March is national colon cancer awareness month and here at Charles A. Dean Memorial Hospital, we’re committed to improving the care and health of the people in central and northern Piscataquis County!

Cancer is often a disease that evokes fear and anxiety.  Almost everyone knows someone who has had cancer.  Maybe even colon cancer.  But cancer is a disease that is well understood and is often cured with today’s treatments.  More importantly, some cancers can be prevented entirely through simple and painless screening programs.  Colon cancer is one such cancer!  It is our hope that through public education and a comprehensive screening program, we can alleviate fear and anxiety and eliminate colon cancer completely!  This is a goal that can be accomplished in just a few years.  Let’s look at this cancer a little more closely.

Cancer in our society is the second leading cause of death after cardiovascular disease [heart attack and stroke.]  ½ of all males and 1/3 of all females in the United States will develop some type of cancer throughout their lifetime!  Many of these are skin cancers that are easily cured with simple removal.  In 2006, a half of a million people in the United States died from cancer.  Half of those deaths could have been prevented through improved diet, regular physical activity, the cessation of the use of tobacco and through comprehensive screening programs.  Colon cancer is the second leading cause of cancer deaths in both males and females after lung cancer.  About 5% of all males and females in America will develop colon cancer.  We have the technology and ability to completely prevent anyone from ever developing colon cancer through our screening program.  In 2006, 810 Mainers developed colon cancer and 300 of them died of their disease.  We could have prevented each one of these cancers!

So how do we accomplish this objective?  The first step is to identify those at risk.  The answer to this question is that we are all at risk!  Therefore, we must all be screened.  The second step is to remove the tissue [a polyp] that the cancer develops in.  This is done through a procedure called colonoscopy.  Once the polyp has been removed, the cancer cannot develop!  Polyps and early cancer do not have any symptoms and the patient is completely unaware of its existence.  This is why it is important to start the screening process with colonoscopy when the patient is healthy and unaware that any problem exists.  Removing the polyp at this stage of the disease eliminates the tissue where the cancer will develop and we’ve completely prevented the second most common cause of cancer death in our society.

March is national colon cancer prevention month and over the next few weeks we will be circulating more information about colon cancer, provide more information about who is at a higher then average risk of developing colon cancer, outline what the screening process entails and when is should begin.  We’ll also talk more about what it means to actually have colon cancer and how it can be cured. If you like, you can take the Great American Health Challenge on line at www.cancer.org/docroot/subsite/greatamericans/index.asp or visit www.americancancersociety.org.  This self assessment quiz is sponsored by the American Cancer Society. As always, if you have questions surrounding symptoms or treatment options, please call the Northwoods Specialty clinic at 695-5205.

Part 2

About 800 Mainers will get colon cancer this year!  We can prevent anyone from ever getting colon cancer through a comprehensive screening program.  Colon cancer starts in abnormal tissue growths in the colon called polyps.  Polyps and early colon cancer generally do not have any symptoms and the patient is unaware of their presence.  The only way we can find and remove the polyp is by screening healthy people who do not have any symptoms.  Removing the polyp or even an early cancer at this stage is curative.  The best way to find these polyps is by doing a procedure called colonoscopy.  We have already shown that by identifying these polyps and removing them, we can decrease the number of people getting colon cancer.  In order to completely eliminate colon cancer, we simple have to screen everyone!

Colonoscopy is a procedure where a flexible tube with a video camera is inserted into the colon and the entire colon is inspected for polyps.  If a polyp or even early cancer is found, it can be removed through the scope, a technique called Polypectomy.  Identifying the disease at this stage and removing it through the scope cures the patient and avoids the need for more traditional larger operations.  Colonoscopy is done as an outpatient procedure.  This means that the patient goes home after the procedure, usually within an hour.  Because colonoscopy can be a little crampy, the patient is given sedation so that they are completely unaware of the procedure and feel nothing.  Most patients have no recollection of even being in the procedure room!  In order to have a good look inside the colon, the colon must be “cleaned out” the day before the procedure.  This is done by giving the patient a “bowel prep.”  This medicine taken by mouth induces diarrhea and “flushes” the colon clean.

At Charles A. Dean Memorial Hospital, we’ve worked hard to make the whole experience of colonoscopy as simple and enjoyable as possible.  We use a low volume bowel prep, only 2 or 3 soda sized bottles of medicine.  The day of the procedure, our staff strives to provide an atmosphere of compassion and comfort and do everything we can to ensure your confidentiality.  After your procedure we offer a small lunch which often includes fresh pastries and muffins from our local deli, Lakeshore Provisions.  Before you leave, your surgeon will explain to you what was found and when you should have your next screening.  A written summery is also given to you in case you forget any details when you get home.

