Medicine: The Slide Show

One of my favorite uses for my digital camera is its ability to be connected to a television and play a slide show of all the pictures stored on the camera at that time. I availed myself of this feature on Tuesday night at my sister-in-law’s house, to give my mother-in-law, Joe’s sister’s, and their families a glimpse into our lives of late.
We sat and enjoyed images of our new house, clothed in the first snowfall of the season, a cat show that we took in at a local convention hall, a late Christmas present exchange we had with my side of the family upon my father’s return from a visit to the Philippines. Suddenly, the images changed. On my sister-in-law’s widescreen HDTV was a gruesome image: a fungating, friable, nearly obstructing rectal cancer.
I yelped an apology, jumped up from my seat and started fumbling with the buttons on my camera. Images, taken during a colonoscopy, which I had loaded onto my camera in preparation for a power point presentation I was going to give at Tumor Board conference, flashed on the giant screen behind me. My audience was mesmerized, and begged me to leave the pictures running.

Then came the questions:
Ø What is that yellow stuff?
Ø Which part is the cancer?
Ø How old is this patient?
Ø Is she going to live?

Clumsily at first, then with a confidence and clarity that must have come from giving a similar talk in November at our hospital’s Colorectal Cancer Symposium, knowing this patient’s history well, and dealing with colon and rectal cancer on a daily basis (now, it seemed, even when I was on vacation!), I answered their questions.
This patient is a 43 year old hairdresser from Poland who came to me for rectal bleeding. She smokes a pack of cigarettes a day, and spends most of her day on her feet, styling hair. She has no family history of colon cancer and assumed that the bleeding was from hemorrhoids.
I found the cancer on flexible sigmoidoscopy, in my office. The rectal ultrasound, which I also did in my office, showed how invasive the cancer was through the rectal wall, and that a lymph node in the area appeared suspicious for metastatic disease. Her CT scans showed some cysts on her ovaries, but no evidence of other organ involvement.
She is currently undergoing intensive chemotheraphy and radiation therapy, which I will follow in 6 – 8 weeks with her surgery, a low, anterior rectal resection. She will spend 5 days or so in the hospital after her surgery, and recover over the next two to three months at home. Her other doctors and I will watch her very closely for two to five years, looking for signs of distant spread or recurrence (return of the cancer). Once she is five years disease-free, her chance of recurrence is very slim.
My family was blown away. Not even the pictures of my adorable son at the vineyard that we stopped at on our way out that day could dampen the intensity of the story they just heard, the images they had just seen.
March is Colorectal Cancer Awareness Month. The word is out in my family. How about yours?

For more information about Colorectal Cancer Awareness Month, please visit:
Ø The American Society of Colon and Rectal Surgeons
Ø Preventcancer.org
Ø The National Colorectal Cancer Roundtable