Friday, 8 October 2010

Have you got it yet?

It strikes me that cancer of the colon is a bit like digital TV. If you haven't got it yet, you will eventually. Actually about 20% of people get it and half of these die from it. The bowel cancer I mean. For TV the figures are higher, but you'll die of boredom instead of secondary spread, although middle-aged spread due to TV is very common too.

I chose the word 'digital' because there was a time when the only way to detect cancer of the colon was by pushing a finger into the nearest orifice, which since the colon is more than a metre long was usually a waste of time and plastic gloves. Then they invented the colonoscope, which was a thick rigid metal tube. Colonoscopy was like having a telescope shoved up your backside and this led to some very unsavoury jokes which I don't need to repeat here.

The flexible colonoscope was a bit better at getting to the bottom of things, since it went round the bend, and it had a camera on the end to photograph your polyps. That's important because 90% of colon cancers start in large polyps in the wall of the large bowel, and they can then be removed before they turn malignant. Barium enema had been the standard investigation for many years, but it was fairly unpleasant, and missed 40% of polyps. The latest development, C.T. colonography is much safer, less painful, and is guaranteed to show your polyps in a new light.

The small bowel is even more difficult to investigate, since it is around 6 metres long, is unstable and has lots of loops. They're tackling this now with a spiral enteroscope which has screw-like flanges which enable it to get a grip and crawl up inside your innermost parts. I thought you'd like to know that they use a gloopy liquid called 'Probe personal lubricant' which was originally developed for the pornographic film industry.

Once the clever doctors have identified the problem in the pipe they call in the plumbers to fix it. These consultant surgeons used to be larger-than-life characters like Sir Lancelot Spratt of 'Doctor in the House' who would boom, "Key hole surgery boy! We shall open her from here to here" with an expansive sweep of the arm as the patient fainted.

Nowadays surgeons are thoughtful chaps who just use 2 or 3 tiny holes to poke their robotically controlled instruments inside. The ultimate goal is to avoid scars altogether since only natural orifices will be used. Tonsillectomy via the vagina is their target.

All my tasteless medical student jokes about plastic surgeons seem to be coming true!

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