Med­i­cal Bytes with Dr. K

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It was Satur­day morn­ing and John woke up ex­cited to kick start his week­end. He looked out­side the win­dow. It was rain­ing cats and dogs. He headed to the bath­room and as he opened his bow­els he felt as though there was a sense of in­com­plete evac­u­a­tion and his stools were ap­pear­ing thin­ner. This had been hap­pen­ing for the past few weeks and he had not taken too much no­tice. He was feel­ing a bit more bloated as well and at­trib­uted it to the beans he had eaten a few days ago. John was a 55 years old sin­gle man who worked as an ex­ec­u­tive in a bank. He had lost his fa­ther 15 years ago to bowel can­cer. John did not like see­ing doc­tors and could not re­mem­ber the last time he has seen one. Upon men­tion­ing these symp­toms to his close friend who was a phar­ma­cist, his friend urged him to make an ap­point­ment to see a GP. Af­ter con­sul­ta­tion with the doc­tor and var­i­ous tests, John was ad­vised to have a colonoscopy (in­ser­tion of a tube with a cam­era through the back pas­sage to see in­side the bowel). Dur­ing the colonoscopy a tu­mor was found and he was di­ag­nosed with bowel can­cer, at stage two.He re­quired surgery and then ra­dio­ther­apy and chemo­ther­apy. As these were not avail­able locally, he had to travel to over­seas for fur­ther treat­ment. On the other side of town lived 85 year old Seru with his 80 year old wife. Seru woke up at 3 am with a very se­vere pain in his ab­domen. The cramps were so in­tense that he was moan­ing and groan­ing in pain. He vom­ited twice and was just not feel­ing right. His wife called the am­bu­lance and Seru was taken to the hos­pi­tal. He was given pain re­lief and an x-ray was done of his ab­domen. It was dis­cov­ered that he had a bowel ob­struc­tion (block­age of his bowel) with lots of stool through­out the in­testines. This was not a sur­prise as he had been bat­tling with con­sti­pa­tion for the past few months. Seru was kept on a fast, given flu­ids through a drip while a tube was passed down into his stom­ach to get rid of the con­tents. He had a colonoscopy per­formed and the con­clu­sion was that he had a very large can­cer on the right side of his large in­tes­tine. Seru’s can­cer was end stage and had spread to his lungs, liver and many other or­gans. The doc­tors per­formed surgery to re­move the can­cer, how­ever the other op­tions of ra­dio­ther­apy and chemo­ther­apy were not avail­able in Fiji and hence Seru was given pain re­lief and kept com­fort­able. He died within a month of the di­ag­no­sis. Then there was 35 year old Ro­hini who was hav­ing bright red bleed­ing from the back pas­sage and some pain in her lower ab­domen. Alarmed by her symp­toms she saw a doc­tor and was told that she had hem­or­rhoids and given a cream to use. This made no dif­fer­ence to her symp­toms and she saw an­other doc­tor who thought that she may have ir­ri­ta­ble bowel syn­drome as she had some change in her bowel habits as well. She was ad­vised of di­etary changes which also made no dif­fer­ence to her symp­toms. She then went to an­other doc­tor who took a good his­tory and ex­am­ined her thor­oughly. She ad­vised her to have blood tests, a scan of her ab­domen and then a colonoscopy. The colonoscopy showed a tu­mor and a biopsy showed she had an early can­cer- stage one. Ro­hini then had surgery in which part of the bowel was re­moved. She re­cov­ered well and had no fur­ther is­sues. All the above peo­ple were of dif­fer­ent ages, gen­der and racial back­ground but had one thing in com­mon - they were all vic­tims of bowel can­cer. In Aus­tralia 1-30 June is bowel can­cer aware­ness month, an an­nual ini­tia­tive of bowel can­cer Aus­tralia to raise pub­lic aware­ness of a dis­ease that claims the lives of 80 Aus­tralians ev­ery week. In Fiji we do not have a spe­cial month, how­ever it’s an op­por­tune time for us to con­sider bowel can­cer which is com­mon and eas­ily treat­able if de­tected early. Bowel or colon can­cer makes it in the list of top five can­cers in men in Fiji (Ministry of Health 2013 an­nual re­port). The an­nual death rate from col­orec­tal can­cer in Fiji in 2013 was 7.6 per 100,000 pop­u­la­tion, which was higher than the rest of the Ocea­nia re­gion at 6 per 100,000 pop­u­la­tion, al­though lower than the rest of the world at 10.8 per 100,000 pop­u­la­tion. Bowel can­cer also known as col­orec­tal can­cer can af­fect any part of the large bowel (colon) or rec­tum. It usu­ally grows very slowly over a pe­riod of up to 10 years be­fore it starts to spread and af­fects other parts of the body. Most bowel can­cers start as in­no­cent growths -called polyps-on the wall of the bow­els. Polyps are like small spots or cher­ries on stalk and do not pro­duce any symp­toms. Polyps are com­mon as we get older and most polyps are not pre­can­cer­ous. One type of polyp called ade­noma can how­ever be­come can­cer­ous. If left un­de­tected the can­cer cells will mul­ti­ply to form a tu­mor in the bowel, caus­ing pain, bleed­ing and other symp­toms. If un­treated, the tu­mor can grow into the wall of the bowel or back pas­sage. Once can­cer cells are in the wall, they can travel into the blood stream or lymph nodes and travel to other parts of the body. For bowel can­cer, the most com­mon place for spread is to the liver and the lungs. In its early stages bowel can­cer may have no symp­toms but many peo­ple ex­pe­ri­ence blood in the stools or on the toi­let paper, a change in bowel habits such as diar­rhea, con­sti­pa­tion or smaller more fre­quent bowel move­ments, a change in ap­pear­ance or con­sis­tency of bowel move­ments such as nar­rower stools or mu­cus in the stools. Many ex­pe­ri­ence a

