent him to me. He had absolutely no problems with his bowels, and certainly wasn’t thrilled about having some long tube stuck up his behind. We discussed the reasons for screening colonoscopy and how colon cancer patients often don’t have any symptoms until it is too late, and finally he agreed to have the colonoscopy done. I performed the colonoscopy the next week, and I easily advanced the scope around a normal-appearing colon while he slept comfortably. I got to the cecum, the very end of the colon, and was greeted by a four centimeter or two- inch colon cancer. Biopsies confirmed cancer and one week later her underwent surgery to remove the cancer and surrounding lymph nodes. We had caught the cancer early enough that no lymph nodes contained cancer, and he didn’t have to receive any chemotherapy. We had done follow up colonoscopies on him first yearly and then gradually spaced out to every five years, and now he was back to see me prior to the next colonoscopy.
“I’m feeling fine,” he said, “and there’s no diarrhea, blood in my stool or abdominal pain. I’ve got your questions down pat by now,” he laughed.
He did look the picture of health.
“My son is coming to see you next month to get his one- year colonoscopy,” he said.
One year before his son, Tyler had turned forty and based on my recommendations and the standard recommendations for someone having a first degree relative with colon cancer, had come in for his screening colonoscopy. He, too, had no symptoms and was a strapping ex-college football player who now worked in his father’s construction business. On his colonoscopy I had discovered a flat 2.5 cm or one- inch polyp on the right side of his colon which I had removed completely. Pathology revealed that it was a sessile serrated polyp, a pre-cancerous polyp made more dangerous by the fact that it grows flat along the wall of the colon and not up and out of the colon like a mushroom. After finding and removing this dangerous growth, I had recommended that the entire family have genetic screening for colon cancer. Thankfully, they did not have any of the currently identifiable genetic causes of colon cancer.
I examined Mr. Collins and everything was normal.
“Everything looks good,” I said. “Let’s get your procedure scheduled.”
As we walked out to my medical assistant’s area I asked Mr. Collins, “How is Mrs. Collins doing?” His wife had been my patient also but had had breast cancer diagnosed seven years before which had already spread to the lymph nodes at the time of diagnosis. She had discovered the cancer herself doing a self-exam, exactly three months after a screening mammogram was read as completely normal.
Tears welled up in Mr. Collins’ eyes. “She passed away seven months ago,” he said. “The breast cancer went everywhere and finally got her. If only they could have found it sooner. She had mammograms every year.”
I patted him on the back. “She was a lovely lady,” I said. “I’m so sorry for your loss.”
“I’ll never get over it,” Mr. Collins replied, “but you know, with her dying breath she said to make sure that our entire family gets their colonoscopies as scheduled since colon cancer screening does make a difference in reducing colon cancer and saving people’s lives.”
I nodded in agreement as I walked back to my office and said, “I couldn’t have said it better myself.”