some statistics, random crap, and why my family wishes we were no longer related

A blog title with statistics, crap, and a family who wants to disassociate from me!! I know. I know. How could you not want to continue reading?!

PLEASE PLEASE PLEASE just humor me and read this one. It's not all crap eggs or IF loss kind of crazy for once. In fact, it's not even related to IF (although I'm sure I can work it in if I try hard enough because IF really does touch everything it seems). This issue scared me, umm, shitless (literally) so I just want to pass along what I have learned in the hopes it can help someone else - maybe your parent, spouse, aunt, sibling, or even yourself.

There is something very simple I will ask of you at the end if you will so kindly oblige me. ALL OF YOU. It will be easy, I promise. You can even just skip all of the babble about me and scroll to read what is below this little mark *~*~*~*. And then I will get off my soapbox and return to regularly scheduled programming.

So stop babbling and get to the chase already, right?

So I learned late last year that despite the fact that I didn't meet any of the common risk criteria* and was categorized in the lowest level risk group** that the odds I would have had colon cancer by the time I was 40 were "highly likely" and before I was 50 (the age recommended for a first colonoscopy) were "almost certain".
*over 50, diet high in fat/red meat, smoke, drink in excess, don't exercise
**Level 1: The person does not have a family member who has had colorectal cancer or adenomatous polyps. Or the person has a family member who had colorectal cancer or a polyp but the affected family member is not their parent, sister, brother or child.

I believe my words were some version of, "Errr, back up there Dr. Grandpa (GI doc #1 who is, well, OLD). Your associate Dr. Nopersonality (GI doc #2 who I think really needs no explanation on his nickname) gave me the old 'Everything is great. Come back in 5 years for a repeat colonoscopy.' just last year and I am certain I would remember if he had told me about these likelihoods."

So let's do a quick recap to bring everyone up to speed with the workings of my colon and why I have 2 GI docs. I know you are all on the edge of your seats now. It gets better I promise think hope.

• September 2006 - occasional (~2x/month) rectal bleeding begins
• March 2008 (yes, it continued for 18 months...I see the error of my ways. No scolding necessary) - bleeding increases to 1-2x/week, analoscopy with primary care doc - found nothing
• April 2008 - sigmoidoscopy (camera scope in the back end to view the lower 1/3 of the colon - no sedation) with Dr. Grandpa which found a 1 cm polyp who was unaffectionately named Earl; IVF#2 bumped for a month so it can be removed (See I knew I could work IF into here somewhere)
• May 2008 - colonoscopy (camera scope in the back end to view the entire colon - sedation required) with Dr. Nopersonality due to last minute scheduling issues to remove Earl the polyp and make sure he didn't have any friends
• June 2008 - learned Earl was not cancer via a phone call from my primary care doc
• July 2008 - learned Earl was pre-cancerous via a 1 page results overview sent by snail mail from Dr. Nopersonality
• August 2008 - follow up sigmoidoscopy with Dr. Nopersonality to make sure Earl didn't leave any garbage behind; get clean bill of health for 5 years and go about my merry IF way
• August 2009 - Rectal bleeding the sequel - and with a vengeance not to be postponed
• October 2009 - met with Dr. Grandpa and learned all those extra details about Earl and my cancer risk. This might have launched a full blown google searching frenzy which may have led to mass pandemonium, but we aren't going to talk about that.

Let's break away from the ass scoping timeline for a minute to see what I learned via Dr. Grandpa (and supplemented with Dr. Google).
There are two main varieties of colon polyps: hyperplastic and adenomas polyps.

1. Hyperplastic polyps tend to be smaller and are not a risk for cancer.
2. Adenomas polyps make up for 75% of all colon polyps and are precancerous. If left in place, they can become cancer.

Of course my polyp was adenomas (precancerous) and this part I already knew.

Adenomas are divided into three sub-types of polyps:

1. Tubular adenomas are encountered most frequently (80-86%) and are the least likely to turn into cancer
2. Tubulovillous adenomas are encountered less frequently (8-16%)
3. Villous adenomas are encountered least frequently (5%) and are the most likely to turn into cancer.

My polyp was, you guessed it, the 5% fucker: a villous adenomas (only 5% frequency with the greatest risk of cancer). It's like being on the crapside (literally though) of IF statistics all over again.

There are a couple different ways that a polyp grows: pedunculated or sessile.

