TRIPLER ARMY MEDICAL CENTER, Hawaii, USA – Daniel Shockley, a retired Sailor living on Oahu, meets with Lt. Col. Ronald Gagliano, chief, Colon and Rectal Surgery and director, Surgical Research, TAMC, to discuss recovery and post-operative…
Due to his hectic work schedule, Shockley rescheduled the screening a couple times and it wasn’t until May 8, 2012, when he got the colonoscopy.
“They usually schedule colonoscopies for 1-hour blocks of time, but they found so much wrong during mine that he had to spend a lot of time documenting and taking pictures,” Shockley explained. “What they found was approximately 100 polyps embedded throughout my colon, rectum and anus. And at the traverse colon, the junction between the large and small intestine, they found a large tumor that was creating an 80 percent blockage.”
Shockley was referred to Tripler Army Medical Center’s general surgery clinic, and the week following the screening, he met with Susan Donlon, a certified genetic counselor at Tripler.
Donlon performed DNA tests on Shockley and within three weeks the tests had come back confirming that Shockley has a gene mutation known as Adenomatous Polyposis Coli, which increases a person’s risk of developing colorectal cancer. As a result of the mutation, Shockley was diagnosed with Attenuated Familial Adenomatous Polyposis, a condition in which numerous polyps form mainly in the large intestine.
“I knew surgery was inevitable and I was willing to accept the worst case scenario the whole time,” Shockley said.
On July 13, Shockley underwent a total proctocolectomy with ileostomy surgery, which removed portions of his large intestine to include the entire colon, rectum and anus.
Shockley spent about two weeks in Tripler’s general inpatient surgery ward recovering before he was able to go home. It was nine weeks before he was able to go back to work.
Lt. Col. Ronald Gagliano, chief, Colon and Rectal Surgery and director, Surgical Research, TAMC, performed Shockley’s surgery and has followed up with him to ensure he is not only well-informed, but also well-educated.
“He knew nothing of his disease and its many facets before we met and our team (at Tripler) began his personal education in order to promote effective counseling regarding his diagnostic and therapeutic options,” Gagliano explained. “Finally we educated him regarding his genetic situation so that he could choose (how to best) inform his family. By giving him great care, we essentially treat an entire family cohort.”
“(Dr. Gagliano and his team) have passion for what they do, and my care was phenomenal,” Shockley expressed. “I cannot say enough good things about my stay and the care they provided.”
Gagliano is very pleased with Shockley’s recovery thus far and attributes it to his attitude.
“I tend not to think about things I can’t control,” Shockley explained. “Medical issues are not something I can control, but what I can control is my attitude and after 51 years on God’s green earth my positive attitude has gotten me this far and I am not going to change it.”
Because of Shockley’s surgeries, he now has an ostomy pouching system, a prosthetic medical device that provides a means for the collection of waste. Nina Lum, certified wound, ostomy and continence nurse, TAMC, who helped care for Shockley throughout his recovery, echoed Gagliano’s remarks.
“Shockley’s resilience in the face of challenges including his tremendous enthusiasm for life, regardless of setbacks, certainly played a huge role in his recovery,” Lum said. “He has always maintained a positive outlook, been fully engaged in his care from the beginning, reached out to the ostomy community not only for support, but also to offer support and advise based on his personal experience.
“He is selfless in trying to reach out to others,” Lum added.
Shockley has embraced his diagnosis and challenged it from the start. He acts as a patient advocate and an ambassador for colon cancer awareness.
“(I want to) share my story with others on behalf of those patients that have gone before me and who were unable to share their story,” Shockley explained. “My catchphrase is ‘AFAP-Seize the disease!'”
Shockley wants to spread the information about his diagnosis and experience so he can inspire others to get the screening and be aware of the condition. Additionally, there is not a lot of information about AFAP available, so he hopes that talking about his diagnosis will help the medical community.
“By maintaining a positive attitude, the opportunity for a success story is much higher,” Shockley said. “This in turn allows me a better chance of overcoming adversities I am faced with during my lifetime.”
PATIENTS who attend bowel screening are more likely to be diagnosed with bowel cancer at an early stage – when there is a better chance of survival – than those who wait until they have symptoms of the disease.
These are the findings of new data presented at the annual National Cancer Intelligence Network (NCIN) conference in Birmingham.
Researchers say the study shows that the NHS Bowel Cancer Screening Programme is working towards its aim to reduce deaths from bowel cancer.
Researchers compared the stage at diagnosis of bowel cancers picked up through screening and those diagnosed from symptoms.
The results showed that 18.5 per cent of bowel cancers detected through screening were at the earliest stages compared with 9.4 per cent of cancers diagnosed through symptomatic routes.**
In contrast, late stage tumours were more common in patients diagnosed through symptomatic routes compared with those diagnosed through screening.***
Sam Johnson, lead researcher based at the West Midlands Cancer Intelligence Unit, said: “When bowel cancer is diagnosed at an earlier stage, it’s easier to treat, has a lower chance of coming back and better survival rates.
