Kirstie Alley dead at 71 from colon cancer

[Sunrises Sunsets]

A lot of this is due to the skill and care of the physician performing the colonoscopy. Why it’s critical to find a top notch caring health professional. Go to a gastroenterologist who is highly skilled and who is going to take his time doing your colonoscopy for a thorough evaluation

I encourage you to perform some online research regarding cancers missed during colonoscopies. Studies have indicated missed colorectal polyps ranged from 17% to 28%. Even the best gastroenterologists have missed polyps, particularly the flat polyps.

 

[missy]

I encourage you to perform some online research regarding cancers missed during colonoscopies. Studies have indicated missed colorectal polyps ranged from 17% to 28%. Even the best gastroenterologists have missed polyps, particularly the flat polyps.

Yes I have done the research and I see the statistics. Unfortunately colonoscopy is still the best diagnostic test we have for detecting colon cancer. It is still considered the gold standard.

I stand my what I wrote regarding the competence of the physician being the single greatest factor for determining a successful colonoscopy. IMO

With any diagnostic test perfection is unobtainable. We do the best we can. Regarding colonoscopies the skill of the physician is critical

Achieving competence in colonoscopy: Milestones and the need for a new endoscopic curriculum in gastroenterology training - PMC

Colonoscopy is considered to be the most effective tool for reducing colorectal cancer (CRC) morbidity and mortality. As a result, certifying trainee competence in the performance of colonoscopy is critical to maximizing CRC screening and prevention ...

www.ncbi.nlm.nih.gov

Also, there are techniques being used to help increase the detection rate of missed lesions. Such as wide angle colonoscopy or the retroflection method.
More (and larger) studies need to be done to figure out the factors involved in not being able to detect all polyps.
And when it comes right down to it Colonoscopy is still our best chance in diagnosing colon cancer as early as possible for the best possible prognosis.


Hopefully in the future there will be new techniques that minimize missed cancers, In all different types of cancer.

 

[Skymonkey2000]

Kirstie was a Scientologist and they don’t believe they’ll get cancer and the only treatment they’re really allowed to do is homeopathic. I’m guessing she ignored symptoms and then refused traditional treatment.

Important PSA nonetheless.

That’s weird, just looked up on their website and it says they do use traditional medicine and doctors…. You don’t know her so maybe don’t assume you know what she did. She was a person, with family who will miss her now, so just always be kind

 

[LilAlex]

Despite the best care and rigorous adherence to screening standards (and there are not many of those), pretty much all of us will die of cancer or blood vessel disease (heart attack, stroke, etc.). And the older and sicker you get, the more docs you see so you are highly likely to die shortly after seeing a doctor. Not all illness is a failure of "the system." I've gotten plenty of flat tires -- even with a lot of tread-life left.

 

[Sunrises Sunsets]

Colonoscopy is still our best chance in diagnosing colon cancer as early as possible for the best possible prognosis.

As I indicated in my earlier post: I only want everyone to be aware that colonoscopies aren't always 100% accurate. I would still highly recommend them routinely and to push for further testing if you are having issues.

Even the very best gastroenterologist has missed a polyp. It goes without saying that people should always seek the best physician possible for their medical care.

 

[missy]

As I indicated in my earlier post: I only want everyone to be aware that colonoscopies aren't always 100% accurate. I would still highly recommend them routinely and to push for further testing if you are having issues.

Even the very best gastroenterologist has missed a polyp. It goes without saying that people should always seek the best physician possible for their medical care.

No argument here . Of course if one is symptomatic one needs to keep searching for answers no matter if one's diagnostic tests were negative.

We both agree colonoscopy is still the most effective screening exam for colon cancer. The statistics bear that out with the first exam detecting colon cancers with about 98% accuracy. That's pretty darn good for any diagnostic test. IMO

 

[Sunrises Sunsets]

When two instances of missed polyps from which deadly cancers have occurred were noted by two people in a forum thread with perhaps a small percentage of readers, one is awakened to possibilities of test failure. Many believe that the colonoscopy was a pretty much fool proof test.

I know you agree with me, Missy, that it is a good marker for colorectal cancer but not perfect, even if you have the best gastroenterologist. Here's wishing all of you good health and regular colonoscopies as your ages and situations require.

Happy holidays!

