By Dr Kebede H Begna
I remember that long day and night at the intensive care unit of the ‘Tikur Anbessa” hospital, one of the largest and teaching hospitals at a metropolitan city, Addis Ababa, Ethiopia. It is the only major referral center of a city with 5 million people. I was the on call medical intensive care unit (ICU) resident. I was then given the privilege to take care of my own professor, who happened to come to the unit after a complicated surgery. He was a devoted teacher at the prime age of productivity. He had had blood in his stool but ignored it after he made a self-diagnosis of hemorrhoids. The bloody bowel movement worsened during a six weeks rural attachment service to Zewai, a small regional town, that he went with the final year medical students. His friends supported his suspicion and attributed the worsening of symptoms to the diet and dehydration due to the rift Valley desert hence did not seek medical attention soon enough. Finally he needed to be transported to Tikur Anbesaa hospital because of intestinal obstruction. The surgeon, a friend of the professor, had to make a difficult decision of closing the abdomen without doing any surgery. The fungating mass arising from his rectum not only closed the outlet passage but spread to the entire abdomen and liver. There was no precedent of survival to a disease of such degree, let alone at that time and that place, even in the age of molecular and targeted therapy.
They say, hindsight is always right, had he sought medical advice when he first saw blood in his stool, the young life would have not be lost. He was a loss to his wife, young children , the medical community , and to the whole country.
In the good old days, residents are expected to work like a robot. After a sleepless night taking care of my professor, and a rather long day, living far away from the hospital with my parents, I need to take a taxi drive through the busiest market in Africa, Merkato. I stopped by a barber shop to have a haircut. The moment I touched the whirling barber chair I fell asleep as if I had narcolepsy. The barber felt something wasn’t right about me. I did not tell him that I was on call and about to lose one of my mentors to cancer.
Colo-Rectal cancer is the second commonly diagnosed cancer after breast; and the third common in men after prostate and lung. It is though to be the second leading cause of cancer death in both sexes [Global cancer statistics. CA Cancer J Clin 2011;61(2):69 and 2014:64(1):9]. Approximately one in three people with colorectal cancer die of their disease.
My country folks say an ounce of prevention is better than a gallon of cure. Screening has been shown to decrease colorectal cancer mortality in number of studies; one module predicted that screening may account for the 53% of the observed decrease in colorectal mortality [Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116(3):544).
With age appropriate screening measure and proactive search for advice with first sign of blood with stool, life and misery can be avoided.
The take home message is do not consider blood with stool as benign with out proper evaluation. It is colon cancer unless proven otherwise, especially above the age of 40.
Dr Kebede H Begna is an accomplished oncologist currently practicing in the US.