34-Year-Old Man With ‘No Family History’ Diagnosed With Colon Cancer After Unusual Fatigue Prompted Doctor Visit: The Symptoms To Know

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Looking back on when his wife was the one to “break the news” to him that he had cancer, he admitted to feeling “more shocked than scared.”

He was declared in remission after six months of chemotherapy.

Expressing his gratitude for the cancer support center — which assisted him through his healing journey — Douglas said, “Being with the other gentlemen is fantastic, because when you say something … I’m fatigued, and I can’t sleep it off … they understand and have walked that path with you.”

Although he’s the youngest in the men’s group he’s a part of, Douglas insisted, “They welcomed me with open arms, which was absolutely fantastic. Everybody’s been absolutely amazing.”

After recounting his surgeon’s powerful words of, ” You’re going to get through this,” Douglas is determined to be an advocate for the disease and help others.

He added, “Being able to show somebody that this can be beaten, and there’s a life after this, is all I would want to do.”

In a recent interview with RUSH Anderson Cancer Center, Douglas offered some insight into the power of support groups, saying, “There are a lot of stigmas about being a big, tough guy.

“You can share or not share, listen or say what you need to say, talk about cancer or pretend you don’t have cancer and talk about a sports game,” he says.

As Douglas has embarked on his treatment and recovery journey, he has also immersed himself in various activities like Tai Chi, yoga, spa programs, exercise classes, and even “sound healing.”

Colon Cancer In Younger Adults

The average age people are diagnosed with colon cancer is 68 for men and 72 for women, according to the American Cancer Society — but the rate at which younger adults are diagnosed has been on the rise. The U.S. Preventive Services Task Force now recommends that adults aged 45 to 75 be screened regularly for colorectal cancer.

The National Cancer Institute reports that since the 1990s, colorectal cancer cases have been rising among adults younger than 50. Research published in CA: A Cancer Journal for Clinicians found that the proportion of cases in people younger than 55 “increased from 11% in 1995 to 20% in 2019.”

Researchers are still trying to determine why younger people are being diagnosed in more significant numbers. Some experts point to risk factors, which include obesity, physical inactivity, and smoking, as a possible explanation for the increase.

“We don’t know for sure why we are seeing earlier onset and death from colon cancer,” Dr. Heather Yeo, a surgical oncologist who specializes in colorectal cancers at Weill Cornell Medicine, told SurvivorNet. “It is likely a combination of factors, including diet and genetics as well as access to care and some environmental factors.”

Understanding Colon Cancer

Colon or colorectal cancer affects your large intestine (colon) or the end of your intestine (rectum).

The cancer starts when abnormal lumps called polyps grow in the colon or rectum. If you don’t have these polyps removed, they can sometimes change into cancer. It takes up to 10 years for a colon polyp to become full-blown cancer, according to SurvivorNet experts.

Looking for Polyps During Colonoscopy

Most colon cancers can be prevented by regular screening. The screening usually involves a colonoscopy, in which a long, thin tube attached to a camera examines the colon and rectum. If no polyps are discovered, the next screening will not be needed for about 10 years.

“We know that colon cancers can be prevented when polyps are found early,” Dr. Yeo explained. “Lowering the screening age helps somewhat with this, but access to care is a real problem.” This is why it’s so important for adults to understand the value in seeking out screening.

A Colonoscopy Explained

A colonoscopy is a procedure doctors use to screen for colon cancer by looking inside your colon.

This procedure requires your colon to be “cleaned out.” To clear out your colon, your doctor will prescribe a “bowel prep,” a liquid you drink the night before the procedure. The prep acts as a laxative that causes you to have multiple loose stools before your procedure.

Once your colon is cleared, the gastroenterologist performing the procedure can have a clear look to evaluate if any polyps or masses are present. Depending on the size and number of polyps found, it may be recommended that patients undergo a repeat colonoscopy within three to five years.

Dr. Zuri Murrell, a colorectal cancer surgeon and Director of the Cedars-Sinai Colorectal Cancer Center, previously explained the colonoscopy procedure to SurvivorNet.

