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Jane (not true name) was referred to me for iron deficiency anemia. This is anemia due to lack of enough iron. She was 62 years old and attained menopause at age 55 after removing her uterus due to fibroid. Jane was divorced yet she enjoyed life and liked to socialize.
Bring up the possibility even before the diagnosis
We discussed her blood count and the evidence that supports iron deficiency. Her anemia was not severe enough to require blood transfusion. I asked her if she saw blood in her stool or have black stool and she said no. We discussed all the possible reasons she may have iron deficiency anemia including cancer.
All patients referred to me for unexplained iron deficiency anemia gets an upper endoscopy and colonoscopy unless information points to a specific location as the source of blood loss.
Tell them what you see looks like cancer but confirmation needed
Jane’s upper endoscopy was normal. There was no evidence of celiac disease. Her colonoscopy however showed a large mass in the colon. The mass occupied about 50% of the lumen of the colon. Biopsies were obtained from the mass and submitted to the pathologist for analysis.
After the procedure, Jane was taken to the recovery room. Patients often come for procedures accompanied by a family member or friend. Mary (not true name) accompanied Jane. I asked Jane some questions to ascertain her level of alertness. She said it was okay to discuss her health in the presence of her friend. I described what I found. Furthermore, I was direct in telling them that I think the mass was colon cancer and the reason she has iron deficiency anemia. Confirmation of the diagnosis is needed from the pathologist, I told them. I ordered a tumor marker called Carcinoembryonic Antigen (CEA test). And, I ordered a CT scan. In addition, I called the pathology department to put a rush on the request.
Over the phone or in-person
Two days later, I received a call from the pathologist. It was poorly differentiated adenocarcinoma of the colon. I asked my medical assistant to make an appointment for Jane to see me. She was told to bring a a family member.
Again, Jane came with Mary. I told her she has colon cancer. Also, her CEA level was high but the CT scan did not show any spread of cancer anywhere else. I waited for her to digest the news. I waited for a response. She expressed understanding of the result.
Where do we go from here
Because the cancer is limited to the colon, there is a chance for cure. I went over treatment options. I asked her what she wanted to do. She chose to pursue treatment and fight. A referral was sent to a medical oncologist and a colorectal surgeon.
Last week, I saw Jane for her 1 year surveillance colonoscopy. She had surgery and chemotherapy. Her colonoscopy did not show any polyp or mass. She had beaten colon cancer.
How to tell patients they have colon cancer
- Know your patient. A knowledge of your patient’s clinical, psychological, social, and economic background will help you take care of the whole person.
- Have someone else with the patient when you break the news. If possible, tell patients of their diagnosis in the presence of a family member or close friend. Often, patients don’t hear any other word after the word cancer has been mentioned.
- If possible, tell the patient in-person. There are times when a phone call will suffice. Usually, there are follow up questions by the patient or a family member. Having the patient in front of you allows you to connect with the patient at their most vulnerable point.
- Be direct. Be frank and honest with your patient regarding the diagnosis and prognosis.
- Stay. Be with the patient has they journey through treatment. Assist in any way possible.
- Recognize your limitation. Despite your best efforts, communication may go wrong or treatment may fail.
Suggested Reading
- How to choose a screening test for colorectal cancer.
- How to understand your colonoscopy result.
- 30 myths about bowel preparation, colonoscopy, and colorectal cancer.
- 3 ways to prevent colorectal cancer.
