Dear Dr. Roach: A recent column regarding the man with advanced colon cancer two years after a normal colonoscopy sent up a red flag for me.
You did a column in March of this year about Lynch syndrome, which occurs in one of every five patients with colon cancer. Sadly, it’s often diagnosed after the cancer is discovered. Due to its aggressive nature, it may be the reason for the rapid advancement of this person’s case.
Would you write an addendum regarding the possibility? It may help in H.B.’s case, and also will bring awareness to Lynch syndrome. Hopefully, genetic testing will be offered to her husband as well as any children they may have.
O.C.
You bring up a good point. It is worth a reminder that the cancer should be tested for Lynch syndrome (also called hereditary non-polyposis colorectal cancer, even though it may cause other cancers besides colon) so that the family can get proper advice about further screening.
Some centres test all colon cancers for Lynch syndrome, but it’s not routine. Especially if there is a family history of endometrial (uterus) cancer or colon cancer, Lynch syndrome should be suspected, and this testing should be done.
Dear Dr. Roach: In 1976, I had a mole on my right calf about the size of a pencil eraser. A biopsy showed it to be melanoma and they thought they had removed all of the cancer, but they did another surgery to be sure that I was cancer-free. I am a natural redhead and never sunbathed or used a tanning bed.
It has been 38 years and I am still cancer-free. I get a skin check from my dermatologist every six months.
At the time of my diagnosis, my family doctor said that if the melanoma spreads inside the body, “the ball game is over.” Is that still true? I know melanoma can be deadly.
W.K.
Melanoma is the most commonly lethal skin cancer. Although there have been some exciting new developments in treating advanced melanoma, the survival rate for stage IV melanoma, where the cancer has spread to internal organs, is only 15 per cent to 20 per cent at five years.
Fortunately, the survival rate for melanoma caught early, at Stage I, is greater than 90 per cent, which is why it’s so important to know the ABCDE’s of melanoma recognition:
A: Asymmetry — one half looks different from the other half;
B: Border — the border in a melanoma is often irregular, not a near-circle;
C: Colour — melanomas usually are not a uniform colour, like most benign lesions. Some areas are light brown, others brown-black, others red or pale;
D: Diameter — greater than six millimetres, the eraser on a standard pencil;
E: Enlargement or Evolution — any change in colour, shape, size or symptoms (including bleeding).
Any of these should prompt a visit to your regular doctor or a dermatologist.
As an internist, these are the features I look for, and I have a very low threshold for sending suspicious lesions to my colleagues in dermatology.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