 

[missy]

When two instances of missed polyps from which deadly cancers have occurred were noted by two people in a forum thread with perhaps a small percentage of readers, one is awakened to possibilities of test failure. Many believe that the colonoscopy was a pretty much fool proof test.

I know you agree with me, Missy, that it is a good marker for colorectal cancer but not perfect, even if you have the best gastroenterologist. Here's wishing all of you good health and regular colonoscopies as your ages and situations require.

Happy holidays!

Best wishes to you too

 

[monarch64]

“That’s weird, just looked up on their website and it says they do use traditional medicine and doctors…. You don’t know her so maybe don’t assume you know what she did. She was a person, with family who will miss her now, so just always be kind”

Yes, DEFINITELY take whatever is on Scientology’s website seriously. And always be kind? I won’t reserve any kindness for cult followers, racists, and those who sunk millions into a cult that tells them if they pay so much money they will become impervious to cancer. Have a day.

 

[Rons Wolfe]

I'm due for my butt-cam again, last was 10 years ago. A note on the liquid, it's easier to drink if you put a little vodka in it.

I only wish there was a way to screen like this for pancreatic cancer too.

 

[missy]

I'm due for my butt-cam again, last was 10 years ago. A note on the liquid, it's easier to drink if you put a little vodka in it.

I only wish there was a way to screen like this for pancreatic cancer too.

Good luck with the prep and the procedure.
As for pancreatic cancer an EUS (endoscopic ultrasound) is accurate and not more invasive (IMO) than a colonoscopy. I had to have an EUS this past summer and it was very easy. No prep even...just fasting before the test. The anesthesiologist administered propofol and before I knew it the procedure was over. Of course I think one needs to have a high risk to get this test covered by health insurance. But this test does exist and can reliably diagnose pancreatic issues.

Role of endoscopic ultrasound in the diagnosis of pancreatic cancer - PMC

Endoscopic ultrasonography (EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography, computed tomography ...

www.ncbi.nlm.nih.gov

"As a diagnostic modality for pancreatic cancer, EUS has proved rates higher than 90%, especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for CT. Besides, EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic cancer."

 

[tyty333]

Had my colonoscopy a couple of days ago. Had the pills which were easy to take. Its still a large volume of liquid (water) to drink
and at one point I thought I was going to throw up. It was mind over matter because I figured I was going to have to drink even
more water if I did. No-bueno! I managed to get past those feelings and kept it down.

Anyhow, all was good. I'm on the 10 year plan for my next visit. I'm glad I did it (and glad is done). I can recommend the pills
for anyone who can get them. Its definitely easier. Wishing everyone an uneventful colonoscopy!

 

[RMOO]

Same. Had mine on Monday, all good. This was not my first colonoscopy, but the first using OTC Dulcolax and Miralax. Prep was much easier to take than the salty prescription powder/liquid. Miralax solution has no flavor except an almost imperceptible chaulky taste, so it was easier to take in. But there is no getting around having to drink that quantity of liquid. I would suggest to anyone doing this prep to change up the liquids you drink in between often, and avoid coffee on an empty stomach. If you need caffeine to avoid a headache, drink cola.

The point is, please don't avoid this important test just because of the prep.

 

[RMOO]

Good luck with the prep and the procedure.
As for pancreatic cancer an EUS (endoscopic ultrasound) is accurate and not more invasive (IMO) than a colonoscopy. I had to have an EUS this past summer and it was very easy. No prep even...just fasting before the test. The anesthesiologist administered propofol and before I knew it the procedure was over. Of course I think one needs to have a high risk to get this test covered by health insurance. But this test does exist and can reliably diagnose pancreatic issues.

Role of endoscopic ultrasound in the diagnosis of pancreatic cancer - PMC

Endoscopic ultrasonography (EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography, computed tomography ...

www.ncbi.nlm.nih.gov

"As a diagnostic modality for pancreatic cancer, EUS has proved rates higher than 90%, especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for CT. Besides, EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic cancer."

@missy I just want to say that you amaze me! You are a fountain of information! Thank you.

 

[missy]

@missy I just want to say that you amaze me! You are a fountain of information! Thank you.

