Thyroid cancer, breast cancer, prostate cancer, cervical cancer, and colon cancer can nearly always be detected in their early stages. When detected early, they have extremely high cure rates, Dr. Hassapis said.
He came to Garberville specifically to encourage people to get tested for these types of cancer, and particularly to urge everyone over 50 to have that most dreaded of diagnostic tests - colonoscopy.
Before discussing colonoscopy, however, he criticized conclusions drawn by studies indicating that mammograms and prostate-specific antigen tests (PSA) are “worthless.”
Mammograms on young women don’t reveal many cancers because younger breast tissue is more fibrous, and fibrous tissue blocks the visibility of the tumors. This is also true of men, who may also get breast cancer. But as women get older, fibrous tissue decreases and tumors show up more clearly on mammograms.
PSA tests are not worthless just because prostate cancer progresses slowly and is considered a “disease of old guys,” Hassapis said. One of his patients was a man in his nineties who was still “kicking butt.” This patient wanted Hassapis to do the surgery right away so he wouldn’t miss the opening of deer season.
Although it is preventable, colon cancer is one of the top three killers of men in the United States, and the second-highest cause of cancer deaths among the entire population, Hassapis said.
During the last 20 years, as the rate of colonoscopies has increased, the death rate from colon cancer has gone down.
Nine out of 10 cases of colon cancer begin as polyps inside the colon - but this doesn’t mean that nine of 10 polyps are cancers, Hassapis cautioned. Only a small number of polyps turn out to be cancers, but the doctor can’t tell by looking at them.
During the colonoscopy, the surgeon removes every polyp he sees, using a loop like a tiny lasso on the end of the scope and a small blade. The polyp is taken out and sent to the pathology lab for analysis, and the site of the polyp is cauterized.
This procedure is done during the colonoscopy. A second procedure is required only in a small number of cases when a polyp is particularly difficult to remove. A minority of polyps are flat, hard to see, and hard to remove. “They drive us crazy,” Hassapis admitted.
Until the development of fiber optics, colonoscopies were miserable for doctors and patients, Hassapis said. Now the scope is much smaller in diameter, more flexible, and the lighting is better.
The procedure is done with the patient under conscious sedation. “That’s like having too much to drink,” Hassapis explained. “The day after the party you ask your friends, ‘Was I dancing on the table?’ And they say, ‘Yeah, you were dancing on the table,’ but you don’t remember dancing on the table.”
The patient is actually awake during the procedure, and the surgeon can talk with him, but the patient rarely remembers any of it. The operating room team often has music playing. One time Hassapis had a patient who was singing along to a Beatles album during the procedure and got all the nurses to sing with him. When Hassapis told him about it later, the patient thought he was lying.
Does the procedure hurt? It feels like gas because the colon is inflated with air to keep its walls visible, Hassapis said, adding, “Whatever gas feels like to you, that’s what it feels like.”
Most people find the colonoscopy preparation, which requires two days of fasting with clear liquids and drinking a gallon of prep mixture to clean out the colon, much more disagreeable than the actual procedure.
The most common prep mixture is polyethylene glycol and salts. “It tastes like sweat,” Hassapis said. “It comes in fruit flavors - cherry, orange, lemon-lime - so it tastes like fruit-flavored sweat.”
For patients who can’t endure this taste, Hassapis offers an alternative that can be mixed with fruit juice, does the job in smaller quantities, and is cheaper. “But there’s no way you’re going to enjoy prep,” he said, “and good prep is important.”
During colonoscopies, many people are found to have diverticulosis, a common condition that causes small “potholes” to form in the colon walls. Digestive waste enters the colon as a liquid and solidifies as it moves lower. The increasing pressure weakens the colon walls, as does straining.
Sometimes the “tics,” as the small pouches are called, become infected, causing pain, fever, and a potentially serious illness, diverticulitis, which requires treatment with antibiotics. Surgery is often recommended for patients with recurrent attacks.
The idea that eating high fiber foods, especially nuts and seeds, causes diverticulitis, is an old wives’ tale, Hassapis said. A high fiber diet actually helps to prevent trouble.
”I’m a great believer in probiotics,” Hassapis said. Probiotics are foods like yogurt with live bacterial cultures or nutritional supplements containing live cultures that increase the number of natural beneficial bacteria to aid digestion in the body. While not yet scientifically established, studies indicate that probiotics help prevent diverticulitis and other gut problems.
”Probiotics are like a big old cloud,” said Hassapis. “The truth is in there, but we don’t know how or why they work.” Everyone is different and many factors play a role, including genetics, diet, and “patterns of poop.... What is the right poop? No one knows. We still don’t know a lot of stuff.”
Hassapis feels he has a mission to help people understand what they need to do to prevent cancer and improve their health. Besides practicing medicine and giving informal talks, he also enjoys going to schools to teach children about health.
Teaching is a two-way street. “I always learn so much from the kids,” he said. “Fifth graders teach me stuff all the time.”
Besides talking about health, Hassapis encourages the students to find something they really like to do and build their careers around that. He also believes that everyone, regardless of age, should take advantage of any opportunity to learn something new.
The most important thing a doctor can do is listen and talk to patients, Hassapis said. “It’s called health care. You have to care - if not, get out,” he said.