July

The practice of medicine is changing rapidly—or so it seems to me. It may be a characteristic of my own aging that I have this impression, since it seems that hours, days, and weeks are also passing at an accelerating rate.

We have identified a problem with high local recurrence rates for rectal cancer in BC. Our overall local recurrence rates are about 16%,[1] compared to 4% to 8% in trials using preoperative adjuvant radiation and the surgical technique total mesorectal excision (TME).[2-4] The Netherlands,[2] Sweden,[3] and Norway[4] have all achieved marked reduction in local recurrence rates for rectal cancer patients by altering their management of rectal cancer in national projects.

Every so often I end up doing something I said I would never do. Generally the philosophical compromise is a few Hail Marys short of a cardinal sin, and usually involves paying way too much for something I didn’t need. For the most part these moral/ethical/philosophical hiccups are more about servicing desperate wants, and as expected, once the initial warmth of possession has waned, the replacement emotion is more angst than ebullience.

Colorectal cancer is the second leading cause of cancer death in BC after lung cancer. The lifetime risk of dying of colorectal cancer is about 3%. Most, if not all, colorectal cancers are believed to develop from adenomatous polyps[1] over a period of about 10 years. Screening for colorectal cancer offers the opportunity to reduce mortality by the earlier detection of invasive disease and by the removal of precancerous polyps, thus preventing the development of colorectal cancer.

Endorectal ultrasound