In the spring of 2000, Robinson, 52, was treated for colon cancer, then embarked on a plan to eat more fiber and drink more water to maintain his remarkable recovery. Usually, he did a pretty good job. But occasionally he slipped, causing his digestive system to back up in a most painful way.Sept. 11, 2001, was one of those days. Robinson woke up feeling uncomfortable enough to delay going to his job at Empire Blue Cross Blue Shield, located in the north tower of the World Trade Center in New York City.
Stunned, Robinson watched the World Trade Center terrorist attacks unfold from his living room in Brooklyn. Nine of his co-workers perished that day.
That wasn't the first time Robinson had been exceptionally lucky.
A year earlier, he'd noticed blood in his stool, a symptom that was almost surely a sign of colon cancer. The symptom came and went, though, and Robinson delayed seeing a doctor for eight months.
A colonoscopy and further tests in March 2000 revealed the worst: cancer in his colon had spread to a small portion of his liver. The colon cancer was surgically removed that month; that was followed by chemotherapy and radiation. The liver was "re-sectioned" four months later.
The majority of liver cancers in the United States are metastatic, meaning they've spread from cancer somewhere else in the body, most often the colorectal region. The risk of having metastatic liver cancer from colorectal cancer is about 20 percent to 30 percent. Though primary liver cancer is rare in North America, it's the most common solid tumor malignancy worldwide, usually a consequence of hepatitis, environmental toxins and other conditions.
Fewer than half the patients who have metastatic liver disease are candidates for surgical resection, a highly technical and dangerous procedure to remove part of the organ. Few procedures are actually successful.
"He was remarkably fortunate in that he had a single early lesion which we picked up on right away," says Dr. Thomas K. Weber, Robinson's surgeon and an associate professor of surgery and molecular genetics at Albert Einstein College of Medicine in New York City.
Colon cancer is usually bad enough -- it's the second-leading cancer killer after tobacco-related malignancies in the United States. Approximately 140,000 new cases are diagnosed and about 55,000 people die of the disease each year.
Unfortunately, despite the availability of several different screening methods, less than 20 percent of Americans are getting appropriately screened for age and risk factors for colon cancer, Weber says.
"Screening rates remain very low. This is why we have so many deaths," Weber says. "The majority of people are diagnosed with symptoms, and this is not a disease where you wait for the first signs."
The American Cancer Society provides a range of recommendations for screenings, all of which start at age 50 for people of average risk (the majority of cases occur in people over 50). The first option is to have a digital rectal exam once a year along with the flexible sigmoidoscopy (the short scope) every five years. Another option is to have the sigmoidoscopy on its own every five years. The third option is to have a fecal blood test every year. The final choice is to have a colonoscopy (the long device) every 10 years, or a double-contrast barium enema every five years.
"There are a lot of options, which is confusing, but the reason is to provide a range of options so something gets done," Weber says. "Something is definitely better than nothing."
The guidelines are very different for individuals at "increased risk," meaning those who have parents, siblings or children who have had colon cancer. Screenings need to begin at age 40. A small number of people in an extremely high-risk category need to begin as early as puberty.
Weber has established the New York Metropolitan Familial Colorectal Cancer Registry to identify at-risk individuals.
"With increased risk groups, it's very, very important that they be screened because that's where the majority of cases will be identified," says Weber.
Individual risk is clarified based on a simple interview. All participants receive a written copy of the American Cancer Society's screening recommendations.
Herb Robinson will be enrolling in the registry, and he unfailingly reports for a colonoscopy once a year.
And on March 27, 2002, he did what for a while had seemed like the impossible: Robinson married his long-time girlfriend, Carmen Adams, a nurse.
"This whole bout with the cancer kind of drew us together even more," Robinson says. "I'm just glad I survived it all."
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