Monday, March 13, 2006

Unexpected findings

Five years ago this month I completed my treatment protocol for colon cancer. A few months later, I was reviewing the latest CT scan with my oncologist. Chest, abdomen, and pelvis. He apparently hadn't read it - or at least not more than cursorily - before I entered the office, because when he flipped to page 2 of the report, he started to laugh.

"You have to see this," he said, as he handed me the report.

Normal findings, except for an enlarged prostate. "Funny they never found that on any of the umpteen previous CT scans, isn't it?" I said. "I wonder what my Gyn will say when he reads this."

The oncologist made a quick phone call to the radiologist's office and found that the Gyn had already called. The whole report had already been re-done by a second radiologist and would be faxed to him immediately. I heard from the Gyn's nurse that he'd had a great deal of fun at the radiologist's expense - but she wouldn't tell me more than that. I've known the Gyn a long time. I can just imagine. His nurse doesn't use that kind of language.

I laughed about that report for years, although it did worry me a little that the radiologist could have made such a whopping error in reading the scan. Turns out he probably didn't. My sister used to type medical reports. She told me that an error of that magnitude in a report would have to be committed by a transcriptionist of exceptional skill. Someone the radiologist really trusted. Someone whose work wasn't routinely proofread, because he or she simply didn't make many mistakes.

She then explained how this almost certainly happened. Experienced transcriptionists tend to type essentially the same report over and over when the results of a scan are normal, because the doctor will dictate more or less the same report in the same order so that nothing is overlooked. In doing large volume, the transcriptionist may save time by calling up the previous normal scan and making the few required changes instead of typing the whole 2-3 page report over again.

It seems likely that the previous normal scan called up by the transcriptionist was of a male with an unremarkable scan, except for that enlarged prostate. Oops.

I have copies of both readings. The first, which will stay with the report, because the radiologist signed it, was a more than adequate reading, except for that enlarged prostate. The second is the most thoroughly documented normal CT scan report you could ever hope to find. The second radiologist not only had to read the scan, he or she had to prove that said scan was on the same patient as all the previous scans in the folder.

None of this would have happened had I paid more attention to other unexpected findings. Over a period of 2-3 years, I ignored some very intermittent, very minor rectal bleeding. I occasionally mentioned it to my internist or one of her partners, but none of us was overly concerned. I also had some problems with constipation and had absolutely no family history of any kind of cancer. Besides, I was way too young to have colon cancer. By the time Katie Couric aired her on-camera colonoscopy, I was 45. She got my attention. I still believed the GI doc would only find internal hemorrhoids, but I wasn't willing to bet my life on that, so I scheduled the colonoscopy. Talk about unexpected findings.

March is national Colon Cancer awareness month.

Trust me, you're not too young to have colon cancer. Having no family history offers no protection. If you have symptoms. Get checked. If you're 50 or over, get checked whether or not you have symptoms. If you have a family history of colon cancer and are within 10 years of the age at which your youngest relative was diagnosed - get checked!

If you've had negative flexible sigmoidoscopies, but never had a colonoscopy, don't think you're safe either. My mom did, so it took over a year to browbeat her into having a colonoscopy. Fortunately her cancer was very small and limited to the distal portion of a polyp which could be removed during her colonoscopy. Now she jokes about her "little cancer" and nags her friends into having colonoscopies.

Your turn!