Dan Holmes, Colonoscopy Patient, and Family
Dan Holmes of Kennett Square had just turned 50 when Chadwick Boseman died last summer from colorectal cancer. Until that day, Holmes says, "colon cancer wasn’t anywhere on my radar." The news of the 43-year-old actor’s passing prompted Holmes to schedule his first colonoscopy. During the exam, two polyps were found in his colon. One was cancerous.
Holmes says he didn’t experience any symptoms over the weeks leading up to the exam, and he did not have a family history of colorectal cancer. In fact, without the news about Boseman's death, Holmes says he probably would have put off the colonoscopy for another six months, or even a year.
"Chadwick Boseman saved my life," he says.
By contrast, Cynthia Flores of West Chester began noticing blood in her stool early last year. She got a prescription for a Cologuard at-home colon cancer screening test, but then stay-at-home orders were issued in response to the onset of the COVID-19 pandemic, and it all became too much for her to process. So the test kit sat on her dining room table through the spring and summer.
As the bleeding worsened, Flores, who says she’s typically careful about maintaining a healthy lifestyle and routine doctors’ appointments, rationalized it.
"Whenever I Googled the symptom, it looked like it could be lots of things. And I didn’t have any other symptoms, so I figured it couldn’t be anything too bad," she says. "Really, I just didn't want to go through a colonoscopy. I’d heard so many horror stories. And now I could absolutely kick myself because it was nothing. The test was so easy."
By last fall, Flores determined that “not knowing was far worse than any procedure,” so she submitted her Cologuard. The result came back positive for colorectal cancer. She saw a gastroenterologist in December and underwent her first colonoscopy, at age 61, on January 4, 2021.
"The doctor who did it told me he didn’t have to wait for the results; it was definitely cancer," she says.
A Silent Killer
Anna Spivak, DO, a colon and rectal surgeon at Penn Medicine Chester County Hospital and Penn Surgical Specialists West Chester, performed essentially the same minimally-invasive, robotic surgery on Holmes and Flores. Holmes underwent his on November 10, 2020; Flores in January 2021. Dr. Spivak removed a small segment of their descending colons and reattached the remaining colon to their rectums.
No radiation or chemotherapy was needed before or after their surgeries. They spent three days in the hospital in all, which Dr. Spivak says is normal for an otherwise healthy person who undergoes such a surgery.
Flores’s colorectal cancer, Dr. Spivak says, was slightly more advanced than Holmes’s – her tumor had already gone through a couple layers of the wall of her colon – but both were caught in an early stage.
It takes roughly 10 years for a colon polyp to become cancerous, Dr. Spivak says. They start as an overgrowth of normal tissue. Without intervention, abnormal tissue can begin to grow within the overgrowth. The polyp is still benign at that point. But as the abnormal tissue continues to spread, the polyp will become what Dr. Spivak describes as "precancerous", then cancerous, before finally developing into an invasive cancer.
A decade may sound like an eternity, but time is of the essence with colorectal cancer. That’s because polyps are common in men and women of all races and ethnicities, and they generally don’t cause symptoms. The vast majority are detected through colorectal cancer screening tests, such as a colonoscopy. New, precancerous, and early-stage cancerous polyps can usually be removed safely and completely.
In 2018, the American Cancer Society started advising doctors to begin regularly screening for colorectal cancer at age 45, five years younger than what it had been recommending. The move was made in an effort to catch more polyps before they became cancerous.
"Colon cancer is unique in that it’s preventable," Dr. Spivak says.
And yet, it is the second-most common cause of cancer deaths in the United States. Nearly 53,000 people are expected to die this year from colorectal cancer.
Dr. Spivak regularly experiences that juxtaposition in her practice. Not long after Flores’s surgery, she operated on a patient in his fifties. "He never made time for himself," she says. After not feeling well for a couple of months, he finally went to see his family doctor, who diagnosed him with anemia and prescribed an iron supplement. But his condition continued to deteriorate.
By the time he reached Dr. Spivak, his colorectal cancer had spread to his liver. There was little she could do for him beyond enhance his quality of life over his final weeks.
"You should absolutely act as your own healthcare advocate, particularly when it comes to this screening, because it can make such a difference," she says.
"I was spared this time"
Both Holmes and Flores will undergo a CT scan and blood tests every six months to a year for the next five years. (If their cancers were to recur, they would most likely do so within the next three to five years.)
They'll also have a colonoscopy a year after their surgery, and then every five years for the remainder of their lives. (For someone who’s never had colorectal cancer, the consensus recommendation is that they undergo a colonoscopy every 10 years beginning at age 45.)
Holmes says there were “no real side effects” from his surgery. And four months removed from it, he feels "good".
He and Flores credit Dr. Spivak’s professionalism and compassion for easing them through what could have been a more difficult period in their lives, emotionally and physically.
"I had so little discomfort after the surgery. I felt great a week later, and even better when I heard my cancer was stage one," Flores says. "I was revving myself up for the possibility of chemotherapy. I was spared this time. I’m never going to let it come to that again."
Related Information from Chester County Hospital