Question

Part II—A Visit to the Doctor

“Good afternoon, Jane,” Dr. Peters said as she entered the examination room. “I understand that you’re here to talk about some concerns related to cancer in your family.”

Jane explained the history of cancer in her family, including her father’s early death from colon cancer and her brother’s recent diagnosis of the same disease, ending with the recommendation from her brother’s doctor to have her own colon checked.

“What does that mean, to have my colon ‘checked’?” As she asked the question, Jane was already feeling a little uncomfortable about it.

“I know that the idea of having a procedure done to look at your colon is a little off-putting,” Dr. Peters began, “but it really can be one of the most important tests if your family has a history of colon cancer.” She continued to explain: “The procedure that allows the interior of the colon to be examined is called a colonoscopy. The purpose of such a screening is to look for sites of increased cell growth in the colon, called polyps or adenomas. These adenomas are small benign tumors that form in the intestinal lining. People who inherit a predisposition to colon cancer are at higher risk to form these adenomas, and at an early age. Although the adenomas are benign, the cells within them are one step closer to becoming malignant. So, colonoscopy screenings don’t prevent cancer, but they do allow sites of altered cell growth to be detected,

so that treatment can begin as soon as they appear. By detecting these adenomas early and removing them before they become malignant, we can prevent colon cancer.

“So regular colonoscopy screenings, beginning at an early age, are highly recommended for people with a familial predisposition to colon cancer,” Dr. Peters continued. “And even if a person doesn’t have a family history of colon cancer, it’s still recommended to have a colonoscopy screening once a year beginning at age 50.”

“I understand now why it would be important to have my colon checked,” Jane said, “but is there some way I can find out for sure whether I have inherited a predisposition to colon cancer?”

“I was just getting to that topic,” Dr. Peters replied. “In some cases, genetic testing can reveal whether you are predisposed to colon cancer. Normally those kinds of genetic tests are done first on family members who are affected. Since your brother lives nearby, I’d suggest you talk with him about making an appointment together with a genetic counselor for more information about testing.”

Questions

1. What does it mean if a tumor is classified as “benign”? What does it mean if a tumor is “malignant”?

2. Why is it easier to treat a benign tumor than a malignant tumor?

3. What does it mean to be predisposed to getting cancer?

4. If someone is predisposed to getting cancer, does that mean that he or she will definitely get cancer someday?

Answer 1

1. A tumor is classified as benign only when the tumor is localized to a certain area of the body. A tumor becomes a malignat one when the tumor cells crosses the epithelial surfaces and metastasizes to other areas of the body via the bloodstream. Malignant tumor cells are far more active and proliferate at a greater rate than benign ones.

2. It is easier to treat a benign tumor because of it's containment. A benign tumor is not strong enough to spread throughout the body and the proliferation can be stopped by radiation therapy or drugs.

3. Predisposition is to be liable to have cancer or not. That means whether the person has a probability to have cancer in his/her lifetime or not.This can mostly be checked by genetic studies because the mutational changes that might lead to cancer can be generally transferred from generation to generation

4. Being predisposed to cancer does not necessarily mean that he/she will have cancer in his/her lifetime. The mutational changes might not be prevalent enough to cause the uncontrolled proliferation or maybe the predisposition factor might not be active in the individual at that rate as it was maybe in the previous generation