Thank you.
Unfortunately I often come by my knowledge due to personal experience lol.
I am happy to share any info I have with my fellow PSers

 

[Rons Wolfe]

Good luck with the prep and the procedure.
As for pancreatic cancer an EUS (endoscopic ultrasound) is accurate and not more invasive (IMO) than a colonoscopy. I had to have an EUS this past summer and it was very easy. No prep even...just fasting before the test. The anesthesiologist administered propofol and before I knew it the procedure was over. Of course I think one needs to have a high risk to get this test covered by health insurance. But this test does exist and can reliably diagnose pancreatic issues.

Role of endoscopic ultrasound in the diagnosis of pancreatic cancer - PMC

Endoscopic ultrasonography (EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography, computed tomography ...

www.ncbi.nlm.nih.gov

"As a diagnostic modality for pancreatic cancer, EUS has proved rates higher than 90%, especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for CT. Besides, EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic cancer."

"Of course I think one needs to have a high risk to get this test covered by health insurance."

Here's the problem, plus doctors won't even order it as a screening like the do the colonoscopy. My husband had colonoscopies, which were always clean, but no tests that could have detected his pancreatic cancer until he was stage 4.

 

[missy]

"Of course I think one needs to have a high risk to get this test covered by health insurance."

Here's the problem, plus doctors won't even order it as a screening like the do the colonoscopy. My husband had colonoscopies, which were always clean, but no tests that could have detected his pancreatic cancer until he was stage 4.

I’m so sorry your husband’s pancreatic cancer wasn’t detected til stage 4

 

[Rons Wolfe]

I’m so sorry your husband’s pancreatic cancer wasn’t detected til stage 4

Thanks. He put up one hell of a fight, but he had no chance.

 

[yssie]

Thanks. He put up one hell of a fight, but he had no chance.

Oh. God. I’m so sorry. So, so sorry

 

[Rons Wolfe]

Oh. God. I’m so sorry. So, so sorry

Thank you, Yssie.

 

[missy]

"

Screening for colorectal cancer (CRC) is both effective and cost effectiveopens in a new tab or window. One of the earliest tests for colorectal cancer screening is detecting occult blood in stool followed by colonoscopy if the test is positive. A randomized clinical trial of annual fecal occult blood testing in the U.S. demonstrated an 18% reductionopens in a new tab or windowin colorectal incidence over 18 years of follow-up and 33% reductionopens in a new tab or window in colorectal cancer mortality sustained through 30 years of follow-up. Screening with colonoscopy gained popularity in the early 2000s, and observational studiesopens in a new tab or window have reported a 60-85% reduction in colorectal cancer incidence.



In the U.S., colonoscopy is now the most common screening modality for colorectal cancer. It has the advantage of detecting not only early cancers but also precursor lesions such as polyps, some of which, if left in place, could turn into cancer. Hence, colonoscopy is an early cancer detection and cancer prevention tool. Despite the widespread enthusiasm for colonoscopy screening, randomized clinical trial data for its benefit were lacking -- until now.

The results of a recent colonoscopy trial have attracted considerable attentionopens in a new tab or window given results that, on the surface, suggest colonoscopy is less effective than previously thought. However, the study has several limitations, and will do more harm than good if it promotes a chilling effect in screening among patients.

Interpreting the Latest Colonoscopy Study

The NordICC trialopens in a new tab or window was a pragmatic randomized trial to test the effectivenessopens in a new tab or window of colonoscopy. Between 2009-2014, the study randomized 84,585 individuals in a 1:2 ratio of colonoscopy to usual care (no screening). The study reported an 18% reduction in CRC incidence and no reduction in CRC mortality with colonoscopy screening, results that have surprised and dismayed the readers.



There are three important considerations in interpreting the results: First, the study was an intention to screen trial, which means individuals randomized to the colonoscopy arm were invited to undergo screening. This is how randomized trials are and should be done, to preserve randomization and balance known and unknown confounders. However, the uptake of colonoscopy was very low, at only 42%. Compare this to the Minnesota fecal occult blood screening randomized trial, where uptake of fecal occult blood testing and subsequent colonoscopy was over 84%. Since those in the arm randomized to colonoscopy are counted in the denominator regardless of completion, one can see how the comparison can show a diluted effect with low uptake of colonoscopy. This is when we look at the per protocol, or the compliance adjusted estimates. In this trial, those that adhered had a 40% reduction in CRC incidence. Still not as high as expected, but better than 18%.



