Going Under the Knife to Head Off Cancer

March 2, 2009— -- Few wouldn't balk at the idea of prophylactic surgery -- the removal a healthy organ or gland that shows no sign of cancer in order to prevent cancer from developing in that organ or gland.

In other words, prophylactic surgery involves cutting from the body a perfectly fine organ.

Or a ticking time bomb.

Or a perfectly fine organ.

And that is the dilemma facing a segment of the population who, due to family history, genetics or personal medical history, are saddled with a higher risk of cancer than the rest of the population and may have to take drastic steps to prevent a disease that kills over half a million Americans each year.

But Brian Chelcun, 26, never wavered for a moment.

"I was seeing my dad go through the effects of having stage IV stomach cancer," said Brian, whose father died Feb. 8 of the disease. Chelcun was released from Massachusetts General Hospital in Boston last week after a gastrectomy to remove his stomach.

"Here's a chance to avoid going through something that is so hard, and difficult to cure," he said.

Chelcun's family is unique, one of perhaps 100 families in the U.S. with a genetic mutation that leads to an increased risk of developing gastric cancer. Because gastric cancer is difficult to diagnose even when in its later stages, the prognosis for those with the disease is poor, with a five-year survival rate of about 24 percent.

Chelcun's aunt and uncle on his father's side have both had successful gastrectomies, and Chelcun said he planned on doing the same within five years, undergoing endoscopies and biopsies about twice a year until he was ready for surgery. But one of his biopsies showed potentially cancerous cells.

"After they found that there was no real reason to wait," Chelcun said.

Strong evidence of hereditary stomach cancer coupled with poor screening methods may have helped make Chelcun's decision clear-cut. But sometimes the problem is more complicated.

There are innumerable variables for those confronted with a genetic predisposition to cancer who are considering prophylactic surgery. The most influential variables include the type of cancer, how effective screening techniques are and the potential outcomes of prophylactic surgery.

And even with the help of genetic counselors, therapists, physicians and surgeons, who are just a few members of any team helping a person who has found they are at risk for cancer, the decision must ultimately be a personal one.

"Any decision they make has to make medical sense as well as emotional sense," said Karen Hurley, assistant attending psychologist at Memorial Sloan-Kettering Cancer Center in New York. "Even with a strong recommendation to have surgery, you still have to find a way to make it your own and not just because somebody else told you to because, in the event of complications, that leaves you open to the possibility of regret."