Doc: Colon cancer screening guidelines
Dear Dr. Roach: I have been getting regular colonoscopies every five years for the past 20 years. This past time, three years ago, four tubular adenomas were found in the cecum, with the largest being .8 cm. There also were polyps in 2008, but I don’t know how many, other than it was more than one. My maternal grandmother died of colon cancer, my brother is presently getting chemo for colon cancer, a double cousin had it and my father’s double cousin also has had a couple of bouts. My gastroenterologist has recommended a repeat exam in five years (two years from now). With the number of polyps removed and my family history, should the next exam be due now, rather than in two years? Other than bowel problems caused by IBS, I am healthy.
Dear A.W.: The U.S. Multi-Society Task Force on Colorectal Cancer released guidelines in 2012 with precise recommendations. For people with four to 10 tubular adenomas, the recommendation for people at otherwise average risk would be a follow-up in three years. Given your family history, I would be more aggressive in getting further screening.
These guidelines are just guidelines, not rules etched in stone, and perhaps your gastroenterologist has information about you not available to me, which affects your case. I certainly would recommend that you tell him or her if you would prefer an earlier screening.
Finally, given the extensive family history, I would try to find out whether anyone in your family has been evaluated for Lynch syndrome or other family cancer syndromes.
Dear Dr. Roach: I am a 23-year-old, working professional. I have had tonsillitis and sinus infection trouble for more than a year. I have been taking homeopathy treatment for the past six months. I often get throat infection, and this increases my fever.
In the past few days, I have had severe throat infection and fever. I took a blood test, and my WBC count was elevated. This happened often in the past year.
Is this because of tonsillitis, or something else? I would like to know if there is a permanent cure for this, as I am losing weight because of this persistent infection.
Dear Anon.: I cannot tell you for sure, but based on your symptoms and high white blood cell count, I would be quite worried about a chronic hidden bacterial infection. The tonsils and sinuses are the most likely places for this.
Finding the true source of infection can be difficult, but because you have had such severe problems for so long, it certainly is time for a more comprehensive evaluation.
If a very careful examination failed to show a problem, I would consider, in a case like yours, a CT scan of the sinuses, and very likely a referral to an ENT specialist. An infection lasting a year or more sufficient to cause weight problems shouldn’t be left alone or treated with ineffective medications. (There is no basis in science for homeopathy; however, some people use the term to include herbal treatments, which sometimes are effective. In your case, what you are taking clearly isn’t working.)
Email questions to ToYourGoodHealth@med.cornell.edu.