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.
Today, Alden is doing well after enduring his chemo regime and continuing to move forward with his life. He proposed to Paradise-McFee in April this year and the couple was married July 2, 2010, in a small wedding at their home.
"I've met an angel, and it's been wonderful," she said before their wedding. "He's my soul mate. We have a lot in common."
Alden continues to see Berger for follow-up colonoscopies and was recently diagnosed with diverticulitis, an inflammation on the wall of the colon, which Dr. Berger is now treating him for as well.
But that hasn't stopped Alden and his new wife from enjoying the things they love to do: golfing, gardening, shell fishing and even raising their 20 chickens.
"Before, I was thinking death," Alden said. "Now, I'm thinking living."
Colon cancer is best prevented through diet, exercise, avoiding excessive alcohol intake and not smoking, but Berger stresses the importance of getting a colonoscopy screening, a test men and women should start scheduling after the age of 50.
"The best thing to do to prevent yourself from getting colon cancer is to have screening colonoscopies," Berger said. "Then you have a better chance of getting these tumors detected at an earlier stage."
Early-stage colon cancer referred to as Stage I means the cancer has not grown through the wall of the colon or the lymph nodes are negative. Stage II would be that the tumor grows through the intestinal wall but the lymph nodes are negative. Stage III, which Alden had, indicates that the lymph nodes are positive.
The final stage, Stage IV, indicates that not only are the lymph nodes positive but it has spread to other organs such as the liver or the lungs.
Your risk for colon cancer -- when you start your screenings and the number of screenings you will need in your lifetime -- can vary based on your lifestyle, family history and age.
Berger explained that someone who older than 50, with no risk factors and no family history of the disease, and who comes back with a clean colonoscopy, could wait 10 years before scheduling their next one.
On the other hand, "if there is a positive family history in someone that has colon cancer before the age of 50, so let's say your mother had cancer before the age of 50, we would recommend screening begin at 40," Berger said.
You may also have a repeat colonoscopy every three years or even annually based on your family history and whether polyps are found in your colon.
Talk with your primary care physician to arrange a colonoscopy appointment with either a gastroenterologist or a surgeon, depending on your community.
The bottom line: "If people get regular colonoscopies, less people will die of colon cancer," Berger said.
For more information on colon cancer and colon cancer screening, visit the American Society for Gastrointestinal Endoscopy's website at http://www.screen4coloncancer.org.