The case of the airman with colon cancer

January 6, 2014

pps
Warren Silberman

Warren Silberman

  • Former Manager, FAA Aerospace Medical Certification 
  • Doctor of Osteopathic Medicine 
  • Expert in Aerospace/Preventive Medicine 
  • Pilot since 1986

I am sure you have all been reading the great articles by my associate and friend, Dr. Jonathan Sackier. You should then know how important it is to get regular colon cancer screenings when you reach the age of 50.   

Third-class airman Bubba Joe Snuffy happened to have a family history of colon cancer in his Aunt Beatrice. He was very much into taking care of himself, since he loved flying so much and wanted to maximize his time in the cockpit. So he got regular check-ups and made sure that he obtained all the recommended preventive tests that his physicians recommended. When he turned 50, he got a colonoscopy, which is a test where a specialist inserts a flexible black tube that has a camera on the end into your rectum, usually under an intravenous anesthetic, and passes this "scope" through your entire colon to look for tumors.

To continue reading, please log in or join AOPA now to have access to these exclusive expert resources.

Unfortunately, they discovered a large tumor in the right side of his colon. The gastroenterologist (an internist who took a fellowship in the study of diseases of the esophagus, stomach, and small and large intestines) sent him to a surgeon who performed an exploratory surgery and removed the right side of his colon. In the pathology specimens, the pathologist noted that the tumor had spread into several lymph nodes just outside the tissue of the bowel. 

He had an uneventful recovery and wanted to return to his flying. Fortunately for him, he had heard Sackier and myself speak at AOPA Aviation Summit and joined the Pilot Protection Service's Plus program earlier that same year.   

He called the Medical Certification staff at AOPA, and they told him that for his particular problem, in order to present his case to the FAA for consideration of a special issuance, he would need the following documents, evaluations, and testing: 

  • history, physical examination, and discharge summaries from the hospitalization for his colon surgery;
  • report from the original colonoscopy and pathology report from the specimen that was taken;
  • operative report from the colon tumor removal;
  • pathology report from the colon tumor surgery;
  • carcinoembryonic antigen test by the gastroenterologist, if it was performed (CEA, or carcinoembryonic antigen, is known  as a tumor marker and is elevated above normal range in colon cancers. It is a way that the physician can follow a person for recurrence of cancer.);
  • results of a current evaluation by the the treating physician that addresses how he has been doing since his surgery; 
  • results of a complete blood count (CBC) (Many times cancers such as the one he had can leak blood and lower one's count. A low blood count reduces one's ability to carry oxygen in the blood and this would make one more prone to hypoxia, or low oxygen levels, while flying.);
  • since a small number of bowel cancers that have spread to the local lymph glands can also spread to the brain, the FAA requires airmen with such spread to have an MRI of the brain.   

This pilot listened to the certification people and ultimately received a third-class special issuance.   

Dr. Warren Silberman is the former manager of FAA Aerospace Medical Certification and a doctor of osteopathic medicine. A pilot since 1986, he is recognized nationally as an expert in aerospace/preventive medicine, and is a regular writer for AOPA’s Pilot Protection Services.