After working as a firefighter for almost 30 years, Tom Alden, now retired, said he always suspected that a cancer diagnosis would be in his future.
"I've sucked in a lot of smoke over the years," Alden, 58, said. "There's a lot of stuff that's burning in a house that's harmful to you, so I wouldn't be surprised if I got cancer. I just wouldn't."
But nothing prepared him for when he found out that blowing off several routine colonoscopy exams proved to be a life-threatening move.
"I've been told since I was 50 that I ought to get a colonoscopy and I had been holding off and delaying it, not for any particular reason, just hadn't gotten around to getting it," he said.
The 58-year-old from Fairhaven, Mass. was diagnosed last year with Stage III colon cancer, treatment for which would require surgery and chemotherapy. Alden said the diagnosis hit him like a ton of bricks.
His girlfriend, Judy Paradise McFee, a critical-care nurse, recommended he seek help at Massachusetts General Hospital in Boston.
Colon cancer is diagnosed through a colonoscopy, a procedure used to see inside the colon and rectum that can detect inflamed tissue, ulcers and abnormal growths. It is used to look for early signs of colorectal cancer and can help doctors diagnose a host of unexplained changes in bowel habits, abdominal pain, bleeding from the anus and weight loss.
For Alden, it started with a severe stomach cramp.
"It was acute," he said. "If I touched it, it hurt like hell. It felt like my appendix was just going to explode."
"I think that night of pain was good. It woke me up. It told me, 'Hey, something's wrong in there. You better get it taken care of, whatever it is.'"
After consulting with his physician, Alden's doctor sent him to the emergency room for a CT scan of his abdomen. The scan showed a mass, which finally led Alden to get a colonoscopy and biopsy of his colon.
On March 12, 2009, Alden met with Dr. David Berger, a gastrointestinal surgeon at Massachusetts General and director of the hospital's Colorectal Surgery Center, to discuss his options. Berger performs about four colon resections a week.
Berger performed a laparoscopic right colectomy on Alden, a minimally invasive surgery to remove his tumor, on March 31, 2009. After removing it, a portion of the tumor was sent to the pathology unit to be examined. Doctors looked to see what kind of tumor it was, how invasive it had become in the wall of the colon, and if there were cancer cells present in the lymph nodes.
About five days after the surgery, Berger learned from the pathology report that three of 14 nodes tested positive for cancer. Alden would need chemotherapy -- treatments designed to attack and kill cancer cells -- hopefully reducing the chance that the tumor comes back.
After reading the results, Berger referred Alden to oncologist Dr. Raymond Wadlow at Massachusetts General.
When he went for an office visit, Wadlow explained, "roughly 15 to 20 percent of patients with Stage III cancers like yours will develop a recurrence within five years. We want to maximize the chances you are cured now."
Chemotherapy could increase Alden's survival odds by a third, said Wadlow, who recommended a six-month regime. Given that the surgery alone offered Alden an 80 percent chance of being cured, chemo could increase those odds to about 87 percent.