Four Polyps Removed From Reagan’s Colon

Doctors removed four polyps from President Reagan’s colon on Sunday during a routine examination for a recurrence of the cancer that was detected and removed 18 months ago, the White House said.

The polyps appeared non-cancerous, according to a statement issued by Army Col. John Hutton, the White House physician. He said they were similar to growths found during previous examinations, and that there was no sign of new malignancies.

The President, who will be 76 years old next month, entered Bethesda Naval Medical Center Sunday for the colonoscopic examination and surgery today to relieve discomfort caused by an enlarged prostate gland.

Only Two Millimeters

“Four small, scattered benign-appearing polyps were found and removed,” Hutton said. He said the growths were no greater than two millimeters, or less than one-tenth of an inch.

Discovery of additional polyps is not considered unusual, and polyps of the size that have been found in the President are not likely to be cancerous.

Hutton said the polyps would be examined under the microscope to determine if they are malignant, and the results would be available today. A polyp in the colon is a growth of tissue from the intestinal wall into the normally hollow area through which wastes pass. Reagan, leaving the White House Sunday morning for the short helicopter ride to Bethesda, Md., a Washington suburb, said he felt “fine, great.” After the procedure, Hutton said Reagan “feels good and immediately began reading briefing papers.”

The colonoscopy was conducted by Dr. Robert W. Beart Jr., a colon and rectal surgeon at the Mayo Clinic of Rochester, Minn. He is part of a team of physicians flown to Washington from Minnesota. They brought specialized equipment with them for today’s surgery. Previous examinations and surgery had been conducted by Navy doctors or, in the case of his cancer surgery, by physicians on the staff of the National Cancer Institute as well.

Similar examinations of the President’s colon have been conducted since he underwent the colon cancer surgery on July 13, 1985. On Jan. 17, 1986, three “very small” polyps were removed and were determined to be “clinically benign.” Last June 20, two small polyps were removed, and were also found to be benign. Such routine checkups are to be carried out every six months for the rest of the President’s life.

Cells Removed From Nose

In addition, cancerous cells were twice removed from the President’s nose in 1985.

In the colonoscopy, a lighted tube is inserted into the lower intestine to search for potentially cancerous polyps or evidence of a tumor. It was this uncomfortable procedure that detected the nearly two-inch cancer that was removed in 1985.

Dr. David F. Altman, director of the gastrointestinal clinic at the UC Medical Center in San Francisco, has said that chances for malignancy in polyps one to two millimeters in size are “infinitesimally small,” and that new polyps “have a period of four to six years before they grow to the size of substantial cancer risk.”

In addition to the colonoscopy, Reagan underwent a cardiovascular examination, including a stress test, chest X-rays and a pulmonary function test, which measures the performance of the lungs.

“All were normal,” said Hutton, recently appointed to his post as physician to the President.

Nancy Reagan at Hospital

Nancy Reagan, the President’s wife, accompanied her husband to the hospital and planned to remain there overnight.

Today’s prostate surgery, which is expected to keep the President hospitalized for several days, is one of the most common operations performed on older men. It is designed to relieve the difficulty and discomfort in urinating that the President has experienced recently because of his enlarged prostate gland.

During the operation, which is expected to last about one hour, urologists Dr. David C. Utz of the Mayo Clinic and Dr. John Randolph Beahrs of St. Paul, Minn., will widen Reagan’s urinary t1918985076prostate tissue. It is expected that an anesthetic administered around the spine will be used, and that Reagan will be awake during the procedure.

Patients undergoing this procedure are usually able to resume eating the night after their operation and begin to walk around the next day, according to Dr. Jean de Kernion, chairman of the department of urology at the UCLA Medical Center. Patients can usually leave the hospital after three to four days.

The prostate gland, which is present in men but not in women, produces some of the fluid contained in semen. Enlargement of the gland under the influence of male sexual hormones is almost a universal phenomenon in aging men, according to Dr. Patrick C. Walsh of the Johns Hopkins University Medical Center.

Gland Surrounds Urethra

Symptoms, such as frequent or incomplete urination and even total inability to urinate, may result because the walnut-sized gland completely surrounds the urethra, the channel through which the bladder voids. But surgery is reserved for the more severe cases; many patients who receive no treatment at all will have no change in their symptoms over many years.

The procedure usually performed to remedy these symptoms--and the one Reagan will undergo--is called a transurethral prostatectomy. Because it is performed through the urethra, a skin incision is not necessary.

The excess prostate tissue is cut away using an instrument called a resectoscope, a tube with a fiber-optic light source. An electric current is commonly used to both remove the tissue with a wire loop and to stop bleeding.

Throughout the operation, gallons of fluid will flow through the tube, to cleanse the urethra and maintain the surgeon’s vision. After the surgery, a tube called a catheter is left in the urethra for several days to drain the bladder and monitor for continued bleeding.

Specimens of Reagan’s prostate will be examined under the microscope for signs of cancer, a standard procedure following operations in which tissue is removed from the body.

Complications of the surgery occur infrequently, according to De Kernion. They include continued bleeding, infection, loss of the ability to control urination and blockage of the urethra by scar tissue. As a consequence of the operation, the sperm is usually ejaculated during sexual climax into the bladder rather than the penis, he said, but impotence rarely results.

Underwent Similar Surgery

The procedure is similar to an operation the President underwent in 1967 at St. John’s Hospital in Santa Monica, while governor of California. Over a period of decades, it is “not uncommon at all” for the prostate gland to continue to enlarge, De Kernion said, making a second operation necessary.

In an interview during the NBC broadcast of the Fiesta Bowl football game Friday night, Reagan predicted that the procedure would be “a breeze.”

The White House made public only limited information about Sunday’s procedure, and said that only official spokesmen would be allowed to issue such information.