MEN'S HEALTH MATTERS:In some countries, routine colonoscopy for those over the age of 50 is recommended, writes THOMAS LYNCH.
Q There has been a lot of publicity recently on the radio about colon cancer, with advice to contact a helpline with the Irish Cancer Society if one is worried. My father died of colon cancer at age 60. I am now 54 years of age and was concerned that I might develop the same disease and recently had a colonoscopy. The doctor found a large polyp in my bowel at colonoscopy and this was removed. I am concerned this will be cancer and, if so, what are the implications?
A Your situation highlights the importance of colonoscopy especially with a family history of colorectal cancer. A colonoscopy is an inspection of the large bowel with a telescope. It allows direct visualisation and the ability to take samples of the lining of the bowel if necessary. Hopefully your polyp will be shown to be benign when examined under the microscope. Even if it is benign the entire polyp will need to be removed and fully examined and you will need further colonoscopies in the future to determine if you have developed more polyps.
Colonic polyps are small benign growths on the inside lining of the bowel. If undetected they can gradually enlarge over many years. If left untreated the cells within these polyps can change (dysplasia) and ultimately turn into invasive bowel cancer.
Colonoscopy is essential for those with a strong family history of colon cancer and in some countries routine colonoscopy for everyone over the age of 50 years is recommended.
Should your biopsies demonstrate cancer you will need referral to a specialist colorectal surgeon for investigation and treatment in a centre with full modern diagnostic and therapeutic facilities where a specialist multidisciplinary team with expertise in bowel cancer will co-ordinate your care. Scans will be performed to assess the extent of the tumour and potential spread to other organs. A CT scan is often sufficient but more detailed MRI or PET/CT scans may be required.
Most patients will initially require surgery to remove their tumour and subsequent chemotherapy may be required. With tumours of the rectum, or lowermost bowel, treatment is more complex and many patients will have radiotherapy and chemotherapy to shrink the tumour initially and then surgery to remove it.
Surgery for cancer of the colon or rectum can now be performed in up to 90 per cent of patients using laparoscopic (key-hole) surgery. This technique allows removal of the colon without opening the abdomen and results in a much faster and easier recovery.
Advances in diagnosis and treatment are gradually improving outcome and more than 50 per cent of patients are fully cured; the chances of cure being much better the earlier the cancer is detected.
Q You wrote previously about a dry mouth. I found it very informative and have recently noticed my mouth has become very dry. What could have caused this and are there implications for my teeth and gums?
A The term used for a dry mouth is “Xerostomia”. This is often a temporary problem, but may also be permanent. The temporary reasons for a dry mouth may be a side effect of some prescription drugs such as those used for an overactive bladder. It could also be due to smoking, diabetes and a range of medical conditions such as Sjögren’s syndrome.
Sjögren’s syndrome is a chronic disease in which white blood cells attack the moisture-producing glands. The hallmark symptoms are dry eyes and dry mouth, but it is a systemic disease, affecting many organs. It is one of the most prevalent auto-immune disorders.
Saliva plays a very important role in protecting the health of the teeth and gums. It also plays a significant role in the comfortable wearing and retention of dentures.
Saliva has a lubricating effect on the teeth and gums, which in turn allow us to speak, chew and swallow comfortably. The lubricating effect also helps to keep the gums healthy as saliva has its own anti-bacterial effect.
Dry mouth can also lead to poor sense of taste, bad breath and even soreness or burning sensation. Sipping water or sucking on sweets may alleviate these symptoms but you can also get saliva substitutes and dry mouth kits from your pharmacist to help you cope.
Topical fluoride applications from your dentist, and the use of high concentration fluoride toothpaste such as Gelkam can help prevent root caries.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin with a contribution from Mr Diarmuid O’Riordain, consultant colorectal and laparoscopic surgeon, Beacon Hospital, Dublin and Adelaide and Meath Hospital, Dublin and Mr John Adye-Curran, dental surgeon, Rathfarnham, Dublin