feel­ing of full­ness or bloat­ing in the ab­domen or a strange sen­sa­tion in the rec­tum of­ten dur­ing a bowel move­ment. There may also be a feel­ing that the bowel has not emp­tied com­pletely af­ter a bowel move­ment. There may be a lump in the back pas­sage or even rec­tal or anal pain. The other gen­eral symp­toms may in­clude un­ex­plained weight loss, weak­ness, fa­tigue and ane­mia. The ex­act cause of bowel can­cer is not known, how­ever peo­ple with cer­tain risk fac­tors are more likely to develop it. These in­clude age over 50, mul­ti­ple polyps, his­tory of in­flam­ma­tory bowel dis­ease and a strong fam­ily his­tory of bowel dis­ease. Cer­tain life­style fac­tors also in­crease the risk such as be­ing over­weight, a diet high in red meat, drink­ing al­co­hol and smok­ing cig­a­rettes. A screen­ing test is avail­able for bowel can­cer. This is es­pe­cially im­por­tant as in its early stages, there may be no symp­toms. This is the fae­cal oc­cult blood test (stool test that looks for mi­cro­scopic blood in the stool). If this test is pos­i­tive then a colonoscopy is re­quired (cam­era test from the back pas­sage). The fae­cal oc­cult blood test is rec­om­mended ev­ery 2 years for peo­ple over the age of 50. If there is a per­sis­tent change in bowel habits, it is strongly rec­om­mended that you visit your GP for a con­sul­ta­tion. On most oc­ca­sions, it will not be bowel can­cer but if your doc­tor is sus­pi­cious, then he or she will or­gan­ise fur­ther tests. You can re­duce your risk of bowel can­cer by main­tain­ing a healthy weight, eat­ing a healthy diet, reg­u­lar ex­er­cise and not smok­ing.

“The an­nual death rate from col­orec­tal can­cer in Fiji in 2013 was 7.6 per 100,000 pop­u­la­tion, which was higher than the rest of the Ocea­nia re­gion...”

DR. KRUPALI RATHOD TAPPOO is an Aus­tralian qual­i­fied Gen­eral Prac­ti­tioner, a Fellow of the Royal Aus­tralian Col­lege of Gen­eral Prac­ti­tion­ers and the Med­i­cal Co­or­di­na­tor for Fiji-based NGO Sai Prema Foun­da­tion. Dr. Krupali is based at Mitchells Clinic in Tap­pooc­ity Suva and has a spe­cial in­ter­est in women and chil­dren’s health.

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