“I Have More Compassion for Patients,” Says UAMS Nurse and Colon Cancer Survivor
| John Reed, RN, is on the front lines of cancer. As a nurse in the UAMS Endoscopy Lab, he spends about 50 weeks a year helping patients through colon cancer screening procedures, mainly colonoscopies.
But after a routine doctor’s appointment in 2020, Reed became the patient.
“I felt fine, but my iron levels were really low. People told me I looked gray,” said Reed. “My doctor was pretty sure they would find something.”
At just 42, Reed was years away from the then-recommended age of 50 for colon cancer screening for men at average risk; guidelines have since been lowered to 45 due to the increase in young adults being diagnosed with the disease.
But there it was — a tumor completely blocking his ascending colon, found by diagnostic colonoscopy. Thankfully, the cancer had not spread to any distant sites.
“It was a little bit of a shock,” Reed said of learning that he had colorectal cancer. “I just had this calm peace about it, though.”
Like many colorectal cancer patients, Reed had no strong family history of cancer, and his symptoms were mild, so he didn’t notice them. Common colorectal cancer symptoms include bleeding, changes in bowel habits and abdominal pain.
“It was so scary for him,” said Kirsten Batts, RN, clinical service manager in the UAMS Endoscopy Lab. “He got in right before the pandemic.”
Within two weeks of his diagnosis, Conan Mustain, M.D., UAMS colorectal cancer surgeon, had Reed in the operating room. Mustain performed a robotic right hemicolectomy to remove Reed’s ascending colon and the regional lymph nodes.
“I’m glad we were able to do John’s surgery robotically,” said Mustain, who leads the robotic surgery team at UAMS and notes that robotic procedures provide better visualization and require smaller incisions. At the time, UAMS was onboarding the latest generation daVinci Xi robotic surgical system.
Now UAMS is a daVinci Case Observation Epicenter for colorectal surgery, training other surgeons in the surgical system. UAMS now has over 20 robotic surgeons in nine specialties, including colorectal, thoracic, urologic and gynecologic oncology, among others.
“With the robotic procedure, I can do more of the operation inside the body and extract the tumor somewhere other than the midline. It’s less painful for the patient, and there is less likelihood of a hernia developing later on,” Mustain said.
Reed (shown here with his family) was diagnosed with colorectal cancer at just 42. Today, he is cancer free and uses his experience to help other patients.
Reed was up walking the day after the surgery and back at home in four days. That was good news for the young father of three whose family could not be with him in the hospital due to the pandemic.
Pathology revealed the cancer had spread to a few of the regional lymph nodes, so surgery was followed by 12 rounds of chemotherapy, during which Reed continued to work.
“I would do chemo on Fridays and have it disconnected on Sundays, so I would have one day to recover before going back to work on Tuesdays,” said Reed.”
Reed finished treatment in October 2021 and received his first clear scan in December of that year. “That was a really, really good Christmas.”
Why Are Younger People Getting Colorectal Cancer?
Reed is one of an increasing number of young adults diagnosed with colorectal cancer since the 1990s. According to the National Cancer Institute, the rate of colorectal cancer (which includes cancers of the colon and rectum) has been rising steadily among adults younger than 50. More younger people are also dying from the disease.
Mustain says he is seeing this alarming trend as well. “I’ve done robotic surgery on 50 patients 45 and under in the last three years. Twenty of them were cancer patients.”
Scientists don’t know what is causing the jump in colorectal cancer among young adults. UAMS cancer researcher, Ruud Dings, Ph.D., associate professor in the Department of Radiation Oncology at UAMS, studies bacteria in the gut, also referred to as the microbiome.
“A lot of these research studies, especially the ones including patients, are correlative at best,” said Dings. “We are not sure at this time what causes it, probably multiple factors. Until we have more and better insights about what initiates and drives colon cancer, from genetic factors to external environmental factors that can also influence the microbiome, early and regular screenings are still the most pragmatic and reliable course of action.”
While only 10-20% of early onset colorectal cancer cancers are caused by inherited factors, Reed did have genetic testing at UAMS that revealed he likely does have a relative with a predisposition for GI cancer. The odds of his cancer recurring are low at 25-30%. He will have close surveillance with CT and colonoscopy.
“John is a very good man with compassion for others. He truly handled his diagnosis, surgery and treatment with bravery and resilience. We are all very proud of him and refer to his case and age frequently to promote and spread awareness about colorectal cancer,” said Batts.
Now two years out from the experience, Reed’s scars have all but faded and life has mostly returned to normal. But he says the experience has made him more compassionate for the patients he sees at UAMS.
“It can get a little depressing when the doctor has to share bad news with the families, but I try to share my experience with them and that seems to make them feel better,” said Reed.
Which Colorectal Cancer Screening Method is Best?
In 2021, the U.S. Preventive Services Task Force issued new recommendations for colorectal cancer screening. People at average risk with no family history of cancer and no symptoms should start screening for colon cancer by colonoscopy at age 45.
Screening tests for colorectal cancer can be broken down into two categories: stool-based tests and structural tests. Stool-based tests look for the presence of blood or mutated DNA in stool to identify patients who may need further tests to determine the cause. If a patient has colon cancer, it is very likely the stool-based test will be positive; however, they are much less successful at detecting pre-cancerous lesions. Stool-based tests are convenient and less invasive, but need to be repeated at regular intervals. Any positive test needs to be followed with colonoscopy.
Structural screening tests include colonoscopy, sigmoidoscopy, double-contrast barium enema, or CT colonography. Structural tests are designed to look at the walls of the colon and require that the bowel be cleansed and filled with air in order to see lesions on the walls. Like stool-based tests, any abnormal structural test needs to be followed by a colonoscopy. During a colonoscopy, a long, flexible camera (colonoscope) is inserted into the rectum and used to view the inside of the entire colon. If necessary, polyps or other types of abnormal tissue can be biopsied or removed during a colonoscopy.
Insurance companies and Medicare/Medicaid will pay for colorectal cancer screening at appropriate intervals, whichever option the patient chooses. However, once a patient has had a positive screening test such as Cologuard, the colonoscopy to investigate the abnormal test would be considered “diagnostic” not “screening.” This distinction may affect what type of test patients choose for their screening. Once patients are found to have precancerous polyps, they are considered “high risk” for colorectal cancer and are no longer eligible for average risk screening. Those patients need “surveillance” colonoscopy to monitor polyps. Other screening tests are inappropriate in this setting. Patients at any age may need a “diagnostic” colonoscopy to investigate symptoms such as bleeding or a change in bowel habits, even if they are younger or older than the ages recommended for screening.
To learn more or to schedule a colonoscopy, visit https://cancer.uams.edu/patients-family/prevention/colorectal-cancer-screenings/ or call 501-686-8000.