Dr. David Rideout is the surgeon in Greenville who performs colonoscopy, offering over 20 years of experience performing colonoscopy.  Dr. Rideout, himself,has had several colonoscopies and polyps removed and his father was cured of colon cancer.  Preventing colon cancer is one of his passions and he is sensitive to the importance of making the colonoscopy experience congenial, painless and confidential.  Many of his patients have commented that the whole process was “not that bad” after all.

WHO SHOULD BE SCREENED AND WHEN?

There are general recommendations published by The American Cancer Society and several other societies.  It is important to interpret those recommendations and tailor the timing to start screening specific to any individual patient.

Patients with normal risk and without any symptoms at all should start screening by the age of 50.  Patients with a change in their regular bowel habits such as constipation, diarrhea or a change in the form of their stool should be screened sooner.  Any bleeding noticed should be followed up with a colonoscopy.

Some patients are at a higher then normal risk of developing polyps and colon cancer.  These patients should be screened at an earlier age.  Some of these risk factors include:

• a history of inflammatory bowel disease
• a family history of colon polyps or colon cancer
• a personal history of other cancers such as ovary, uterus, stomach, pancreas, kidney, small bowel, ureters and the bile duct
• a diet high in red meat
• obesity
• smoking
• high alcohol intake

Risk factors are important because they help is identify people who are at a higher then normal risk for getting colon polyps and colon cancer.  But it is important to remember that the increase in risk is often small.  Remember, we are all at risk.  The primary importance of risk factors is that they help us identify those patients who should start their screening at an earlier age.

If you have any of these risk factors, your risk of developing colon cancer is higher than baseline and you should start your screening process at an earlier age.  The providers at Northwoods Healthcare can assess your overall risk and develop a screening plan tailored to your specific risk profile. C.A. Dean has stream lined the process of getting your colonoscopy.  You no longer need to have a consult with your surgeon before the procedure is scheduled.  If you’re comfortable meeting Dr. Rideout on the day of the procedure, you can be scheduled directly and avoid an additional office visit.  Of course if you’d rather meet with Dr. Rideout for any reason beforehand, we’re happy to continue to provide that service.

If you should have any questions regarding risk factors, screenings or treatment, please call the Northwoods Specialty Clinic at 695-5205. With an aggressive and comprehensive screening program, we can eliminate colon cancer from out community!  Make sure you have your screening done!

Part 3

Welcome to the third part of our four part series on colon cancer.  So far we have discussed the magnitude of the problem of colon cancer in America and Maine.  We’ve discussed how colon cancer starts in an asymptomatic polyp and then develops into a cancer.  Colon cancer can be prevented if the polyp or even an early cancer is discovered and removed before it has had a chance to spread.  This is best done before the patient has any symptoms.  A proper screening program utilizing colonoscopy can achieve this.

But what does it mean if someone actually gets colon cancer?  All is not lost!  Many cancers and especially colon cancer is very curable if found at an early stage.  Cancer is the abnormal growth of tissue that has the capability of spreading to other parts of the body.  It is the spread of cancer that is life threatening.  If cancer is treated before it has had a chance to spread, cure rates can reach close to 100%!

When cancer is discovered, the tumor is “staged” to determine how far along it has progressed before a treatment plan is developed.  Characteristics of the tumor, status of surrounding lymph nodes and whether or not it has spread to other organs are all part of the staging process.  Once the stage is known, the prognosis and a treatment plan tailored to the specific needs of the patient can be made.  Because symptoms correlate poorly with these characteristics, your Health Care Provider will rely on various investigations to determine the stage.  Blood work and various X-Ray examinations are necessary.

Generally speaking, cancers are staged as stage I, II, III or IV with stage I being the earliest.  How any cancer is treated and its’ prognosis is dependent on staging.  The treatment of any cancer can involve surgery, radiation therapy and/or chemotherapy.  The role of each arm of possible treatment depends on the stage of the cancer and other health issues of the patient.  Surgery is the primary treatment for all stages of colon cancer.  Chemotherapy and occasionally radiation therapy are used in the more advanced stages.  Chemotherapy for colon cancer is well tolerated and is not associated with the toxic side effects most of us think about when we hear about chemotherapy.

