DS and strong family history of colon cancer...

[mlleelise]

I'm hoping to get a little advice from some seasoned DS vets. I am fighting my battle to get a revision from lapband to DS - and will get the external review decision within 2 weeks.
So, while I've been holding my breath, I've been catching up on appointments with specialists so I wouldn't have to worry about them during the healing process. This week I visited my gastroenterologist, who I see regularly because of severe constipation - and regular (every 3 years) colonoscopies. I have a very strong family history of colon cancer: my mom, her sister, their mother (my grandmother), and 7 out of 8 of my grandmother's siblings. The 8th died of brain cancer.
So, it would seem the cards are stacked against me on this. I should add I'm 58 yrs old. My gastro wants me to get genetic testing to see if I have a marker for colon cancer, which I will definitely do. Here is the problem: My gastroenterologist was upset about my plans for a DS. He said that with my family history, I should leave my intestines alone - the day may come when I need every inch of intestine I can get. AND he posed an interesting question: what if I'm going through chemotherapy and get deathly sick - and become unable to tolerate vitamins supplements /protein drinks? Being able to depend on my body's own reserves would be vital at the point, if I were to survive colon cancer. It could become a matter of life or death.
He really has me concerned...is this an unsafe move for someone with my family history? Does this outweigh my obesity related co-morbidities?? Has anyone on the forum dealt with chemo/cancer AFTER the DS? I know that no one can make this decision for me, but I sure would appreciate your educated thoughts on my situation.
Thanks so much!

[allraindrops]

Hmmm.....well I am not a seasoned DS vet but that would have me concerned too! So sorry you have this history against you! What is your weight now and what are your comorbidities?

[Deleted]

Your intestines will all still be in there. Revision to increase your absorption can be done laparoscopically.

Your chance of getting cancer overall go down with bariatric surgery.

[clpeltz]

What Diana said :-)

[shann_ds]

There are several people who have had cancer after DS (I stink at names...). I know of at least one who had a revision to increase malabsorption like Diana suggested. For me, the strain of obesity on my heart outweighed the spector of cancer that floats over my head (dad died of a heart attack, mom of cancer)

[larra]

While the part of the stomach that has been removed of course can't be replaced, the small intestinal portion of the DS is (relatively) easily revised either by lengthening the common channel and alimentary limb, or, for full or near full reversal, by attaching the two limbs to each other. The Hess article with a 10 year follow-up has an excellent drawing of this. As Diana said, no part of the small intestine is removed with the DS.
And as you probably know, the colon isn't changed at all with the DS.
And most patients tolerate the types of chemo used for colon cancer very well - different cancers require different chemo, and the drugs used for colon cancer are usually well tolerated, unlike, let us say, though used for leukemia.
And let us not forget that even before jumping to surgical revisions, absorption can be increased with use of digestive enzymes, you could take all sorts of protein and other nutritional supplements if needed, etc.
I appreciate your gastro's concern with that awful family history, but I disagree with his conclusion.

Larra

[mlleelise]

Thank you all for your excellent advice. It's good to know that there are some who have dealt with chemo successfully, after the DS. Larra, I had forgotten about the digestive enzymes...good point.
All in all, I must follow through on this. I am so excited I could burst! I have a plan A (with insurance, Dr. Roslin, date unscheduled) and plan B (self-pay, Dr. Keshishian , on 1/27/12). Self pay will be tough to handle, but I will do it, with support of my husband. Should get final answer from the board by the 17th.
Although my gastro raised some good questions, he is less educated about the DS procedure than most of you. It is wonderful to have a place to go - people to turn to - who have walked this path ahead of me. Thanks so much.

[huskerchad]

I have a family history as well. Not as much as yours it seems, but it's there, and I'm old enough to be having regular colonoscopies based on that history. So, this was a bit of a concern for me as well.

First, as others mentioned, colon means large intestine, which is not modified by the surgery. So worries about cancer relating to the actual surgical site are unfounded.

On the larger concern of nutrition during a prolonged battle with cancer, including chemo and whatever else--cancer patients are often given either central lines and TPN, or feeding tubes. In both cases your vitamin and protein needs can be taken care of that way. With TPN you are bypassing malabsorption completely. A feeding tube is, as I understand it, placed in our BPL.

They're concerns, they're valid, and they're reasons to stay on top of things, but they are not reasons not to have a DS, IMO.

[KathyF]

I also have a family history of colon cancer. My father passed away from it 12 years ago. However, huskerchad is right, your colon is not modified by the DS surgery and chemo is given through IV. Stay on top of getting your colonoscopies and you should be fine.

[sandyv63]

Lissey is currently undergoing cancer treatments (although not for colon cancer) and she has not needed any kind of revision of her DS. She hasn't been posting lately for obvious reasons, but I agree with everyone else that your comorbidities, which are definite and already affecting you, need to be your top prority rather than the possibility of another illness which can still be managed even with the DS. BTW, I bet getting the DS will DECREASE your chances of contracting this awful disease. One of the reasons I got my DS is because cancer runs rampant in my family (both sides) and obesity becomes a huge risk factor for getting it. I will do anything and everything I can to avoid it.

[mlleelise]

Yes, I believe nutrition would be more the issue than anything else. It is reassuring that there are ways to deal with it, if it ever becomes necessary. KathyF... I was also told I had a 'tortuous colon!' Sure had never heard THAT one before! My doc described mine as being all twisted -up - as if someone had opened me up, taken my intestines out, then shoved them back in a jumbled mess. He never said they were extra long though. Anyway, he described my tortuous colon - after accidentally perforating it during a colonoscopy. That was a nasty experience!! From then on, he has used a baby scope for my colonoscopies.
I'm in agreement with all of you: the risk/damage from my current co-morbidities is my top priority; and the DS is a great step towards resolution of most of them.
Thanks for all the encouragement!

[Psyche]

I have a family history of colon cancer and my doctors have said losing the weight was the best thing I could have done for myself. Frankly, the co-morbidities would have gotten me first anyway.

[Dudette]

My father is currently dealing with colon cancer and is being treated at the Mayo Clinic. He's on his last round of chemo right now. Sometime this spring, when he gets the all-clear, they'll re-attach his small intestine to his colon. He currently has an ostomy (basically the end of his small intestine hangs out a hole in his lower abdomen into a bag). Yuck. But he's doing fine.

The IV chemo caused a really bad reaction so they have him on the oral chemo pills. However, as another poster mentioned, the chemo is not as devastating for colon cancer patients. Dad still has all his hair and is fairly mobile. He just left yesterday for a Caribbean cruise and took the last couple days of his chemo pills with him. I think he's nuts for going on a trip before he's done with his chemo, but whatever makes him happy.

I knew about his situation when I went in for my DS a few months ago. I still went ahead with the procedure and would do it again. It was a choice between fixing extremely high blood pressure (at the time) and second guessing the possibility of cancer down the road. I was so miserable with the high BP it was a very easy decision for me.

[Happy DSr]

I am not a doctor nor do I play one on TV......

colon cancer is in the colon, not intestines

with a family history, you will have regular screening/colonoscopies so should minimize your risk

like other have said, there are ways of reversing/reducing the malabsorbtion effect, should the need arise

and most importantly, without the DS you may be seriously ill or dead from many obesity related conditions. I chose to accept a risk of medical complications arising from malabsorbtion than to accept the certainty of obesity related death

[Avonlea]

I would worry about the kind of protein you will need to take in going forward, but that's going to be a concern for you no matter what. Colon cancer is strongly correlated with red meat consumption.