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Cancer? I really don't want to know - (4/10/2018)

By Dr. Ron Gasbarro

John, 55, came into the pharmacy with a prescription for a bowel cleanser. “When is your colonoscopy, John?” the pharmacist asked. “Next week,” he replied with a frown. The pharmacist knew that John had canceled 2 previous appointments for his colonoscopy and that his doctor said that if he does not keep next week’s appointment, then he will drop John as a patient. Asked the pharmacist, “Don’t you want to know if you have cancer?” “I’m scared. I really don’t want to know,” John said.

If the pharmacist did not know John, he would guess that John could not tolerate the colonoscopy prep, which was not exactly pleasant. Yet, according to John’s records, he had the prep prescription filled twice before. “When was your last colonoscopy, John?” the pharmacist asked. “About 20 years ago,” John confessed. Since that time, both his father and his maternal aunt died of colon cancer. Thus, John has a family history of malignancy, so it is especially important that he get the procedure done. 
The pharmacist explained to John the advantages of getting a colonoscopy. Colorectal cancer is one of the most dangerous malignancies. According to the American Cancer Society, it holds the number 2 spot among all cancer deaths. As with most forms of cancer, though, the key to surviving and beating colorectal cancer is to catch the disease early. That can be accomplished by being knowledgeable about the disease and having a solid understanding of its signs and symptoms. Blood in the stool, inconsistent bowel movements, and sudden anemia are a few of the signs that the colon is in trouble. Although experiencing just one of the symptoms associated with colorectal cancer can be common, prolonged and/or intense activity associated with several of these symptoms can be a sign that one should see a doctor as soon as possible. 

Besides the fear of being slapped with a Stage 4 diagnosis, a common concern regarding side effects of a colonoscopy includes the possibility of perforation during the procedure. Endoscopic perforation happens when the instrument punctures the wall of the colon during the screening. This can happen at any time during the procedure with some individuals being at a higher risk than others. Advanced age, female sex, multiple co-morbidities, diverticulosis, and bowel obstruction can increase the risk of perforation. Yet, perforations are rare. The frequency of perforation is 1 for every 1400 colonoscopies. The pharmacist knows that the clinic where John is to have his procedure does many colonoscopies each year and they have an excellent success rate. Therefore, John need not focus on that. 

Another good thing: A colonoscopy gives the clinician a chance to check for polyps. These growths in the large intestine can be a warning sign of colorectal cancer, but they can also cause pain and discomfort. In some cases, having polyps can have no symptoms, so one may not even be aware of their existence. A colonoscopy can collect tissue samples to ensure they are not cancerous. The larger the polyp, generally the higher the chance they may be malignant, states the Mayo Clinic. So even if one does not have symptoms, it is best to talk to the doctor about catching any potential problems early.

The pharmacist told John to have confidence in the people who will be assisting him on that day. Ask questions if he has any. No question is too silly or dumb. Be brave. Get it over with. John returned to the pharmacy a few weeks later and said to the pharmacist “All they found were 3 polyps which were non-cancerous. Other than that, I am fine! I’m really glad that I know!”

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com 


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