Let me introduce you to four of the patients I have met over the last year. I will introduce them to you in no particular order. I have changed their names to preserve their anonymity.
1) Justin is a fifty-three-year-old indigenous man. I met him and his wife in the summer of 2021. Justin told me that he was having on-and-off belly pain in his right lower abdomen for about three months prior to his cancer diagnosis. Over that time, he also noted a change in frequency of pooping, having to go more often in a day than what was normal for him. He had alternating diarrhea and constipation. At no time did he notice blood in his poop. In fact, the color of his poop had not changed at all. He has an office job and was working full time. He also works as an indigenous liaison in his community. He lives with his wife, son, and daughter. He has no other medical problems. He smokes one pack of cigarettes a day but is trying to quit. He does not drink alcohol or use any other drugs. He has a family history of a few different cancers, but he doesn’t think colon cancer is one of them.
2) Laura is a seventy-five-year-old woman who I met in the fall of 2021 accompanied by her husband, her only son, and a Cantonese interpreter. She speaks very little English. She immigrated to Canada in 2013, which is incidentally when she stopped smoking. Laura has always had normal (for her) poops. She denies any change to the frequency of her bowel movements. She did not have any pain in her belly. She didn’t even think there had been a change to the amount of times she farted each day. Her energy was as good as it ever had been and pretty darn good for a woman in her eighth decade of life. She denies any cancer in her family. She is a retired materials trader. She drinks alcohol socially. She does not do any other drugs.
3) Jill is a thirty-six-year-old Caucasian woman. She saw me for the first time in the summer of 2021. She came to medical attention after noticing blood in her poop. Along with bleeding, she noticed some changes to her bowel movements. She was pooping a lot more frequently. Her poop had gotten thinner. For much of the previous year, her poop was softer than what she would consider normal for her. She is a non-smoker. She drinks alcohol socially. She consumes legal marijuana edibles once a month at most. No one else in her family has had cancer. She lives with her male partner. She does not currently have any children. When I met her, she was in the process of freezing her eggs with the local fertility team as a precaution in case her treatment deemed her infertile and she wished to have children in the future. Jill works as a nurse but was on medical leave.
4) David is a sixty-five-year-old man with anxiety who I met with his male partner in the spring of 2021. He had a past medical history of a colon cancer in 2014 that was cured with surgery. His mom died of colon cancer when she was seventy-seven. He is unaware of any other cases of cancer in his family. He is a retired construction worker. He has been a lifelong non-smoker. He drinks two alcoholic beverages a day. Because of his personal history with colon cancer, his family doctor and surgeon were monitoring him with regular colonoscopies every three to five years. The colonoscopy that was done a few weeks before I saw him diagnosed a new colon cancer.
In a typical week, I meet three to six newly diagnosed cancer patients. More than half of the new patients I meet will die from their cancer; some weeks, that fifty percent is a gross underestimation. Depending on the type of cancer, my patients might have a few months or a few years to live. I can rely on data and my experience with other patients to guide my average estimates of prognosis for the person in front of me, but I do not have a crystal ball, tarot cards, or other mystical powers that allow me to pinpoint how long a person lives.
What I do know for sure though is that colorectal cancer can be cured. If cured, these patients will go on to have a normal lifespan, whatever that was to be for that person.
Colorectal cancers originate from polyps. Polyps are non-cancerous growths. If polyps are left to change over time, they will eventually change enough to turn into a cancer. Take out the polyp, no cancer can result. If a polyp does become a cancer and that cancer is found before individual cancer cells escape the area of the colon, the cancer is curable.
The four patients above have a few things in common and many things that are not similar. The common things include:
1) They all have been diagnosed with colorectal cancer.
2) They all had curative surgery for their cancer.
3) Two of them did not have symptoms and were diagnosed via screening with a Fit test followed by colonoscopy. Two of them had symptoms (bleeding, pain, changes to their pooping patterns) prompting investigations including colonoscopies which diagnosed their cancer.
4) All four patients should be cured of their cancer.
Everything else about these patients is different: age, sex, family history of cancer, where they live, what they do for a living, what they eat, how much they sleep, how much (if any) they drink or smoke, personal history of cancer, ethnicity, sexual orientation, religious or spiritual affiliations, family support. The list of things that are uncommon amongst them goes on and on. Men, women, those who don’t label themselves as either, people of all shapes and colour, those of faith or those with none – anyone can get colorectal cancer. Colorectal cancer does not discriminate. And it certainly is not convenient.
