At 44, Dr. Brian Elford had it all. A successful ear, nose and throat practice in the South Hills of Pittsburgh, a wonderful wife, four kids and a new home under construction in the suburbs.
But on a recent December night, Elford awoke writhing in pain. The pain emanated from the lower left part of his abdomen, and he didn’t know what to do.
Within an hour the pain subsided, so Elford reacted the way many of us do. He assumed it was something he ate or a symptom of irritable bowel, and toughed it out. However, the same pain occurred a few more times over the following month, so Elford reached out to his long-time friend and colleague, Dr. Mark Cedar of Pittsburgh Gastroenterology Associates.
Detective work
As Cedar began asking questions, something about Elford’s pain did not add up. He did not have any bowel changes that might suggest Crohn’s disease, colitis or celiac disease. He did not have any bleeding, fatigue or weight loss. He also did not have any risk factors for cancer or Crohn’s, such as tobacco use, obesity or family history.
Elford had thought perhaps he had celiac disease, so he eliminated gluten from his diet for a short time, and thought he felt a bit better. But, Elford’s self-diagnosis of irritable bowel or celiac disease did not make sense, in Cedar’s view.
So, Cedar ordered a CT scan and blood tests, hoping to find a simple explanation such as a kidney stone. Instead, the scan showed an irregularity in the colon. Cedar then performed a colonoscopy, which confirmed Elford had a large, partially obstructing, malignant mass in the left lower part of his colon.
The size of the mass, comparable to a ping pong ball, explained Elford’s severe intermittent pain. Abdominal pain is not a typical symptom of colon polyps or colon cancer, which are often asymptomatic until the later stages. Instead, Elford’s pain was caused by blockage preceding his bowel movements.
Cedar saw many prominent lymph nodes on the CT, so was concerned the cancer had spread to the lymph nodes or nearby organs.
Three days later, Dr. Leigh Nadler, colorectal surgeon at St. Clair Hospital, successfully removed the mass. Luckily, the mass was diagnosed as stage 2 cancer and the lymph nodes were cancer-free, significantly diminishing the risk of cancer spreading to Elford’s other organs. It also meant Elford would not need chemotherapy. A few weeks later he was back to work and feeling great.
“A real life-changing event,” Elford says.
Time is of the essence
The best thing Elford did was not ignore his pain. Otherwise the outcome could have been much different, Cedar says. If someone who is diagnosed with colon cancer is also found to have cancer cells in their lymph nodes, the person’s five-year survival rate drops from 90% to 60% to 70%, according to Cedar. And if it spreads to other organs such as the liver, the five-year survival rate is closer to 10%. Additionally, side effects from chemotherapy could have impaired Elford’s ability to perform surgery.
“He was very fortunate,” Cedar says. “Had he waited much longer the tumor would have spread and he would have certainly required chemotherapy.”
It may seem that Elford was too young to have colon cancer, but his story is not unique. A recent study from the journal Cancer found that 15% of all colorectal cancer patients are diagnosed under age 50. These cancers may also be more aggressive.
Most doctors recommend people begin regular colonoscopies at age 50, but if they have a family history, they should get their first colonoscopy at 40, Cedar says. He hopes this recent journal article helps push the starting age of colonoscopy earlier.
Although colorectal cancer is the third-most commonly diagnosed cancer in males and second in females, both the incidence and mortality rates have been slowly but steadily decreasing in the United States, Nadler says. Approximately 8% of all cancer deaths are related to colorectal cancer, he says.
“Over 95% of our patients with colorectal cancer are treated laparoscopically,” Nadler says. “We use the DaVinci robot in select cases, especially rectal cancer. St Clair Hospital also participates in the OSTRiCh Consortium (Optimizing the Surgical Treatment of Rectal Cancer), to provide quality state-of-the-art rectal cancer care through a multidisciplinary team in the evaluation and treatment of rectal cancer. Ultimately, laparoscopic and robotic surgery allows faster recovery with shorter hospital stay, quicker return of bowel function, smaller cosmetic incisions, with no detrimental impact on recurrence or survival compared with open surgery.”
St. Clair recently instituted for all colorectal surgeries an Enhanced Recovery After Surgery protocol, which includes pre-op, intra-op and post-op measures to minimize post-op pain, decrease wound infection and shorten the time hospitalized.
Power in prevention
About one in 20 people will in his or her lifetime get colon or rectal cancers. This doesn’t have to happen, Cedar says, because colonoscopies allow doctors to potentially preempt the problem.
“The goal of most preventive exams is to detect a cancer when it is small. But the goal of a colonoscopy is to remove the polyp before it even turns into a cancer. I find pre-cancerous polyps (adenomas), on average, on nearly 50% of all average-risk, first-time colonoscopies,” Cedar says.
One big barrier to early diagnosis is patients who self-diagnose stomach and abdominal pain, bowel changes or blood in their stool. Not only are they obviously unqualified to make a diagnosis, gastroenterologists consider a detailed patient history before making a diagnosis.
“I have so many patients who have already searched the internet and labeled themselves with irritable bowel syndrome, or tried gluten-free diets and probiotics for many months or even years before they come to see me,” Cedar says.
“Many of my patients have heard me say that ‘Dr. Google’
is the world’s most dangerous doctor.”
Also, many patients have a tendency to minimize their gastrointestinal symptoms, hoping the problem will just go away. If something is bothering you, Cedar says, don’t wait to get it checked.
“There is nothing magical about waiting until age 50 to pay attention to possible gastrointestinal problems. Listen to your body and don’t self-diagnose,” Cedar says.
“Brian is only 44, healthy and has no family history. Colorectal cancer does not discriminate; it can affect anyone regardless of age, gender or family history.”
