Why do good people have a bad outcome in Cancer?

I do not know Atul Chitnis.  I have not even heard of him earlier, till Sharat told me about his accomplishments in helping start-ups by open source software.

http://atulchitnis.net/

I read about a remarkable highly motivated and energetic person wanting to help others.   What really struck me on reading about him is that unfortunately he succumbed to colorectal cancer.  I read an update on his health in January 2013 and I started wondering on 2 issues:

  1. How can someone who is educated, well informed, well connected be

diagnosed  with Stage IV Cancer.

  1. The same issues which plague many of our patients like Chemotherapy toxicity and  expense, have affected Mr. Chitnis.

It is indeed a tragedy that good people like Atul Chitnis had a late diagnosis, a bad outcome and succumbed to the disease.

Let me put it in a proper perspective ‘How do you diagnose or how do you suspect colon cancer’?  I always ask  my patients are there any symptoms and how long did they have symptoms?  They invariably have at least 6-8 months of symptoms – like feeling lethargic and weight loss,which are really warning signals.  Then there can be dark stools, sometimes blood in stools and the bowel does not behave as it should.  The alteration of bowel habits would alert one to do a simple test for occult blood in stools.  If occult blood is present in the stools for 3 consecutive days, then colonoscopy is necessary and perhaps CT Scan too. Colonoscopy is quite simple and takes half a day. Its not painful at all. Here’s how its done.

Should all normal people undergo a colonoscopy, like in the West after the age of 50. (American cancer society guidelines attached). As a health policy on population based screening it would be an enormous load and not cost effective. Those who are conscious and want a clean chit every year can do so. But certainly those who have symptoms like the GI upsets that do not respond in a couple of weeks and have anaemia(low hemoglobin) for unexplained reasons should be on alert. Its difficult to lose weight. I know it to well.  Unexplained weight loss is an important pointer as the tumor starts drawing energy from whatever nutrition is consumed.  So let me say that the message is: ‘Please be on the look out for these early warning signals and seek medical advice early’.  Then perhaps we will be able to save more good people in our society.

Here is simple message for  your treating  doctor. Don’t’ assume that bleeding is due to ‘Piles”, a rectal examination and sigmoidocopy are a must for those who have symptoms. A visit in time will save many years of life.

My sympathies to Mr. Chitnis’ close and extended family and I do hope that the good work he started continues.

American Cancer Society guidelines for early detection of Colorectal cancer:

Beginning at age 50, both men and women should follow one of these testing schedules:

Tests that find polyps and cancer

  • Flexible sigmoidoscopy every 5 years  or
  • Colonoscopy every 10 years, or CT scan with contrast

Tests that primarily find cancer

  • Yearly fecal occult blood test (gFOBT)
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