My mother has been seeing her doctor for a bowel problem. They tried to do a colonoscopy, but could not see well enough because the colonoscope would not go through a narrowed area. The doctor thinks it is diverticulitis, but wants to rule out cancer. Can you explain the situation better for us?
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As we age and get beyond 60 years, diverticular disease becomes much more common. Diverticula are small saclike outpouchings of the bowel lining, or mucosa, through the muscle layer of the bowel. They can occur anywhere in the bowel, but most commonly affect the latter part of the colon, or sigmoid, as it is called. The herniations usually occur at the spots where blood vessels penetrate the muscle layer and, consequently, weaken the muscle coat. Consumption of a low-fiber diet is felt to play a major role in developing diverticula, as persons eating a diet rich in refined foods are more prone to diverticular disease. If the opening to the diverticula gets plugged, inflammation of the sac takes place with the formation of small abscesses. This reacts like appendicitis, but typically on the opposite side of the abdomen. Severe complications such as bleeding, peritonitis, or obstructions of the bowel may occur. Complicated cases may require the use of computed tomography. The question of cancer is one your doctor has to bear in mind. This is because diverticulitis can be a red herring to the making of a correct diagnosis, and your doctor’s vigilance should be reassuring. It is possible to treat colon cancer with excellent results if dealt with early enough, and the doctor’s ruling out cancer will help get to any problem sooner rather than later.
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I am overweight, and my periods are very irregular. My doctor thinks I have polycystic ovaries and wants to put me on a birth control pill. She says it lowers my risk of cancer. What is your advice?
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This is a fairly complex situation that we will try to reduce to a simplified answer. During normal menstrual cycling, an egg is released from the ovary about every month. In the portion of the cycle before ovulation, only estrogen is produced; after ovulation, both estrogen and progesterone are produced. The progesterone modifies or suppresses some of the stimulation of the estrogen. Menstruation happens when these hormones fall to lower levels. Ovulation is regulated by two pituitary hormones, one of which stimulates the follicle to grow (follicle-stimulation hormone), and the other luteinizing hormone causes release of the egg and consequent progesterone secretion. The diagnosis of polycystic ovary syndrome is made by a combination of history, physical examination, ultrasound examination of the ovaries, and the use of hormonal analysis. In the polycystic ovary syndrome, the normal pattern of a rising and falling of the two pituitary hormones does not happen, and a more steady state is found. The luteinizing hormone level is often higher than the follicle-stimulating hormone, in what is a reversal of the usual ratios. The fact that ovulation is not regular means that estrogen is continually present, but only irregularly opposed by progesterone, which is secreted only after ovulation. Infertility can be a consequence. Persons with polycystic ovaries also have higher testosterone levels, which tends to make them heavier and overweight. Persons with endometrial cancer have been shown to be overweight, have irregular menses, be infertile, never have been on birth control pills, have high blood pressure, and—in some cases—have taken estrogen without progesterone. It has been noted that persons with polycystic ovary syndrome, as a group, do have an increased risk of endometrial cancer. It is felt this is because of the presence of unopposed estrogen activity. We hope this necessarily brief and incomplete discussion helps you as you discuss this further with your doctor.
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