1. Pedunculated look a bit like a mushroom with a small stalk and then a head.
2. Sessile are missing the stalk and thus have a larger surface area connected directly to the colon. If I told you that sessile are more likely to be cancerous (33% vs. 13% for pedunculated) and are harder to remove when larger than 1cm, which do you think I would have?

Ding. Ding. Ding. Ding. Ding. Yes, the sessile is correct. Actually, most villous adenomas are sessile.

The National Polyp Study found that the only independent factors to predict if a polyp will progress from precancerous to cancerous were adenoma size and histology. They defined advanced polyps as larger than 1 cm or as those containing villous tissue or high-grade dysplasia.
I was already at risk with my villous histology, but why not add the risk that my polyp was also 1 cm.

So even though Dr. Nopersonality had given me the old, "Your-polyp-is-fully-removed-you-are-good-to-go-come-see-me-in-5-years-for-your-next-fun-filled-colonoscopy-now-go-enjoy-your-life" babble back in August 2008, learning this new information along with the return of the bleeding was cause for concern.
Back to the timeline...

• October 2009 - sigmoidoscopy with Dr. Grandpa shows nothing (despite the fact that I bled 3 times the morning of the procedure)
• October 2009 - colonoscopy with Dr. Grandpa shows nothing
• December 2009 - met with general surgeon who (with a very short scope) found the source of the bleeding to be several very irritated "possible ulcerated patches" that he wants Dr. Grandpa to biopsy
• Today - still bleeding, but in need of a new GI. (If Dr. Grandpa can't find anything in a sig or colonoscopy, I suspect he will have trouble finding something to biopsy... I was hoping I wasn't the only one that this wasn't lost on.)

So a big hoopla of scare to find out that I may have ulcerative colitis and that I need to be proactive at scheduling my colonoscopies every 5 years.

*~*~*~*

Soapbox rant BEGIN.
So here are some of the facts followed by my little PSA spiel.
About 90% of people diagnosed with colon cancer are older than 50. The screening guidelines for someone with the lowest level of risk (where I was categorized and where most of you are likely categorized) is to have a first colonoscopy at age 50 and repeated every 10 years unless there is an issue (polyp, cancer, etc) which then shortens the time in between procedures anywhere from 1 to 5 years.
If you have a first degree family member (parent, sibling, child) who was diagnosed with colon cancer before age 50 or had a polyp before age 60, it is recommended that you have your first colonoscopy 10 years earlier than the age your family member was diagnosed. (ie If your dad was diagnosed with colon cancer at age 45, you should have your first colonoscopy at 35.)
Why does 10 years keep popping up? Dr. Grandpa assured me that it takes about 7-8 years (Dr. Google says 5 years) for an adenoma polyp to grow to 1 cm and an additional 5 years before it turns into invasive cancer. The earlier the polyp is caught, the less likely it has of becoming cancer.
If found early, the 5-year survival of those with colon cancer is 90%. NINETY PERCENT!! This number drops to 7% for those detected late. EARLY DETECTION and PREVENTION IS KEY!!
Of course there are always exceptions to the rule (me being a case in point), but MOST colon cancer cases can be prevented by following the simple screening guidelines.

My plea today is to ask all of you to probe someone you know who may be at risk. I know everyone here knows at least one person who is over 50!
Tell them about some info you came across on the web or send them something like this article or ask if they have had one or if their doctor has suggested they have one. Please just make mention of it in some way.
March is National Colorectal Cancer Awareness Month so no better time than the present to raise awareness.
I have persuaded both my 39 year old brother and 59 year old mom to "get theirs". Thanks to me they are now at a risk Level 3***. My mom didn't think she needed one because she is healthy, feels fine, and takes really great care of herself. She now knows that by simply being 50 that she is at risk. She will (along with me and my brother) be getting her back end scoped every 5 years. Fortunately?? for them we all had colonoscopies in 2009 so I have claimed the job to force gently remind them to get theirs when I get mine.
***Level 3: The person has a parent, sister, brother or child who had colon or rectal cancer before age 50 or a polyp before age 60. Or the person has two close relatives (parent, sister, brother, child) who had colon or rectal cancer after the age of 50 and/or an adenomatous polyp at any age.
I've had mine. Do you know if your at risk loved ones have had theirs?
Soapbox rant END.