Dr. Donohue: Following colon cancer after treatment

Syndicated Columnist
Published Sunday, January 02, 2005

DEAR DR. DONOHUE: I see and hear lots about screening for colon cancer, but I don't see or hear much about what to do for it after you have had it. What's the proper follow-up? I was operated on six months ago. Where does it spread to, and how does a person know if it has? Please give me the true survival statistics for it. -- W.M.

ANSWER: When colon cancer is detected early and treated promptly, the five-year survival rate is 90 percent. If the cancer has spread to lymph nodes before it is treated, the five-year survival rate is around 65 percent. If it has traveled to distant organs, then the five-year survival rate falls considerably.

The first place where colon cancer metastasizes is lymph nodes. The second place is the liver. It can also spread to lungs and to the abdominal cavity.

Colon cancer can recur at the site of the original cancer, or a new cancer can spring up in the colon.

One common follow-up test for a recurrence or spread is the blood test CEA -- carcinoembryonic antigen. Its blood levels rise if the cancer comes back. The test is usually done every three to six months in the first two years following treatment, and then every six months for the next three years.

Colonoscopy is an important tool in detecting a recurrence at the original site or the appearance of a new colon cancer, something that happens more frequently to a person who has already had one cancer than it does to someone who has never had a colon cancer. The schedule for colonoscopy depends on the size and extent of the cancer, but many doctors arrange for a scope exam one year following surgery, repeat the exam after one more year and repeat it again in three years.

There are many other tests that doctors arrange for their patients -- scans, X-rays, blood work and stool exams. You should not have been left in the dark about a surveillance program tailored to your particular circumstances. Get in touch with your doctor promptly for specifics. If that is impossible, find a new doctor.

Readers can order the booklet on colon cancer by writing: Dr. Donohue -- No. 505, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: What is Billy Rubin disease? I have heard that a co-worker has it. Is this an infection? If it is, how catchy is it? The talk around here is that it is infectious. -- R.K.

ANSWER: You are not the first to write about this and spell it this way. It's a justifiable mistake because the word sounds just like the way you spelled it. However, it is not "Billy Rubin," but "bilirubin."

Bilirubin is a material that comes from the breakdown of red blood cells. The liver siphons it from the blood and disposes of it.

When the liver isn't working as it should, blood levels of bilirubin rise. It's a pigment. Excess bilirubin infiltrates the skin and the whites of the eyes and turns them yellow. The condition is called jaundice.

Many illnesses sabotage the liver and cause a rise in blood bilirubin levels. Liver cirrhosis is one example.

There are infections that can impair liver functions, too, and raise the bilirubin level. Hepatitis -- all three varieties -- is such an infection.

Few infectious causes of jaundice are spread by casual contact. You and your fellow workers have no grounds for concern.

DEAR DR. DONOHUE: When you mention cholesterol, you include the values in both the American and Canadian units. For that I am quite appreciative. Many other articles that come from the States don't do so. Would you tell me how to convert the American reading into Canadian units?

This is more than a matter of casual interest for me. I am 50 years old and have returned to school to work in the public-health field. I need the information for my classes. -- K.J.

ANSWER: It's simple. Multiply the American cholesterol units by 0.0259 to obtain the Canadian value.

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