I always here on the news about women at high risk for breast cancer having mastectomies. I was wondering how effective is this at preventing breast cancer in this high risk group? And more importantly, can this step be taken to prevent colon cancer?
I’m mainly asking because my family (on my father’s side) has a history of colon cancer. My grandmother on that side, my father and atleast one uncle (I’m not very close to that side of the family so there might be even more relatives affected that I don’t know about) dies from colon cancer, my father specifically due to complications after the operation to remove his colon.
So I figure, why not get it over with now that I’m young an healthy? And that’s yet another question I’m asking, how dangerous is this operation, and will doctors perform it on someone with a fmaily history fo the disease, or do I have to wait to get cancer before they’ll do anything?
Might I suggest that a better approach would be to get periodic colonoscopies to screen for possible cancer? Taking out one’s healthy colon as a preemptive strike is far too extreme.
I had my colon removed 35 years ago. The surgery is not without risk. It is expensive and time-consuming (mine took ten hours), and the prospect of facing the rest of one’s life pooping into a plastic bag glued to one’s belly is not a pleasant one, particularly for a young person who is concerned about physical attractiveness. In addition, there are often horrendous, painful skin excoriation problems in the area surrounding the stoma (the stub of the bowel that protrudes from the abdomen). I cannot imagine anyone being willing to undergo all of this as a preventive measure, particularly since the detection of early colon cancer and pre-cancerous lesions is now possible.
Genetic testing is available to help evaluate hereditary risk for colon cancer.
There are also guidelines for surveillance (i.e. by colonoscopy) of people found to be at higher risk for colon cancer compared to the general population.
Geez, a buddy of mine just had part of his colon removed. I can’t imagine going through that electively and the aftermath electively. It’s pretty radical surgery.
My fiancee has a family history of colon cancer on both sides of her family and is considered high risk for colon cancer. She just goes for screening and a colonoscopy every couple of years and fecal testing yearly. Changing dietary habits with prevention in mind can help as well and avoiding certain kinds of medications.
Research has determined that there are some unfortunate people carrying a gene variant that means that they will almost certainly have colon cancer if they live long enough - into their 30’s or 40’s if I recall.
Given that these people have such a high risk of colon cancer medical ethicists usually feel that pre-emptive removal of the colon is a reasonable trade-off and such people have had their colons removed in their 20’s. They still remain at risk of other cancers, but not quite so high as for colon cancer. As pinkfreud points out, there definite downsides and side effects to such surgery, but if you’re going to lose your colon anyway eventually it could be argued that doing it when you’re young and healthy - therefore better able to endure any surgery - and before cancer arises and has a chance to spread might be your best option. Or might not.
A strong family history of colon cancer, particularly in younger relatives, would be indicative that a person may be carrying such a gene variant. However, colon removal is not to be taken lightly. You would have to talk to at least one, possibly several, specialists about what is the best option for you. If the colon cancer in your family is one of the known variants there might at this point be a test that would determine if you carry it. If you do, well, then you need to discuss options. If you don’t then you’re most likely at normal risk of colon cancer, not elevated. If you have a strong family history and your relatives don’t have a known variant it gets more complicated - again, this is something you would need to discuss with medical professionals. Close monitoring might be more sensible than surgery in many cases.
Does colon removal prevent colon cancer? Sure - if you have no colon you can’t get that particular cancer. However, there’s lots of other potential cancers out there and, as already mentioned, people with a genetic predisposition to it tend to be vulnerable to other forms of cancer and will need to be carefully observant no matter what they do with their colons.
Prophylactic colectomy is done on FAP patients in their teens or twenties, often with reconstructive surgery, although they still need annual surveillance of the ano-rectal cuff. Reconstructive surgery is not risk free and sucess is not guaranteed. Colostomies are not fun.
Otherwise, unless you have 2 or more first degree relatives with colon cancer or a personal history of inflammatory bowel disease, a colonoscopy every 5 years after 50 is more than adequate, and safer than a colectomy. Not fun either, but 24 hours in hospital every 5 years is better than weeks recovering from major abdominal surgery.
Remember polyps are removed at colonoscopy, ideally before they become cancerous. Colonoscopy isn’t just about looking at the colon, it’s about removing lesions before they get bad.
Colon cancer does not develop instantly, but takes years, firstly for a polyp to develop, then for the polyp to become cancerous. Most guidelines suggest stopping surveilllance after 70 or 75 if no polyps are found, because the time it would take to develop colon cancer is longer than the average lifespan.
My fiancee’s doctor insisted she start having colonoscopies starting at 40 given her family history of colon cancer. (Her other risk factors are low due to her lifestyle, but her genetic risk is really high).
On the positive side, catching colon cancer at its earliest stages can have a very good prognosis. There are different layers to the colon. If the cancer is just starting and is in the lining of the colon, prognosis is quite excellent. 90% of cases with the earlierst stage of colon cancer are curable. When it gets through the bowel wall, the survivability rate drops to 50%-70% and treatment is more aggressive. The sruvivability rate also depends on where the cancer is in the colon (higher or lower, IIRC).
My buddy only lost about a third of his colon. Aside from no longer having a belly button (that was a major incision point for his surgery), he is cancer free and doesn’t have any obvious signs of having had the surgery. They think the tumour had been growing for about 8-10 years, which meant that it started when he was 30. :eek:
So if you have a strong family history, regular screening should be your priority and start younger. (In North America cancer is on the rize in people under 40). Your doctor and/or oncologist will have a much better idea if you are at a high enough risk to warrant such an uncomfortable and radical procedure while you are still healthy. If you’re worried, talk to your doctor now about a prevention plan. It won’t do you any harm to start the screenings early.
My buddy was clenched in agony when he first woke up. His doctors were worried because he was so tense he wasn’t breathing properly, but he told us that he felt he had to keep his body tight because it hurt so bad it felt like he was still ripped open and that his insides would fall out if he relaxed. But he was up and walk around two days after the surgery (little strolls down the hall) and was home by the weekend, which amazed us.
BTW - don’t be afraid of a colonoscopy. The procedure has come a long way, even in the past ten years.
My fiancee had her colonoscopy two weeks ago and it was really no big deal. The technology has come along really far. She had brunch with me on Sunday around noon, then starting around 4pm, she had to start taking all sorts of nasty laxatives to clean out her system, and drink a ton of Gatorade. Her last laxative was some awful-tasting clear liquid stuff that affects some people differently, so she was briefly afraid she was going to be heaving out both ends (it really made her feel nauseated).
And that was the worst of the whole experience.
At the hospital they gave her valium or something, then some stuff that put her to sleep. Then she woke up and felt as if nothing had happened. (She was expecting a sore ass, but she didn’t have one). She’d been anxious before hand, but she said the whole thing was a non-event. She had a great little nap and woke up in recovery. Had a chat with the doctor about her results (all clean) and that was it.