Would an early diagnosis have made a difference in this case? Read more at BS757.com.
A fifty-three year-old man entered the office of his family physician complaining of rectal bleeding. He was born with Gardner’s Syndrome (GS). This condition is inherited as an autosomal dominant (if either parent has it you have a 50% chance of getting it) and is life-altering. By age twenty you will have developed hundreds to thousands of colon polyps. By the time you are 45 you have a 90% chance of getting colorectal cancer and if you don’t die of something else a 100% chance of eventually getting it. Patients with GS get other cancers and benign tumors as well but not as often as colorectal cancer.
At age thirty his local surgeon did a subtotal colectomy and ileo-proctostomy. With that operation his entire colon was removed except for his rectum; the end of his small intestine was then hooked up to his rectum. He underwent annual examinations of his rectum thereafter with a proctoscope because it was at risk for the development of cancer. The only reason the rectum was not removed was that he would have needed a permanent colostomy and he did not want one.
For the four years prior to this visit his surgeon had removed polyps from his rectum each time he was scoped. The last two times the polyps had dysplasia, or pre-malignant changes. The surgeon and our patient discussed again the desirability of having his rectum removed but the patient still did not want a colostomy.
During these conversations the surgeon never mentioned that at a university teaching hospital a hundred miles away surgeons were capable of hooking up the distal small intestine to the anus (the very last portion of large intestine, which is not at risk for developing cancer because the lining cells are different from those of the remainder of the intestinal tract) and leaving the patient with a way to have bowel movements without needing a colostomy.
At the visit with the family doctor he was referred back to his original surgeon who scoped him again even though a full year had not passed since the last procedure. In the remaining rectum there was a large cancer. He then went to the university hospital and had the rectum removed and the small intestine hooked up to the anus. Unfortunately a year after this was done he developed metastases to his liver and eventually died. His family sued his surgeon for not having removed his rectum years earlier.