Screening for colorectal cancer is easy. We should all be doing it when our time comes. Equally important is seeing a doctor for symptoms that might arise. I understand it is not always a simple thing to make an appointment with a doctor and often it’s not convenient either. But it might just save your life.
Let’s talk about poop more. Pooping is part of life. Everyone does it. If you don’t poop, you die. That’s a simple fact. We all must pass our poop. We all fart. We must. Every once and a while we all have diarrhea or constipation. These are normal things the body does. It should not be taboo to talk about poop. I talk about poop with people every single day. It’s a matter of life and death. And, in the wise words of Shrek: “Better out than in”!
Get screened. Please.
Listen to your body. You are the best judge of whether something is normal for you. If something seems off, please go to your doctor to talk about it.
I love my job, but I would love it even more if I didn’t have to see you in my clinic.
Author Notes:
I love music. Sometimes, songs randomly pop into my head. As I was writing this blog post, a song found itself in my head and it wouldn’t leave me alone. I decided to play with it a little.
If you don’t know the hit song “Let’s Talk About Sex” by Salt-N-Pepa, have a quick listen so you get the right melody and beat in your head. To the same beat, sing this out loud to all your friends and family and then please talk to your doctor about the correct timing and method of getting screened for colorectal cancer.
Please note: the words to this song are the creative genius of Salt-N-Pepa, except for the poopy ones . . . .
Toiletbowl, let’s flush it down One Time
Oh, oooh, ooooh, oooh ah (Mmmmh hmmm)
Oh, oooh, ooooh, oooh ah (Ooops)
Oh, oooh, ooooh, oooh ah (Ah ha)
Oh, oooh, ooooh, oooh ah
Come on!
… Let’s talk about poop, baby
Let’s talk about it you and me
Let’s talk about all the good things
And the bad things that may be
… Let’s talk about poop
Let’s talk about poop
Let’s talk about poop
Let’s talk about poop
… Let’s talk about poop right now
To the people at home or in the crowd
We all do it daily anyhow
Don’t be coy, avoid, or make void the topic
Cuz that ain’t gonna stop it
Now, let’s talk about poop on the snapchat and instagram feeds
Many will know anything goes
… Let’s tell it how it is, and how it should be
How it changed, and of course, how it shouldn’t be
Those who think it’s dirty, have no choice
Pick up a FIT test, test it, don’t you dare ignore it
‘Cuz that can harm us, right? You know it!
All right then, come on, Flush
Let’s talk about poop, baby
Let’s talk about it you and me
Let’s talk about all the good things
And the bad things that may be
Let’s talk about poop
Let’s talk about poop (A little bit, a little bit)
Let’s talk about poop
Let’s talk about poop
Hot to trot, sometimes our farts pop
If they stop, go get checked – make sure you’re not blocked
Your stools shouldn’t drool, nor should they be constipated
If so, see your doctor because trouble could be loomin’
Gas, toots, cramps, stomach gurgles
Nothin’ our guts do should embarrass
You seeing blood in the bowl, on toilet paper
Go see your doctor, because in no case is that normal
Please do not mess with,
Get screened, put it on the to-do next list
And believe me, you,
It’s as good as true
Catch it early, there’s little chance colorectal cancer kills you
Get screened, avoid a poop bag so you can be very glad
You don’t, I’ll be mad and sad and feelin’ bad
Thinkin’ about the cure that we never had
Get screened, just poop, get a healthy doctor’s note
That last scope was dope (Ooh, ooh, ooh, take it easy now)
Let’s talk about poop, baby (sing it)
Let’s talk about it you and me (sing it, sing it)
Let’s talk about all the good things
And the bad things that may be
Let’s talk about poop (come on)
Let’s talk about poop (do it)
Let’s talk about poop (uh-huh)
Let’s talk about poop
Humans, all the humans,
Louder now, help me out
Come on, all the humans
Let’s talk about poop, all right
Humans, all the humans,
Louder now, help me out
Come on, all the humans
Let’s talk about poop, all right
Yo, Flush, I don’t think they’re gonna play this on the radio
And why not? Everybody havin’ poops
I mean, everybody should be makin’ poop
Come on, how many humans do you know talking ‘bout poop?
Let’s talk about poop, baby
Let’s talk about it you and me
Let’s talk about all the good things
And the bad things that may be
Let’s talk about poop
Let’s talk about poop
Let’s talk about poop
Let’s talk about poop
La-la-la-la-la!
Talking about poop saves a lot of my patient’s lives. Let’s talk about poop! Talk about it with your friends. Talk about it with your significant other. Talk about it with your kids. Talk about it with your doctor. Please get screened.