“Our research shows that screening can play an important role in improving bowel cancer survival by picking up cancers at an earlier stage.”
Bowel cancer is the third most common cancer in the UK – around 40,000 people are diagnosed with the disease each year.
Researchers said that once the NHS Bowel Cancer Screening Programme has been established for several more years, and has been rolled out completely to people aged 60 – 74 years old, they would expect to see fewer late stage cancers.
Chris Carrigan, head of the NCIN, said: “When bowel cancer is found at the earliest stage, there is an excellent chance of survival, with more than 90 per cent of people surviving the disease at least five years.
“Compared with breast and cervical cancers, bowel cancer tends to have a lower five-year survival rate.
“This study highlights the potential improvements we can make through encouraging more people to take-up their screening invitation so the disease is diagnosed earlier.”
According to new data from the North-East of England, published in the British Journal of Cancer, patients whose disease was spotted via screening had a better chance of beating their disease than those diagnosed after developing symptoms.
This is great news, and shows that bowel screening can make a real difference.
It comes after a Scottish study last year found that bowel cancer death rates were cut by 27 per cent among those who had attended screening compared with those who did not.
But at Cancer Research UK, we’re not ones to rest on our laurels. Although the programme spotted some cancers, it missed others.
We can do even better. And we’ve had our thinking caps on to work out what Governments need to do to make the UK nations’ bowel cancer screening programmes even more comprehensive, and save even more lives.
The bowel cancer screening test offered in the UK uses a test called the faecal occult blood test, or FOBT. It’s done at home, and involves posting a series of stool samples off for testing. The test looks for the presence of traces of blood in the stools – which can be a sign of bowel cancer.
The test is offered every two years. But in terms of who is eligible, the devolved nations of the UK all operate slightly different screening programmes.
But across all four nations, only about half of those invited to participate actually do so.
We would like to see more people participate in the programme. This means more encouragement from GPs, from awareness campaigns and from peer-groups. We need people to know about the programme, and its benefits. Given how effective we now know bowel screening is, and that bowel cancer is among the most common cancers, even a small increase in uptake could make a big difference.
Researchers have invented a newer, better, simpler version of the screening test. It’s called ‘faecal immunochemical testing’, or FIT, and it doesn’t just detect whether blood is present or not, it detects the amount of blood present. This makes it more sensitive, and requires people to take fewer samples. Evidence suggests that it will also detect more cancers and pre-cancerous growths than FOBT.
It’s unlikely to be more expensive than FOBT, and evidence is emerging to suggest that introducing the FIT test will improve uptake.
So we want the UK’s governments to begin planning for a switch-over from FOBT to FIT right away.
In April 2010, a landmark trial, which we helped fund, showed that a single bowel screen using a tiny camera on a flexible tube (called a flexi-scope) could both prevent and detect bowel cancer. The test not only spots cancers, it can detect and remove pre-cancerous polyps.
In October that year, Prime Minister David Cameron announced that the test would be incorporated into the NHS’s bowel screening programme in England. This would then be followed by stool testing from age 60. This could make a huge difference to bowel cancer rates in the UK.
But 18 months later, we’re still waiting for clarification over where, when and how the programme will be rolled out. So we want to see two things:
This is absolutely crucial – not just for flexi-scope, but for the whole screening programme, and for spotting bowel cancer early. We’ve heard from experts in the field that the UK’s endoscopy services aren’t what they could be. But the recent Be Clear On Cancer awareness campaign increased the demand for endoscopies, as more people were referred by their GP with symptoms.
If the NHS is to properly implement flexi-scope screening as well, it needs to make sure it has a world-class endoscopy service – which means more trained and equipped endoscopists.
This is particularly true in England. Last year, the Westminster government earmarked an extra £450m, to be spent over four years, in part to improve endoscopy in the English NHS. But a recent survey by GP Magazine showed that only just over half of local health authorities were actively spending this cash. This needs to change.
We want the Westminster government to update plans for rolling out flexi-scope in the NHS in England and to ensure everything is in place so that they can move forward with implementation. And while high quality roll-out is the top priority, we need to see the detailed plans for how things will be kept moving.
In Scotland, Wales and Northern Ireland, we want the governments to start planning for and piloting flexi-scope. Currently, flexi-scope is proposed to be carried out at age 55. In Scotland, where screening begins at 50, the government will need to work out how to incorporate flexi-scope into their existing screening programme.
We want to stress – the existing bowel screening programmes are a success, and we would like to urge people to take part when invited. But we can’t be complacent. As more evidence emerges, we will continue to pressure our politicians to make sure the UK public are getting the very best bowel screening.