Understanding Rectal Cancer
- At 42, Shannon Ivey, a single mother from South Carolina, discovered she had Stage 3 rectal cancer after ignoring early symptoms such as unexplained bleeding, unusually thin stools, and frequent but unproductive bathroom urges.
- Now, almost a decade later, Ivey is cancer-free and shares her story in her book “Welcome to the Sh*t Show” to inspire others to listen to their bodies and speak up for their care.
- Rectal cancer, colon cancer, and colorectal cancer, are typically detected via colonoscopy, which looks for polyps (small growths) in the colon.
- Colon cancer is highly treatable and curable when detected early. Screening options include at-home tests like Cologuard, though medical experts recommend a colonoscopy for more effective detection.
- Colorectal screenings are generally advised starting at age 45, but individuals with higher risk factors, such as a family history of colon cancer, may need earlier testing. Consulting a doctor about screening options is recommended.
Ivey, who believed the symptoms might be related to the digestive issues she had dealt with for most of her life, which also run in her family, shared her story with TODAY.com in hopes to further spread awareness of the disease.
Read MoreIvey added, “In the end, you have to believe that being alive is worth it, worth it enough to be uncomfortable in advocating for what you need from the medical system.”
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Ivey explained that since several women in her family had experienced perimenopause at a younger age, she initially believed the “mystery blood” on her underwear was merely a sign of her periods starting to change.
And when her digestive problems worsened, she started using a toilet stool to aid her bowel movements and increased her fiber intake.
However, what ultimately alarmed her was when she noticed an unintentional weight loss of 26 pounds.
Ivey, who has a daughter, said she lost the weight in just six months. She noted that she decided to weigh herself after someone commented that she’d lost weight.
“I knew that I was very sick when I saw that number,” she recounted to TODAY.com
After her diagnosis, Ivey underwent a grueling course of treatment, including 28 radiation sessions, oral chemotherapy, surgery to remove the tumor, and a second round of chemotherapy, which also led to significant weight loss.
We’re delighted to hear how Ivey is doing well with no evidence of disease since undergoing treatment, and using her “Welcome to the Sh*t Show” book to encourage others to get checked.
A description of her new book reads, “A clear-eyed account of one woman’s fight to survive late-stage colorectal cancer. As a single working parent, the last thing on Shannon Ivey’s mind in 2016 was her own health. Then she was diagnosed with late–stage III colorectal cancer and given a 40 percent chance of being alive in five years.
“Shannon discovered that she was part of a trend of younger people and more women receiving the diagnosis: By 2030, colorectal cancer is projected to be the No. 1 cancer killer for people ages 20 to 49. Shannon had entered a terrifying new reality, navigating a medical system ill-equipped to recognize her unique circumstances.”
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The Difference Between Colon and Rectal Cancer
Both colon cancers and rectal cancers affect the large intestine, so the symptoms, screening tools, prevention, risk factors, and diagnosis are the same for both. The treatment, however, could be different.
The rectum is the final part of the colon; it is about 6 inches long, and its main function is to store stool until a bowel movement can be made. A cancer of the colon can start anywhere in the colon, which is about five feet long and absorbs water from stool.
“Any cancer of the rectum, we treat a little bit differently than cancer of the colon, for the reason that because it sits in the pelvis, which is essentially a bony ice cream cone, it makes any surgery in this area much more challenging,” Dr. Kyle Cologne, a professor of clinical surgery at the Keck School of Medicine at USC, told SurvivorNet.
“This is also why for rectal cancer we may use, much more so than colon cancer, things like chemotherapy, potentially even before surgery, radiation, and these all are part of your diagnosis that your surgeon should talk to you about,” Dr. Cologne added.
Video: Co-founder of the Anal Cancer Foundation Justine Almada discusses stigma and the future of the disease.
Where the cancer is located (whether it is in the colon or rectum) is important because the rectum does not have the same protective outer layer (called the serosa) as the colon, so it may be easier for a tumor to break through and begin to spread locally in the body. This also means that rectal cancer is more likely to recur after treatment compared to colon cancer.
“With rectal cancers, they come in all shapes and sizes,” Dr. Cologne said.
“I like to tell patients is, it’s like buying a house. It’s all about location. So, tumors that are in the upper rectum are much easier to treat than tumors in the lower rectum,” Dr. Cologne continued.
Navigating Life After Treatment
If patients have not experienced too many complications from their treatment, “they are often able to go back to many of the same things that they did before they had their diagnosis of cancer and are able to live full and complete lives,” Dr. Michael Jain, medical oncologist at Moffitt Cancer Center, previously told SurvivorNet.
So what’s next after successful treatment? “At that point we often focus on the survivorship issues that they may have, preventing second cancers, and properly following them,” Dr. Jain says.
