BY PATRICK L. BROWN
The fire service lost a good man earlier this year. I wouldn’t call him a friend (I didn’t have that kind of relationship with him); he was a fellow firefighter with whom I crossed paths at shift change when we worked at the same firehouse. He was a good man, always taking time to stop, say good morning, and chat awhile. He seemed to have a funny/happy smirk on his face all the time. I never worked with him but have been told he was a very good firefighter. This year, he was awarded the Medal of Honor, the highest award given to a firefighter by the state of Illinois, posthumously. You might think this story is about another tragic line-of-duty death, but it isn’t. Chris died after a long battle with colon cancer.
Colon cancer (also called colorectal or bowel cancer) is the third most diagnosed cancer in the world. The disease is characterized by the abnormal growth of cells/tissue within the large intestine (colon). Most often, the disease starts out as polyps (fleshy growths) within the colon. The polyps can be benign (noncancerous), premalignant, or malignant (cancerous). Malignant polyps (stage 0 cancer) have a very high cure rate. If the cancer is confined to the wall of the large intestine (stage 1 or 2), it can be cured with a 90-percent survival rate after five years. As the cancer extends into the lymph nodes (stage 3) and to other sites (stage 4), the survival rate after five years drops to about seven percent.
As you can see, early detection is key. The problem is there are few outward signs that cancer is growing within your colon. Many of the signs or symptoms, such as constipation, diarrhea, vomiting, and fatigue, are often disregarded because they are thought to be the result of a cold or something less severe. Other signs and symptoms like blood in the stool, narrow stools, bleeding from the rectum, mucus in the stool, abdominal pain, pale skin, and weight loss are often ignored out of fear, denial, or ignorance.
Colon cancer can strike anyone, but some people have an increased risk compared to others. Smokers and heavy drinkers have a higher incidence of the disease. Age increases your chance of being diagnosed with colon cancer—90 percent of colon cancer patients are age 50 or older. African-Americans, the obese, and diabetics also have an increased risk.
Your daily diet affects your chances of getting the disease. A diet high in red meat/processed meats, low in vegetables and fruits, and low in fiber increases your chances of getting colon cancer. Conversely, if you eat fish, fruits, vegetables, and fiber regularly, you decrease your risk.
Genetics always plays a role in your health. If you have an immediate family member who has been diagnosed with colon cancer, especially before the age of 55, your chances of getting the disease increase. If you have multiple immediate family members who have been diagnosed with colon cancer, your chances of getting it increase exponentially. Firefighters and workers in certain industrial occupations may have an increased risk of being diagnosed with colon cancer.
So what can you do? You can impact your chances of getting and surviving colon cancer. You have to watch your diet as mentioned above. You need to stay physically active, manage your weight appropriately, stop smoking, and limit your alcohol intake. Pay attention to yourself! If you notice changes in your bowel habits or your stool starts to look different in shape or color (yes, you need to look in the toilet), let your doctor know. If you seem unusually tired more frequently, let your doctor know. If you feel like you need to have a bowel movement after you had a bowel movement or you have abdominal pain or distention, let your doctor know. If you notice you are losing weight even though you are not trying, let your doctor know.
Get an annual physical. Talk to your doctor about your job. Let him know that firefighters may have a higher risk of getting colon cancer. The general rule for colon cancer screening is to start screening at age 40 unless there is a family history of colon cancer, which means screening should start earlier. Initial screening involves a digital rectal exam with fecal occult blood testing (the doctor checks a very small amount of your stool for blood using a chemical reagent). The presence of microscopic blood in your stool indicates there is some source of bleeding within your colon and requires further evaluation. I know the rectal exam is uncomfortable and embarrassing, but in the grand scheme of things it is really no big deal. The procedure lasts only a few seconds and is relatively painless. If your doctor does not perform the test during your annual physical, ask why, and encourage him to do so.
The next phase of testing involves viewing the colon using a scope that is inserted into the rectum (colonoscopy). The discomfort of this procedure is highly overblown. The procedure itself is painless. You are sedated during it and do not feel a thing. Proper and complete visualization of the colon does require the colon to be clean. The day prior to the test, you are allowed to drink only liquids and must take some form of bowel cleanser, which leads to frequent watery stools. Preparation for the procedure is frustrating and annoying but, again, really not a big deal. During visualization, any polyps that are found can be removed and biopsied if needed. After the procedure is finished, you awake, have a snack and a drink, and then go home.
Visualization is usually recommended for those without significant risk factors, beginning at age 50 with repeat tests every seven years. That being said, firefighters may have a higher risk of colon cancer, so talk to your doctor about having a screening colonoscopy at age 45.
There are other, less-invasive tests to visualize the colon involving CAT scans, but they are not as reliable and require colonoscopy to further evaluate any polyps found during the scan. Hence, colonoscopy is the best test to truly evaluate and treat any colon problems. Talk with your doctor about which colon cancer screening test he prefers.
You may wonder what happens if you are found to have colon cancer. Treatment varies, depending on the location, stage, and size of the tumor. Stage 0 colon cancer (cancerous polyps) can often be removed by the colonoscopy, but sometimes the tumor may be too large and require a surgery called a colectomy (the removal of part of or the entire colon). The colectomy can be performed traditionally by an abdominal incision (laparotomy) or minimally invasive through laparoscopy. Stage 1 colon cancer (involving inner layers of the colon wall) is usually treated by colectomy without any additional treatments. As the cancer advances, so does the treatment regimen. In stage 2 (the cancer has spread from the colon to nearby tissues), your doctor may add chemotherapy and radiation therapy to the colectomy surgery.
In stage 3 (the cancer has spread to lymph nodes), the regular course of treatment involves the colectomy with removal of affected lymph nodes and chemotherapy. In some cases, radiation therapy may also be recommended. Stage 4 (the cancer has spread/metastasized to other organs such as the liver and lungs) is very difficult to treat. Treatment for Stage 4 cancer usually involves surgery to remove the cancerous part or the entire colon and may also involve the removal of part or all of the organs now affected by the spreading cancer. Depending on the extent of this cancer, the surgery may not cure the disease but may help you live a longer life. Your doctor will add chemotherapy and may add radiation therapy to the treatment plan. Also note, whenever a colectomy is performed, there is a chance that you will be required to use a colostomy bag. In a colostomy, a healthy portion of the colon located above the repair site is brought through an opening in the abdomen where a bag is attached to collect feces. You may be required to use the colostomy bag while the repaired colon heals; or, depending on the extent of the surgery, you may be required to use the colostomy bag for the rest of your life. The courses of action noted for each stage of colon cancer are current common practice, but new procedures and courses of action are being developed all of the time. As you can see, the treatment of colon cancer is nothing you want to have to endure.
Your health and wellness are your concerns. Without proper screening, colon cancer is often not found until it is well advanced and treatment is much less satisfactory. Be an active participant in your healthcare. If your doctor does not do the tests a physician should for a patient in your age group, find another doctor. If your doctor will not listen to your concerns and act on them satisfactorily, find another doctor who will listen and will act accordingly.
Colon cancer is scary. It can sneak up on you if you don’t pay attention to yourself and don’t get regular physicals that include colon screening tests. Remember, colon cancer is very treatable and curable if caught early. Get the tests done. Stay safe. Stay healthy.
Author’s note: In memory of Firefighter Chris Reischl, Chicago (IL) Fire Department, Squad 2. “Good men must die, but death cannot kill their names.”
PATRICK L. BROWN is a firefighter and paramedic with the Chicago (IL) Fire Department. He is a state-certified firefighter III, fire officer I, and instructor II as well as a licensed registered nurse specializing in emergency medicine and trauma.