If a cancer is found early such as a malignant polyp, often all that is required is just removal of the polyp, which is done at the time of a colonoscopy.  If additional surgery is required, C.A. Dean is proud to offer the new procedure of “Minimally Invasive Colectomy!”  This is a procedure where a portion of the colon is removed using laparoscopic techniques.  Instead of making a large incision on the abdomen, the colon is removed using several small 5 to 10 mm incisions with the aid of a laparoscope, something like a telescope.

The benefits are that the patient is exposed to a decreased risk of the procedure, has a quicker recovery time with a shorter hospital stay, will experiences less pain and can return to normal activity and work sooner then with a regular large incision.  For some stages of colon cancer, it appears that the cure rate may actually be higher with the laparoscopic approach then with the traditional “open” operation.  C.A. Dean’s general surgeon, Dr. David Rideout, is skilled and experienced with Laparoscopic Colectomy and has been doing the procedure for over 10 years.  He was one of the first surgeons in Maine to perform a Laparoscopic resection of colon cancer!  Afar the surgery, patients are usually on a modified diet the same day of the operation and many patients will go home in 1 to 2 days.

After surgery, C.A. Dean will help coordinate any additional necessary treatment in cooperation with the Cancer Care Center of Maine in Bangor.  We also offer additional services such as physical therapy and rehabilitation as needed.  Our goal is to provide a comprehensive treatment service to help patients cope with their cancer and its’ treatment.  We strive to provide a friendly and compassionate environment where our patients can get the treatment they need and the confidentiality they deserve. 

Colon cancer is potentially a very a curable disease.  With regular screening and early detection of the disease, less invasive treatments can used which means less of an impact on the patients’ life and a higher cure rate.  Chance of cures for colon cancer at an early stage can be over 90%!  Still, we’d like to stress that the most important thing is for you to have your screening started and the right time and continue the screening process at the appropriate intervals.  We have the ability to eradicate colon cancer from our society through such a program.  If you are due for your screening or wonder when you should start your screening, call your Primary Care Provider or give Dr. Rideout a call at Northwoods Specialty Clinic today!  Our number is 695-5205.  We stand ready to provide these services for you.  Spread the word and tell a friend.

Part 4

We’ll wrap up our month long series on colon cancer with a summery of the issues surrounding colon cancer.  We also have some testimonials about the screening process and how colon cancer has the ability to disrupt the lives of patients and their families.

Colon cancer is the second most common cancer and second most common cause of cancer deaths in Maine and the United States.  This cancer starts in a polyp that can be present in the colon without any symptoms for years.  A polyp can turn to cancer and that cancer can spread to an incurable stage before the patient has any awareness of its presence.  These polyps can be identified and removed by a simple out patient procedure called colonoscopy.  By performing screening colonoscopy in every Mainer at the appropriate time, we can identify and remove these polyps before the cancer has a chance to develop.  Colon cancer is one of the few cancers we can actually stop and prevent before the patient ever gets the cancer.  We can make colon cancer a thing of the past in our society!  The key is to institute a comprehensive screening program in our community.

Risk factors for developing any cancer are well known.  Risk factors for developing colon cancer include:  a personal or family history of colon cancer or colon polyps, inflammatory bowel disease, a diet high in animal fat, obesity, smoking, heavy alcohol intake, diabetes, radiation exposure and a history of having had certain other cancers.  Risk factors help providers identify people who are at a higher then normal risk for developing colon cancer.  They are not important for identifying who should be screened but when screening should start!  Depending on a patients specific risk factors, the appropriate age to start screening can be determined.  The absence of any risk factors means that an individual’s risk of developing colon cancer is at baseline or is “normal.”  The baseline risk for developing colon cancer is 5%.  Because we cannot yet completely eliminate our chance of getting colon cancer, we must eliminate the polyps where colon cancer starts through screening colonoscopy in everyone!

Here at CA Dean, we’re committed to the prevention and treatment of colon cancer.  We have established a comprehensive screening program and have state of the art equipment for performing screening and diagnostic colonoscopies.  Our endoscopic specialist, Dr. Rideout, has 20 years of experience performing colonoscopy and is passionate about preventing and eliminating colon cancer.  We also offer the latest surgical techniques for the treatment of colon cancer with our Minimally Invasive Surgical Program.  CA Dean partners with Cancer Care of Maine in Bangor to provide any necessary additional treatment such as radiation therapy or chemotherapy.  Our staff is ready to provide a caring, warm and confidential environment for your treatment.  Supplemental programs of Physical Therapy, Occupational Therapy, Rehabilitation services and financial assistance are also available at CA Dean.  We will do all we can to limit the physical, emotional and financial impact of having cancer.