I had done a quick physical exam and history prior to preparing him for a colonoscopy which he had been referred to us to receive. He was happy and ready to get his colonoscopy over and he made some small talk and joked about having a camera put up his rear end. The anesthesiologist gave some medications to put the patient into conscious sedation and we began the procedure. About half way in the colon we came upon and enormous mass. Usually you look for lesions on the way back out of the colon, so you stick the camera in and make your way to the end of the colon casually looking for signs of disease and then you start the journey back out of the colon and look more carefully for disease. If you see a polyp you remove it. The mass we saw was much to big to remove so we took several biopsies to send to pathology so they could tell us what it was. We did not really need to send it to pathology as we both new it was cancer and not a good sign. This cancer had been growing for 10 + years most likely.
After the procedure the patient woke up and when he was with it, the doctor and I went in to talk with he and his wife. Prior to entering the room the doctor and I discussed the case. The doctor said "this guy is done, this cancer most likely has metastasized and is a stage 4 caner and the cure rates are dismal." The sad part is that colon cancer is a slow developing cancer and no one should die of it. You get a colonoscopy at 50 and then every 10 years if your 1st colonoscopy was normal. If a polyp is found it is removed before it turns to cancer and you have a repeat colonoscopy every 2 - 3 years and to look for more polyps or the beginnings of cancer and that is it. However if you do not get the colonoscopy and a polyp is there then over the course of several years the polyp turns into cancer and eventually spreads to the liver and by the time you finally go into the doctor because of blood in the stool or a blockage it is too late and you die. Of course before you die you go through a whole bunch of invasive treatments to try and stop the cancer which are usually not too successful.
We entered the room and the doctor said "we found a mass, but we do not know yet what it is, it could be a cancer but there is no need to worry yet as we do not really know for sure what it is. We took a biopsy and will know more once we get the results back." The patient turned to his wife and said "see honey, I told you it was nothing! I will be fine." The doctor and I gave him follow up instructions and left the room.
Ultimately the pathology came back as cancer which was no surprise and in the mean time the patient went in for an MRI of the abdomen and a mass was detected in the liver. Now he is scheduled for a liver biopsy to determine if the mass is in fact cancer. We are fairly certain that it is cancer which would mean this patient has a stage 4 colon cancer and the cure rates are 10 - 15% at 5 years which means most patients are dead within 5 years. I later asked the patient when he first noticed blood in his stool and he told me he noticed it 10 years ago but never told anyone or thought anything about it.
So here is a patient that is most likely going to die and if he had gotten a biopsy at any time between 50 - 60 years of age it would have been found and removed before it became anything too serious but now at age 62 it has grown and spread and most likely can't be cured. Does the patient realize this? Probably not. He remains hopeful which is probably a good thing, if there is going to be any chance of a cure he is going to need as much hope as he can muster up.
When you turn 50 get your colonoscopy!
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