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Tests Are a Pain; Then Again so Is Cancer

October 29, 2001|ROBERT DELLINGER

I don't like to be poked, pampered, pinched, squeezed or stuck with needles. I hate needles. If I have the choice between giving a blood sample and climbing a greased flagpole, I'll opt for the climb every time.

Therefore, it was an apprehensive moment when I watched a self-assured young doctor at the Veteran Administration's James Wadsworth Hospital in Westwood study a lab report.

I was hoping to be told I only had had a precancerous polyp, and that the abnormality had been corrected by my recent colonoscopy. Instead, I heard: "You've got cancer. I couldn't believe diseased cancer cells were homesteading somewhere in my colon, capable of destroying me. I had felt no pain. No nudges. No tiny signals to alert me that something deadly had been taking place for some time inside my gastrointestinal tract.

I would not have even known I was nurturing a clutch of terrorist cells if my primary VA physician, Dr. Frank Basa, had not insisted that I get a colorectal cancer screening test.

Then slowly--ever so slowly--anger began to percolate. I was mad at myself for having ignored a clue that something inside me was not as it should be. There had been blood in my stool a few months earlier. It did not alarm me.

I rationalized its appearance as a possible tear in my rectum, or some such temporary malfunction that would self-heal.

I would later learn that blood in the stool is one symptom of precancerous tissue. Other symptoms include changes in normal bowel movements, narrowing of the stool, abdominal pain, weight loss and constant fatigue; none of which I had experienced.

I was also angry with myself for having shined off Dr. Basa's recommendation two years earlier that I get a cancer screening. Ninety-four percent of colorectal cancer cases occur after age 50. Now 71, I am smack in the middle of the age group that suffers the highest incidence of cancer.

I had taken a pass on the test because my uptight tendencies made me uncomfortable with letting strangers poke around where the sun doesn't shine. It was a self-inflicted taboo, a product of my Midwestern conservatism of another era.

Another hard-to-admit reason I had skipped out on the previously scheduled cancer screening was my unwillingness to take the enemas that are necessary to clean the colon before the doctor can perform a sigmoidoscopy, an examination in which a flexible, lighted tube is used to inspect the rectum and lower third of the intestine (the sigmoid) for polyps, or unusual growths.

My memory of childhood enemas was one of embarrassment. The passing of time had not changed my attitude.

This year, Basa had not let me slide. Just short of dragging me into the exam room, he convinced me that no matter how well I took care of my body, it could still breed a stealth killer.

After agreeing to the test, I went on the Internet for a little statistical grazing. The results were demoralizing. Colorectal cancer is the second-highest cancer killer in the United States, just behind lung cancer and ahead of prostrate cancer.

About 135,400 new cases will be diagnosed this year, with 56,700 deaths. Although the disease strikes men and women almost equally, men are more likely to die from it. No one knows exactly why.

My unscientific hunch says one reason for this is that there are a lot of men like me who consider rectal exams unpleasant business. Cancer researchers say delayed detection in men is partly to blame for the gender discrepancy.

Armed with my Internet facts and a resolve to step over the ghost of my past, I gritted my teeth, cleaned my colon the night before and went in for the sigmoidoscopy. As I lay on the examining table watching a video screen as a miniaturized camera surveyed my glistening, smooth-as-a-baby's-bottom insides, I saw an abnormal growth that appeared to be about the size of my little finger.

It looked like a soft, sickly stalactite. A pink, spidery trail of blood was trickling from where it was attached to the colon wall. I knew I was in trouble before the nurse raised her voice slightly and called, "Doctor," an alarm signal if I ever heard one.

Within an hour I was admitted to the hospital's surgical wing and prepped for a colonoscopy, a more advanced technique that allows the doctor to examine the entire colon up to the cecum, and immediately remove any growths.

And now, as I sat in the surgical suite, listening to the young doctor who had graduated from Harvard Medical School tell me the tissue samples had been examined in the laboratory and were cancerous, I fought back the conflicting emotions of fear and anger, and tried to concentrate on what she was saying. It was not easy.

Just how far the cancer had spread was not known. The area where the polyp had been located was not fully accessible to the lighted scope. Only by opening me up surgically would they be able to learn the extent of the cancerous area.

Surgery was scheduled for that April. I signed the standard, "If I don't survive papers," an act that reinforced my queasiness.

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