Expert: Claes-Gustaf Nordquist, M.D. - 9/8/2005

Question
Hello, my mother is 52 and just found out last week she has colon cancer. She had a colonoscopy, they removed 8 large polyps and a day or so later she was told one was cancerous. She had some bleeding complications later that day (after the colonoscopy) and had to go back to the hospital and get patched up as the site was bleeding (long story, but scared her and my father). 5 days later (yesterday) she felt woozy, found blood on the couch, went to the bathroom and passed out. My father called 911. She was given 2 blood transfusions (bleeding eventually stopped on its own yesterday), and today had another colonoscopy where they found more bleeding sites and supposedly fixed them. On Tuesday she will be seen by a specialist from Georgetown to get the cancer staged I am told (my sister is updating me as I live in Arizona and they live in Maryland).I am worried about her of course. She also announced that the Dr said it was a heriditary type of colon cancer (Lynch syndrome I think) and all four of us kids should get tested soon. So, this is where my questions begin....

First, regarding my mom, how long will she have to wait to find out what stage it is at if she has the sonogram (not sure that is what it is) with the specialist to stage on Tuesday? Are results usually given same day?

Second, I have a couple questions below regarding my own upcoming colonoscopy, but first want to give a brief background to give insight on my situation....

I am 32, have two young children (2 & 4), and a husband who is in the military and so have much of my care performed by military Drs. I have had stomach problems since I was 17. They thought I had CVS (Cyclical Vomitting Syndrome) and more recently they have said it might be stomach migranes (I get "episodes" occasionally every few months, often the week before my period, where I get incredible stomach pain so bad I vomitt uncontrollably from 20 minutes to up to days...sometimes I can manage at home, other times I go to the ER, I didn't get them while pregnant in the 2nd & 3rd trimester or 1st 6 months of breastfeeding, I also noticed them not being as bad while on Atkins this past yr from dec-june...lost 30 pds, would like to loose 15-20 more as I'm 5'2" & 130 pds now). Bottom line is after all these years they are still guessing. I read that those with Chron's and IBS can have a greater chance of having colon cancer and now am worried that my stomach woes plus potential Lynch syndrome could be a double whammy...

In the past year I also have had a PAP come back high grade dysplasia after one being fine the year prior. I had had dysplasia and cryo in college several months after a date-rape incident, but have been clean ever since. DH has been faithful as well. Anyway, they said it was an unusual type too and aggressive. They caught it in time, got it all, and I have had one successful PAP since & due for another one in October. I also read that one type of the Lynch syndrome increases odds for other cancers and wonder if this is a coincidence or related now.

Anyway, more recently I have had an occasional stomach pain in the upper right side that is sharp. It started before I knew what was going on with my mom. It has only happened 3-4 times the past 2 weeks. I have not been "regular" in at least 2 years, and am tired a lot (but I figure that is normal for a mom with preschoolers). The base Dr ordered an ultrasound and it was fine (no gallbladder problems which is what they thought it might be, or anything else showed up). I let them know of my mom's diagnosis on Tuesday and they have scheduled me for a colonoscopy. I have the consult late this afternoon (Thursday). I am a bit nervous if they decide to do it in-house on whether or not the military Dr will be well trained enough and see everything. The other Drs I have had so far have been great, but the flight Dr I have been seeing said he is not sure if the GI on base has done colonoscopies or not. I am also concerned about complications. After hearing what my mom has gone through, I am, of course, nervous about going through the procedure myself (not so much so that I won't go through it, but definately want someone well-trained to do it). They do occasionally refer out for this kind of thing I am told by my general Dr and if I pushed for it, I probably would get approval.

What should I ask the Dr to see if he/she has perfomred enough of these if they are suggesting I do it on the base hospital clinic? How many times is considered enough? Also, I am in Phoenix, AZ, is there a Dr or clinic in the Phoenix area that is particularly well-known for colon cancer that I should request if I do go out in town? Should I be genetically tested after the colonoscopy (is that even possible with Lynch syndrome?)?

Thank you,
Bridget

Answer
Well this was a lot at one time! I'm sorry to read about all the trouble your mother has had! If she has had so many polyps, one of them being cancerous, there is obviously an increased colon cancer risk for her children including you. That has nothing to do with your other abdominal problems. Your gynecological problem is most probably coincidental.
Being at a higher than normal colon cancer risk makes it important that you will undergo colonoscopies regularly. By asking your dr. how long he has been doing colonoscopies and how many he performs per year you will get some idea of his credentials in this field. He should at least do several per week and have been doing them for several years to be considered to have enough expertise. Please remember that also your children may be at a higher risk in the future. There is at the moment no sure genetical test for colon cancer. But that may change though I do not think only one gene is involved but many. Good luck!

C.-G. Nordquist, M.D.
Former chief medical officer, The Royal Guards & The Royal Horse Guards & The Royal Household Brigade, Royal Swedish Army Medical Corps.