A survivorship plan will include a schedule for follow-up exams and tests, plus a schedule for tests to check for any long-term health impacts from your cancer or treatment, and screening for any new cancers.
Your doctor will likely tell you what to look out for in terms of side effects that could show up late or over the long term. Your care team will provide you with diet and physical activity recommendations as part of your survivorship plan.
Moving On From Treatment
It’s natural to feel continuing mental health effects, such as depression and anxiety, even after your treatment ends. This is where you can benefit from a supportive community. Look to strengthen your relationships with friends and family, faith groups, support groups, and mental health professionals to buoy you as you move on from treatment.
In addition to caring for their mental health, people who finish treatment and are in complete remission will want to move on from cancer with a physically healthy lifestyle. Eating nutritious foods, exercising regularly, staying at a healthy weight, and not smoking are all lifestyle practices that generally contribute to a healthy quality of life.
Indeed, the cancer and its treatment might naturally point survivors in the direction of such practices. “Mostly [we’re] trying to maximize the quality of life that people have, because once you have a cancer diagnosis, I think it is an important time in someone’s life where they can take stock and really understand what’s important,” Dr. Jain says.
Understanding Colon Cancer
Colorectal cancer happens when polyps are not removed and become cancerous. It can take up to 10 years for a colon polyp to become cancerous, according to SurvivorNet experts.
“We know that colon cancers can be prevented when polyps are found early,” Dr. Heather Yeo, a surgical oncologist who specializes in colorectal cancers at Weill Cornell Medicine, told SurvivorNet.
“Lowering the screening age helps somewhat with this, but access to care is a real problem,” Dr. Yeo added.
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. So, there’s no pain.”
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.
Looking for Polyps During Colonoscopy
The American Gastrointestinal Association lowered the recommended initial age for a colorectal screening from 50 to 45.
The U.S. Preventive Services Task Force recommends guidelines that state colon cancer screenings should begin at 45 years old. This is in response to the increase we see in colon cancer diagnoses in younger adults.
However, many insurance companies still do not cover the cost of screenings for those under 50. In the past, the disease had predominantly been found in adults 50 years or older, but for those predisposed to getting it at a younger age, these new guidelines could help catch it earlier.
Colon Cancer: A Silent Killer
Dr. Heather Yeo, a colorectal surgeon and surgical oncologist at Weill Cornell Medicine and New York-Presbyterian, previously told SurvivorNet, “Colon cancer is considered a silent and deadly killer.
RELATED: How Does a Colon Polyp Turn Into Cancer?
“What happens is people often don’t know that they have colon cancer. They don’t have any symptoms. That’s why we screen for colon cancer in the United States.”
The Rate of Colon Cancer is Increasing in Those Under 50
“You should be screened for colon cancer, even if you have no family history. Once you have your initial screening colonoscopy, if there are no polyps and you have no high-risk factors, usually once every 10 years is fine,” she advises.
“Colon cancer is a slowly progressing cancer. If you have any family history of colon cancer, you should be screened about 10 years before your family member had colon cancer. So if you have a family member that was 53, you should be screened at 43.”
Dr. Paul Oberstein Explains Common Colon Cancer Symptoms
What Increases Your Risk for Developing Colon Cancer?
For some people, certain risk factors can influence their risk of getting colon cancer. They include the following:
- Are older. About 90% of cases are in people aged 50 or older, according to the U.S. Centers for Disease Control & Prevention (CDC). Yet it is possible to get this cancer earlier in life.
- Have inflammatory bowel disease. Crohn’s disease or ulcerative colitis can, over time, cause cells in your intestines to turn cancerous.
- Have a family history of this cancer. Just under one-third of people who get colon cancer have family members with the disease.
- Have a gene mutation. About 5% of colorectal cancers are caused by an inherited genetic mutation that causes syndromes such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (Lynch syndrome).
- Don’t exercise very often. Staying active can lower your risk.
- Eat a diet that’s high in meat. Regularly eating red meats like burgers and steaks, and processed meats such as hot dogs and bacon might put you at higher risk. Eating more fruits, vegetables, and whole grains instead might lower your risk.
- You are overweight or obese. Having too much weight increases your risk of both getting colon cancer and dying from it.
- Drink a lot of alcohol. Limiting alcohol to one drink daily for women and two drinks daily for men could help lower your risk.
- Use tobacco. Long-term smokers are more likely to get this cancer than nonsmokers.
Which Treatments are Best for You?
It’s important to understand that your doctor has many ways to treat colon cancer, depending on what stage the cancer is, including:
- Surgery
- Radiation therapy
- Chemotherapy
- Targeted therapy
- Immunotherapy
Surgery
Surgery is the main treatment for most early-stage colon cancers, according to the doctors SurvivorNet spoke with. 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 wastes 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:
- 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
Contributing: SurvivorNet Staff
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