Second, after decades of research on the topic, we know that colonoscopy is highly operator dependent, and that only high-quality colonoscopies are able to detect and remove the early cancers and premalignant polyps that confer protection from subsequent colorectal risk. As a result, in the U.S. we have developed a set of quality indicators that have been validated against risk of developing colorectal cancer in the near future. The best studied ones are cecal intubation rate and adenoma detection rate (ADR). The bar we have set is 95% and 25%, respectivelyopens in a new tab or window, for these two indicators.

In the U.S. we perform a lot of colonoscopies (more than 15 millionopens in a new tab or window per year), and we do them well. U.S. endoscopists, who perform this procedure, meet and exceed these benchmarks for the most part. However, the endoscopists in the NordICC study fell short of these benchmarks. Nearly 30% had ADR below 25% and cecal intubation rates less than 95%. The study reports on only 35 endoscopists that performed 30 or more colonoscopies during the study period, and it is not known how many more endoscopists participated who may be low volume and have unknown quality indicators. This does call into question the generalizability of the study to the U.S. in particular.



Third, the study is underpowered to detect a difference in CRC mortality between the two arms. Colonoscopy detects premalignant polyps, which otherwise would take 8 to 20 years to become cancer, and another 5 to 10 years to advance, spread, and become fatal. Hence the benefit in reducing death from such lesions is expected to be realized over a long period of time. With enrollment ending in 2014, and follow-up in 2020 (national death registries generally lag 2 years behind), the follow-up time period is insufficient to expect a difference in risk of death. The authors are continuing to follow these individuals, and we are likely to see more information on CRC mortality in 5 and 10 years. Therefore, the conclusion of no benefit in CRC mortality is premature.

The last, and perhaps most important, aspect of the study is the questionable generalizability to the whole U.S. population. The way the study was designed, individuals were not consented (or told) they were being randomized to colonoscopy or usual care. Hence the authors have no information on the risk factors of these individuals, such as their body mass index, baseline risk of colorectal cancer, smoking history, and dietary and other lifestyle factors that we know are associated with risk of colorectal cancer, and attenuated in many subgroups of the U.S. population. Hence the benefit may not reflect the effect in an at-risk population in the U.S. We know the endoscopists and the colonoscopy practice are certainly not generalizable. Taken together, it's hard to see how this may apply to our practice.



Placing the Study in a Broader Context

Randomized clinical trials are the holy grail of scientific evidence. Estimates from observational studies are generally inflated, and time and time again we have seen these estimates become smaller and more conservative when the rigors of a randomized trial with concealed allocationopens in a new tab or window are applied. In the context of colonoscopy, we expected the estimates to shrink somewhat, and the 95% confidence estimates to get tighter compared to results from observational studies -- but this study may have missed the mark due to its limitations.

What we want is the study to be taken in the context of the body of evidence on effectiveness of colonoscopy, and for people to understand that it is one more data point, with more to come from ongoing trials. We also need the public to understand that screening for colorectal cancer reduces the risk of developing and dying from CRC, and that colonoscopy is a highly effective modality. Clinicians must ensure their patients understand this, and continue to encourage screening. Let's not throw the baby out with the bathwater just yet.



Aasma Shaukat, MD, MPH,opens in a new tab or window is the Robert M. and Mary H. Glickman Professor of Medicine and Gastroenterology and the director of outcomes research in the Division of Gastroenterology & Hepatology at NYU Langone in New York City. She is a practicing gastroenterologist and researcher in colon cancer screening and quality indicators of colonoscopy.



"

 

[Sunrises Sunsets]

Thank you, Missy, for providing links to the study that show colonoscopy is not always effective and polyps can be missed.

It is an example that people should be screened with colonoscopy. But, at the end of the day, the patient is the best reporter of changes or occurring issues if a recent colonoscopy is negative. Do not presume the colonoscopy procedure is gospel truth.

 

[missy]

Thank you, Missy, for providing links to the study that show colonoscopy is not always effective and polyps can be missed.

It is an example that people should be screened with colonoscopy. But, at the end of the day, the patient is the best reporter of changes or occurring issues if a recent colonoscopy is negative. Do not presume the colonoscopy procedure is gospel truth.

