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| John Reed, RN, is on the front line of cancer. As a nurse in the endoscopy lab at UAMS, he spends about 50 weeks a year helping patients through colon cancer screening procedures, primarily colonoscopies.
But after a routine medical appointment in 2020, Reed became the patient.
“I felt fine, but my iron levels were really low. People told me I looked gray,” Reed said. “My doctor was pretty sure they would find something.”
At just 42, Reed was years away from the age of 50 then recommended for colon cancer screening in average-risk men; the guidelines have since been lowered to 45 due to an increase in the number of young adults being diagnosed with the disease.
But here it is, a tumor completely blocking his ascending colon, discovered by diagnostic colonoscopy. Fortunately, the cancer had not spread to distant sites.
“It was a bit of a shock,” Reed said upon learning he had colorectal cancer. “I just had this calm peace about it, though.”
Like many colorectal cancer patients, Reed had no significant family history of cancer and his symptoms were mild, so he didn’t notice them. Common symptoms of colorectal cancer include bleeding, changes in bowel habits, and abdominal pain.
“It was so scary for him,” said Kirsten Batts, RN, head of the clinical department of the UAMS endoscopy laboratory. “He came in just before the pandemic.”
Within two weeks of her diagnosis, Conan Mustain, MD., A colorectal cancer surgeon from UAMS, had Reed in the operating room. Mustain performed a robotic right hemicolectomy to remove Reed’s ascending colon and regional lymph nodes.
“I’m glad we were able to do John’s surgery robotically,” said Mustain, who leads the robotic surgery team at UAMS and notes that robotic procedures provide better visualization and require smaller incisions. . At the time, UAMS featured the latest generation daVinci Xi robotic surgical system.
Today, UAMS is a daVinci case-sighting epicenter for colorectal surgery, training other surgeons in the surgical system. UAMS now has more than 20 robotic surgeons in nine specialties, including colorectal, thoracic, urological and gynecological oncology, among others.
“With the robotic procedure, I can do more operations inside the body and extract the tumor somewhere other than the midline. It’s less painful for the patient and there’s less risk of a hernia developing later,” Mustain said.
Reed (here with her family) was diagnosed with colorectal cancer aged just 42. Today he is cancer free and uses his experience to help other patients.
Reed was walking the day after surgery and was back home in four days. It was good news for the young father of three whose family could not be with him in hospital due to the pandemic.
Pathology revealed that the cancer had spread to a few of the regional lymph nodes, so the surgery was followed by 12 rounds of chemotherapy, during which Reed continued to work.
“I would do chemo on Friday and take it off on Sunday, so I would have a day to recover before going back to work on Tuesday,” Reed said.
Reed completed treatment in October 2021 and received her first clear scan in December of that year. “It was a very, very good Christmas.”
Why do young people get colorectal cancer?
Reed is among a growing number of young adults diagnosed with colorectal cancer since the 1990s. According to the National Cancer Institute, the rate of colorectal cancer (which includes cancers of the colon and rectum) has been steadily increasing among adults under 50. More and more younger people are also dying from the disease.
Mustain says he’s also seeing this alarming trend. “I have performed robotic surgery on 50 patients aged 45 and under over the past three years. Twenty of them were cancer patients.
Scientists don’t know what’s causing the jump in colorectal cancer in young adults. UAMS oncologist, Ruud Dings, Ph.D., associate professor in the Department of Radiation Oncology at UAMS, studies the bacteria in the gut, also known as the microbiome.
“A lot of these research studies, especially those that include patients, are correlative at best,” Dings said. “We don’t know at this time what is causing it, probably several factors. Until we have more and better information about what triggers and drives colon cancer, from genetics to external environmental factors that can also influence the microbiome, early and regular screenings remain the best course of action. pragmatic and most reliable.
While only 10 to 20 percent of early-onset colorectal cancers are caused by hereditary factors, Reed underwent genetic testing at UAMS that revealed he likely had a parent predisposed to gastrointestinal cancer. The chances of his cancer recurring are low at 25-30%. He will have close monitoring with CT and colonoscopy.
“John is a very good man who has compassion for others. He truly handled his diagnosis, surgery and treatment with bravery and resilience. We are all very proud of him and frequently refer to his case and his age to promote and raise awareness about colorectal cancer,” Batts said.
Now, two years after the experience, Reed’s scars have almost faded and life is almost back to normal. But he says the experience has made him more compassionate towards the patients he sees at UAMS.
“It can get a bit depressing when the doctor has to share bad news with families, but I try to share my experience with them and it seems to make them feel better,” Reed said.
Which colorectal cancer screening method is the best?
In 2021, the United States Preventive Services Task Force released new recommendations for colorectal cancer screening. People at average risk with no family history of cancer and no symptoms should start screening for colon cancer by colonoscopy at age 45.
Screening tests for colorectal cancer can be divided into two categories: stool-based tests and structural tests. Stool-based tests look for the presence of blood or mutated DNA in the stool to identify patients who may need further testing to determine the cause. If a patient has colon cancer, it is very likely that the stool-based test will be positive; however, they are much less successful in detecting precancerous lesions. Stool-based tests are convenient and less invasive, but should be repeated at regular intervals. Any positive test must be followed by a colonoscopy.
Structural screening tests include colonoscopy, sigmoidoscopy, double-contrast barium enema, or CT colonography. Structural tests are designed to examine the walls of the colon and require the intestine to be cleaned and filled with air in order to see lesions on the walls. Like stool-based tests, any abnormal structural test should be followed by a colonoscopy. During a colonoscopy, a long, flexible camera (colonoscope) is inserted into the rectum and used to view the inside of the entire colon. If necessary, polyps or other types of abnormal tissue can be biopsied or removed during a colonoscopy.
Insurance companies and Medicare/Medicaid will pay for colorectal cancer screening at appropriate intervals, regardless of which option the patient chooses. However, once a patient has had a positive screening test such as Cologuard, colonoscopy to investigate the abnormal test would be considered “diagnostic” and not “screening”. This distinction may affect the type of test that patients choose for their screening. Once patients have precancerous polyps, they are considered “high risk” for colorectal cancer and are no longer eligible for medium-risk screening. These patients need a “watch” colonoscopy to watch for polyps. Other screening tests are inappropriate in this setting. Patients of any age may need a “diagnostic” colonoscopy to look for symptoms such as bleeding or a change in bowel habits, even if they are younger or older than the age recommended for screening.
To learn more or to schedule a colonoscopy, visit https://cancer.uams.edu/patients-family/prevention/colorectal-cancer-screenings/ or call 501-686-8000.
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