“When we see a polyp, we actually physically take the polyp out through the colonoscope,” he explained. “What does that mean? That means we basically put a wire through with a little bit of a flange at the end, and we pull the polyp out. Now, note there is no pain with that. Inside the colon, there are no pain fibers.”

The advantage of a colonoscopy is that your doctor can remove any polyps found during the test. Many colon cancers can be caught on colonoscopy before they develop or when the polyps are small enough to be removed without surgery.

What Increases Your Risk For Colon Cancer?

Certain factors can increase the changes that someone will develop colon cancer.

For example, risk increases with age. About 90% of cases are in people aged 50 or older, according to the U.S. Centers for Disease Control & Prevention (CDC).

Other risk factors include:

• History of inflammatory bowel disease
• Family history of colorectal cancer
• Genetic mutations
• Lack of exercise
• Diet high in meat
• Being overweight or obese
• Alcohol use
• Tobacco use

How Is Colon Cancer Treated?

There are several treatment paths available for patients with colon cancer. Here, we break down the most common approaches.

Surgery

Surgery is the main treatment for most early-stage colon cancers. The surgeon will remove the part of the colon or rectum where there is cancer, along with a small area of healthy tissue around it. Taking out as much of the cancer as possible is important for improving your outcome.

The surgery may be performed through small incisions (laparoscopy), or through a larger incision. Some people may need to wear a special bag (ostomy) to collect waste after surgery.

Radiation Therapy

This treatment aims high-energy X-rays at the cancer to destroy the abnormal cells. The radiation can come from a machine outside your body, or be placed directly inside your body. Sometimes people get radiation before surgery, to shrink the tumor and make it easier for the surgeon to remove. This is called neoadjuvant radiation.

Chemotherapy

This treatment uses strong medicine to stop cancer cells from dividing, no matter where they are in your body. You may get a combination of chemotherapy drugs as your first treatment. Chemotherapy has been very well studied for colorectal cancer, and it is known to improve survival.

The most common therapy is a combination of chemo drugs called FOLFOX, which includes:

• FOL = leucovorin calcium (folinic acid)
• F = fluorouracil
• OX = oxaliplatin

Your doctor may add medications like irinotecan (FOLFIRI) or cetuximab, depending on how well your tumor shrinks with treatment and other specifics about your particular cancer. For FOLFOX, the medications are given through the vein and require regular doctor visits.

To determine exactly which chemotherapy regimen you get, your doctor will consider your age and how well you might tolerate the side effects of chemotherapy. Gene mutations (for example, BRAF and KRAS) and the location of the primary colon tumor also factor into the decision.

You can also get chemotherapy before colon cancer surgery, which is called neoadjuvant chemotherapy. Getting chemo first helps to shrink the tumor, which can make both the surgery and recovery easier, according to SurvivorNet’s experts. Chemo is also a treatment for cancer that returns after therapy.

Targeted Therapy

This treatment targets substances like proteins or genes that the cancer needs to grow. This makes targeted therapy more precise than chemotherapy, and less likely to damage healthy cells. One example of targeted therapy is bevacizumab (Avastin), which stops the growth of new blood vessels that feed tumors. Another group of targeted therapies are called epidermal growth factor receptor (EGFR) inhibitors, which block the cancer from growing.

Immunotherapy

This treatment makes your own immune system a more efficient cancer fighter. A group of drugs called checkpoint inhibitors, which includes pembrolizumab (Keytruda) and nivolumab (Opdivo), work by preventing cancer cells from hiding from your immune system. Checkpoint inhibitors may extend the amount of time before the cancer spreads.

Dr. Paul Oberstein, on which treatments doctors use to turn stage 4 colon cancer into a chronic but manageable disease

Questions To Ask Your Doctor

If you are facing a colon cancer diagnosis, here are some questions you may ask your doctor.

• What are my treatment options based on my diagnosis?
• If I’m worried about managing the costs of cancer care, who can help me?
• What support services are available to me? To my family?

Contributing: SurvivorNet Staff

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