You are welcome. As with all tests and procedures nothing is foolproof. We work with what we have and of course clear patient and physician communication is critical. We never base things on findings alone. To get a complete picture we take into account all we have

 

[Sunrises Sunsets]

You are welcome. As with all tests and procedures nothing is foolproof. We work with what we have and of course clear patient and physician communication is critical. We never base things on findings alone. To get a complete picture we take into account all we have

Yes and I think the problem is when people don't realize that a "clear colonoscopy" can be incorrect and assume they are good to go for the next 3 or 5 years.

 

[LightBright]

THIS!!! Do not be lulled into believing your colonoscopy is accurate. Trust your instincts about your body.

A woman, who routinely went for her colonoscopies but missed early 2021 due to covid concerns. She went to her family physician this January complaining of feeling of pressure and pain in the lower regions. Dr. said colonoscopy should be performed and it couldn't be scheduled until the end of March. Colonscopy went fine and she was given the all clear. She contacted her Dr. after about 3 weeks stating the pain she was feeling had gotten worse. Her physician sent her to a OB-GYN in the event it was some type of prolapse of the female organs. The woman had to wait another month for that appointment. An MRI was scheduled to take a look at what may be causing the issues. She then had to wait another length of time for the MRI to be performed. Long story short, she was diagnosed with stage 3 colorectal cancer after the first week of August! The OB-GYN looked back at the colonoscopy pictures and said, "there it is, it was missed". It was a large tumor that is now believed may have been missed even previously to the latest colonoscopy. By the time this was diagnosed, the patient needed such strong pain medication for the unbearable pain that Narcan was sent home with her family, if needed. She was then looking at long radiation treatments, chemo, colostomy and more chemo and even then, prognosis was not great.

Thankfully, her oncology team also applied to her insurance for use of a newly approved but very effective immunotherapy for her type of cancer. It was approved and within the first week of treatment, she was able to discontinue the pain medication and the tumor, at last check, had shrunk 70 to 80%. She will need to continue this immunotherapy for the rest of her life at this point and may still require radiation/surgery to remove remaining tumor elements. Time will tell what her future prognosis will be but the moral of this story is don't ignore symptoms that may be telling the true story.

Thank you for sharing this story. Do you know the name of the newly approved immunotherapy? I’m curious to know. Thankful that it worked for her.

 

[LightBright]

Yes and I think the problem is when people don't realize that a "clear colonoscopy" can be incorrect and assume they are good to go for the next 3 or 5 years.

The same can be said for mammograms and ultrasounds. Sometimes cancers grow very fast “out of nowhere”, so one or two year old imaging wouldn’t show it.

My life lesson: Always investigate symptoms and changes. Imaging, a doctors (second) opinion, nor bloodwork tells the whole story. Biopsies are the most direct way (as far as I know) to know if you have cancer but they are sometimes not easy to obtain.

 

[Sunrises Sunsets]

Thank you for sharing this story. Do you know the name of the newly approved immunotherapy? I’m curious to know. Thankful that it worked for her.

The FDA granted accelerated approval for GSK's "Jemperli" in April 2021. It has been extremely effective in treating the type of colorectal cancer in the patient who I mentioned previously. However, there are no long term results with which to provide a prognosis so for now it's viewed as a quality, life extending treatment. The other shoe could fall at any time but we are all hopeful it will continue to be a treatment that is effective and that the patient can tolerate it systemically.

I hope this helps.

 

[TooPatient]

Yes and I think the problem is when people don't realize that a "clear colonoscopy" can be incorrect and assume they are good to go for the next 3 or 5 years.

I would love to see it become recommended that people get the usual colonoscopy BUT also get the fecal sample screenings every year or two so there is something in between to stand a better chance at catching things early. Not instead of, but in addition to as one more tool to help people.

 

[Sunrises Sunsets]

I would love to see it become recommended that people get the usual colonoscopy BUT also get the fecal sample screenings every year or two so there is something in between to stand a better chance at catching things early. Not instead of, but in addition to as one more tool to help people.

I agree and think there are so many tests which could be used for screening that aren't approved for insurance coverage. For example; routine ultrasound screenings for ovarian cancer which is usually so insidious and deadly.

 

[autumngems]

Hubby just had his, I go in March