What’s a great medical tragedy? It’s being diagnosed with a disease for which there is no cure. Possibly an even greater tragedy is dying from what’s been called the “Stupidity Factor”. These cases occur because patients ignore symptoms which indicate cancer may be present. But due to either fear or the hope it won’t happen again, they do nothing, thereby signing their own death warrant.
This folly occurs in both sexes, resulting in failure to get a test done. The prime example is colonoscopy, which detects polyps in the large bowel that can be removed. This procedure can save people from premature death.
Another major folly is to ignore rectal bleeding. I recall a friend who confided he had noticed rectal bleeding. I advised him to arrange a colonoscopy immediately. But he responded, “They’re not going to do that to me!” I repeatedly stressed that the slight discomfort from this procedure was minor considering the months of pain of terminal cancer. But the stupidity factor won. Nine months later my friend was dead.
During my career as a gynecological surgeon, I witnessed several follies. Patients who could not believe abnormal vaginal bleeding is due to cancer. Such bleeding may occur between periods, or there may be excessive menstrual bleeding. Or bleeding following menopause, the most dangerous type.
Uterine cancer is a major cause of pelvic malignancy. Why it happens is unknown, but some facts increase the risk. For instance, long term use of the female hormone estrogen, without accompanying use of the other female hormone, progesterone, can trigger cancer of the uterus.
In addition, women who are childless, and those with diabetes, share twice the risk. Add to that women with polycystic ovaries, breast cancer patients being treated with the drug tamoxifen, and those who are either inactive or obese. And women who experience numerous menstrual periods during their lifetime are also at increased risk.
This diagnosis is usually made by obtaining a small amount of tissue from inside the uterus. It is then examined by a pathologist. This determines whether bleeding is due to a non-malignant problem, a precancerous lesion, or an early malignancy. The usual treatment for uterine cancer is hysterectomy to remove the uterus, fallopian tubes and ovaries.
What about prevention? Doctors have been aware for years of a link between obesity and colon, breast, and uterine cancer. Now a report published in the British Journal of Surgery, adds further proof of this relationship.
The study involved 8,794 obese patients who underwent several types of gastric surgery. In some cases, a band was placed around the stomach to make it smaller. Or surgery removed a major portion of the stomach. Both put part of the stomach out of commission to help weight loss and prevent diabetes, hypertension, and coronary attack.
Patients who had this surgery showed a 77 percent decreased risk of breast, uterine, and prostate cancer, over the control group that did not have surgery. But it was associated with twice the risk of developing colon cancer.
Shakespeare was right when he wrote that “Desperate diseases demand desperate cures.” I agree that some obese patients, who are grossly overweight require surgery as a last resort.
But unfortunately, you rarely get something for nothing in medicine. In this case losing part of the stomach may be associated with abdominal cramps, vomiting, and constipation with less food and fiber in the diet. Or, due to complications, further surgery is needed. For instance, the constricting band may slip from its original location. And there is always a greater risk of infection and cardiovascular problems in obese patients.
A successful operation also demands a different lifestyle. You may still desire to eat a whole pizza, but you pay a price if you do.
What is the ultimate tragedy? It’s that every year in North America 150,000 of these operations are required due to obesity, much of which is due to faulty lifestyle.
It’s also tragic that the stupidity factor continues to claim so many lives.
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