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INTRODUCTION

Many types of cancer exist. With all cancers, cells in the body change and grow out of control. Usually, the multiplying cancer cells form a lump called a cancerous tumor. Cancerous tumors are also called malignant tumors. Sometimes malignant tumor cells can break away from the mass and travel through the bloodstream or lymphatic system to other parts of the body. This process is called metastasis. Not all tumors are cancerous. Those that are not are called benign. Cells from benign tumors do not spread to other parts of the body.

These statements seem straightforward enough and are probably adequate for the majority of people who have not encountered the most dreaded three words in the human language: You have cancer! However, when I am in the unfortunate situation of having to say these words to a new patient and his or her anxious loved ones, this explanation is woefully inadequate. Those involved need to know so much more. The questions are endless: Where did it come from? Why did it happen to me? When did it start? How far has it gone? How big is it? Has it spread? How can it be stopped, treated, and cured? For those who are actively battling colon cancer or who are supporting a spouse, child, parent, loved one, or friend who is suffering with colon cancer, this book is for you. This is the what, where, when, why, and how of colon cancer that hopefully will make sense of everything that you have heard, seen, been through, or are about to experience. In short, I hope to answer all of the questions about colon cancer that you may have—hence the title, Colon Cancer Answers.

Despite family and friends, the physician consultations, books, and the Internet, patients like Doris and Sam remain in the isolation of the unknown, their minds inextricably fixating on the worst-case scenario. Doris and Sam and the tens of thousands of people like them cannot find comfort or calm their irrational fear until they understand the physiologic and biologic processes related to this odyssey. They need time to digest the myriad of pieces of information thrown at them, and they need the fact filtered from the fiction. They need the information accessible to digest at their pace, not in the 30 minutes allotted to them in the doctor’s office. This book provides that information. This book is for every Doris and Sam, their children and siblings, their caring friends, and their parents. It is for the more than 150,000 newly diagnosed colon cancer patients this year and the millions of men and women living with a diagnosis of colon cancer in the United States. It is also a book for those at risk of colon cancer, which includes all of us over 50 years of age, as colon cancer is a disease which can be prevented and if found early, cured.

CELL INJURY AND CARCINOGENSISIS

Throughout your lifetime cells are continuously injured and repaired. Bruises, scrapes, cuts, burns, infections, chapped lips, and tongues burned by pizza cheese and hot coffee are a sample of the myriad of everyday cellular injuries that you experience. Your body has the remarkable ability to repair this cellular damage and does so in a constant, ongoing process. Some cellular damage is below the surface, caused by the tobacco smoke that we inhale, the chemicals in the food that we eat, the radiation from the sun, and the internal (natural), physical, chemical, and hormonal stresses that are part and parcel of being alive. Sometimes, if the injuries are chronic or recurrent, or if there is a genetic predisposing defect, the body is unable to repair the cellular injury. The body’s failure or inability to repair cellular injury can lead to cancer. The process by which the failed repair of cellular injury leads to cancer is called Carcinogenesis.

THE MOST DIFFICULT JOB I HAVE AS AN ONCOLOGIST

For patients like Eric the first postoperative visit comes with much anticipation, as the review of the surgical pathology will determine the probability of cure. The most difficult job I have as an oncologist is during this first postop visit when I have to explain to the patient that although the surgeon said, “I got it all,” he/she really meant to say “I removed all of the cancer I could see.” Microscopic cancer may still be in the body. No matter how positively I try to present the pathology findings, when the probability of cure is not 100%—and it usually is not—a cloud of gloom hangs over the discussion. Eric’s chances of cure were excellent but not 100%; so, I placed a box of tissues on my desk and emotionally prepared Eric, Kim, and myself for our discussion.

TARGETING CANCER CELLS

A cancer-specific treatment would by definition affect only cancer cells. However, these cancer cells are so genetically similar to normal cells that they escaped the recognition of the immune system. How could science accomplish what nature failed to do—target the cancer cells? The answer is in the DNA. In the past few decades, through ongoing work to translate the human genome (the basic DNA blueprint of all human cells), scientists are beginning to gain a deeper understanding of what makes a cancer cell behave the way it does. With these insights, cancer management is evolving. Cancer is no longer considered an organ disease or even a cellular one. Today, cancer is considered a genetic and molecular disease. Reflecting these changes, the therapy of cancer today is not just of a cellular nature, but also one of a genetic and molecular nature.

SANITY DURING TREATMENT

Shortly after initiating Eric’s treatment, Kim called regarding an article in the newspaper that praised a new wonder drug for colon cancer. The “wonder drug” discussion raised the broader question of how a patient and their supportive family members remain sane amidst the endless reports of breakthroughs, miracles, and cures. There is no easy answer. In my observation, the key to sanity can be found in a patient’s trust in the integrity of his or her caregiver and faith in his or her own judgment. All patients will reach a line in the sand when they have to decide on treatment. Only by believing that they have performed adequate due diligence and by trusting their caregivers’ recommendations can that decision be made without regret. Eric and Kim went through such a process. I believed they had a foundation of faith and trust that would keep them sane in the coming months and years.