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Bruce Bracken, MD
One day in the summer of 2000 my friend, Sue Johnson from Keewatin, Ontario, advised me to have my gall bladder removed as her husband Larry had recently died from gall bladder cancer. Larry and I shared the diagnosis of ulcerative colitis – his severe, mine asymptomatic. Add to it, I also have sclerosing cholangitis another complication of ulcerative colitis
I had a CT when I got back from vacation and it showed a small tumor in my gall bladder. Joseph Fischer, then head of Surgery at the University of Cincinnati, had recruited many good surgeons, at least 6 of whom could have treated me well. I chose Douglas Hanto, a hepatobiliary liver transplant surgeon, to do my surgery. I asked Diane Bridenbaugh to be my anesthesiologist and Terri Campbell and Dan Peters (both urology OR nurses) to scrub on my case – both still work in the operating room on weekends. I recuperated on the urology/5E floor- with “my nurses caring for me”. I received world class care and I returned to work part time 10 days later.
The primary tumor was small, but there was a 2.5 cm metastatic lymph node full of adenocarcinoma which I thought was a death sentence. Duane Sigmund treated me with 4 months of Gemzar adjuvant chemotherapy and I prepared to die. After 1 year with no evidence of disease, it was clear I wouldn’t die, and I remain well 22 years later.
My cure is due to early diagnosis; a summer holiday conversation with Sue Johnson that led to a CT, good surgery, great care at University of Cincinnati Medical Center , and effective adjuvant chemotherapy by Dr Sigmund, as well as luck because in spite of early diagnosis, the cancer had spread.
If we want to utilize early diagnosis for gall bladder and other intra-abdominal cancers, we need to employ routine imaging rather than physical diagnosis. It is time to teach our medical students to perform routine abdominal ultrasound when they see patients in the office instead of relying upon physical examination of the abdomen. There will be plenty of false positives that will require more sophisticated imaging, but only if we adopt early diagnosis will gall bladder cancer patients have the chance that I have had - effective early treatment and the chance to live to talk about it decades later.
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