June Kim, a 60-year-old man from Syosset, is vigilant about taking care of his health, and it shows. Most days, Mr. Kim rises at 5 a.m. and begins his daily routine. The owner of a plumbing and heating supply business, Mr. Kim heads to work early, so that by 2 or 3 in the afternoon, he can enjoy a round of golf, go for a long walk outside or hop on the treadmill in his basement. He was understandably stunned when his routine colonoscopy revealed that not only did he have a large polyp in his colon, but also that it was cancerous.
“This was a shock. I consider myself a very healthy man and never had any serious health problems in the past,” explained Mr. Kim. “My screening was a miracle. I would never have known I had cancer if I hadn’t checked it.”
“When I met Mr. Kim, I was surprised by his age because he looks no older than 40. He is that visibly fit,” said Marc Greenwald, MD, chief of colorectal clinical services at North Shore University Hospital (NSUH). “But Mr. Kim is also typical of many colorectal cancer patients because he had no symptoms of being sick, let alone having Stage II colon cancer.”
Virtually all colorectal cancer cases start as a polyp, an abnormal growth of tissue found on the wall of the colon or rectum. Most often, these polyps are asymptomatic and therefore don’t cause pain or bleeding, and often go undetected on blood tests. For this reason, people who have no identified risk factors — other than age — should begin regular colorectal cancer screening at age 50, when the incidence of polyps substantially increases.
“I like to explain to my patients that a polyp is like a little seed,” said James Sullivan, MD, associate chairman of surgery in the Division of Surgical Oncology at NSUH. “We know that not every seed grows up to become a tree. But every tree was once a seed. Every case of colorectal cancer was at one time a polyp. This is why when polyps are detected, they should be removed at the pre-malignant state to prevent the development of colon cancer.”
Cases on the Rise
There are nearly 150,000 new cases of colorectal cancer in the United States each year, making it the third most common cancer diagnosed in both men and women excluding skin cancers, according to American Cancer Society estimates. More concerning, colorectal cancer is the second leading cause of cancer-related deaths in the United States when both sexes are combined and was estimated to cause nearly 50,000 deaths during 2009. Last year in New York State, more women died of colorectal cancer than of breast cancer.
“It is widely known that mammograms detect cancer at an early stage. But as crucial as it is for women to get mammograms, they actually don’t prevent breast cancer,” said Dr. Sullivan. He added that colorectal cancer is preventable through regular screening. A colonoscopy can either find benign polyps before they develop into cancers or find the cancer in its earlier stages when the disease is easier to cure.
The colonoscopy procedure allows the physician to view the entire length of the large intestine by inserting a colonoscope (a long, flexible, lighted tube) through the rectum up into the colon. The physician examines the lining of the colon to identify and remove any abnormal growths, such as polyps, for further examination.
John Procaccino, MD, is chief of colon and rectal surgery at NSUH and director of the Center for Colon and Rectal Diseases, a state-of-the-art facility that administers colonoscopies in a convenient ambulatory setting.
“One of the reasons I wanted to build a center for colon and rectal diseases was to make it patient friendly,” said Dr. Procaccino. “We have a certified colonoscopy suite in our center that meets very stringent criteria set by the New York State Department of Health so patients can undergo the procedure outside the hospital. A colonoscopy takes between 15 and 30 minutes. If no polyps are found, the patient doesn’t need another screening for another five to 10 years. If polyps are found, they can be removed then and sent to our lab for analysis.”
The Earlier, the Better
Colorectal cancer is very curable if it is diagnosed at an early stage. The treatment of colon and rectal cancer almost always necessitates surgery, which entails removing the diseased tissue and then resecting, or splicing, the healthy sections together. Chemotherapy and radiation therapy may also be used depending on the case and stage.
“Removing the segment of the colon that has cancer does not have long-term effects on patients’ bowel patterns, eating habits or physical activities. There is so much redundancy to the colon, which is actually five feet long. If you take one foot out, the remaining four feet will more than compensate for what was removed,” said Dr. Procaccino.
There have been many surgical advances in the treatment of colorectal cancer within the last 10 years, including minimally invasive, laparoscopic-assisted colorectal surgery, which is done extensively at NSUH. Laparoscopy requires very small incisions on the abdomen, and reduces how long patients stay in the hospital and the severity of pain during recovery. Dr. Sullivan uses a robot in surgery for some cases.
“Robotic surgery gives us a minimally invasive approach with the best articulation,” explained Dr. Sullivan. “The instrumentation is so advanced, we can do things with the robot that we couldn’t do before.”
For rectal cancer, many patients receive radiation therapy or chemotherapy to shrink the cancerous tumor before surgery. This course of treatment prevents the need for colostomies, which are rarely necessary today.
The treatments of Stage III and IV colorectal cancer also have undergone major breakthroughs. More advanced and aggressive treatments of liver metastasis, the most advanced stage of colorectal cancer, including new surgeries and radiofrequency ablation, have increased survival rates in these further advanced stages.
Work Becomes Personal
For Ivy Algazy, her June 12, 2009, colonoscopy marked the day her professional and personal lives collided. She has been the director of communications for women’s health services for North Shore-LIJ Health System for nearly two years. In February, Ms. Algazy completed her last course of chemotherapy treatment for Stage III colon cancer.
“My job for the health system is to promote the message of prevention and wellness and taking care of ourselves, for women. If we don’t take care of ourselves, we won’t be able to take care of our families,” said Ms. Algazy. “These words could not have become truer for me than on the day of my colonoscopy. If I did not take charge of my health and get my colonoscopy, I would never have caught the cancer early enough to get treatment and save my life. Moreover, one of the best things that came out of this ordeal is that my three children will begin to get their screenings at age 35 to ensure early detection.”
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+Colorectal cancer is a very curable disease if it is diagnosed at an early stage.
To find a colorectal surgeon, call (888) 321-DOCS or go to NorthShoreLIJ.com and click on “Find a Physician.”