Unusual Signs of Colon Cancer People Ignore for years
This common form of cancer is often diagnosed in later stages because there may not be many clear symptoms.
LOOKING BACK, THERE were a few vague signs that something was wrong. So says Rick Osterberg, 45, who was declared cancer-free in December 2018 after a long year of aggressive treatment for stage 3 colon cancer. In the summer of 2017, about six months before he was diagnosed, he struggled with constipation while on vacation in London. “It largely resolved when we got home, so I attributed it to travel and unfamiliar food.”
Then, in September 2017, about three months prior to the cancer diagnosis, he had more mild constipation and gastrointestinal cramping. It was bad enough to send him to the doctor, but given that he’d had an “occasionally sensitive stomach for decades,” the discomfort was chalked up to a mild case of irritable bowel syndrome. Osterberg was advised to take fiber supplements, which helped enough that “I considered it resolved.”
But then in December 2017, Osterberg says he developed a low-grade fever – 99.5 degrees Fahrenheit – “and was feeling a bit off.” He went to the doctor and was told, “quite reasonably,” that it was “likely a seasonal virus of some kind that I was fighting off.”
The doctor did bloodwork, which turned up no red flags. “He advised that I come back if things didn’t improve in a couple weeks. They didn’t improve, so I was back two weeks later with symptoms unchanged.” Additional bloodwork showed nothing alarming, he says. Although a test for mononucleosis, a common viral infection that causes low-grade fever and fatigue, came back negative, the doctor still suspected a persistent viral infection. “But he had another instinct that said to rule out bigger things. He said that he was going to order a CT scan so that we could rule out a whole bunch of ‘scary stuff’ if only so that it would make me less anxious about ‘scary stuff,’” Osterberg recalls.
That CT scan, as it happened, turned up something scary. The doctor told Osterberg there was a mass in his sigmoid colon, the part of the large intestine closest to the rectum and anus. He was immediately scheduled for a colonoscopy – a procedure in which a doctor threads a camera into the colon to have a look at what’s inside. The growth was cancerous and had begun to spread, so Osterberg was diagnosed with stage 3 colon cancer, a serious but treatable disease.
How Does Colon Cancer Start?
Colon cancer, also sometimes called colorectal cancer, usually starts out as a noncancerous growth called a polyp inside the inner lining of the colon, also known as the large intestine and a major component of the digestive tract. Together, the colon and the rectum form the large intestine, a long tube that extracts nutrients from mostly digested food and moves waste products to the anus for excretion.
Dr. Sreeram Maddipatla, a medical oncologist/hematologist for the Liver Center and Pancreas Center at Orlando Health UF Health Cancer Center, says polyps naturally occur over time. “These are a small lump of cells that forms on the lining of the colon. Most colon polyps are harmless, but some of them may develop into cancer.” Hyperplastic polyps are benign and don’t usually pose a threat, but are often removed because they can grow and cause obstructions. But another type of polyp, called adenomas or adenomatous polyps, can turn cancerous and need to be removed.
Polyps form for a variety of reasons related to genetics, not eating enough fiber, eating a diet high in red meat and other risk factors. “Over time, certain mutations will happen in the lining of the colon that will form these polyps. It takes five or 10 years for polyps to turn into cancer,” Maddipatla says. Polyps are more common in older adults and when they turn cancerous, they can become deadly.
“Colon cancer is the third most commonly diagnosed cancer in both men and women, says Dr. Emmanouil P. Pappou, a colorectal surgeon at Memorial Sloan Kettering Cancer Center in New York. “It affects roughly about 1 out of 20 people in the United States. We have about 145,000 cases of large intestinal cancer every year and about 50,000 people succumb to this cancer, accounting for roughly 8 percent of all cancer deaths, so it’s a significant issue,” he says.
In the past, colorectal cancer was most often found in older adults, but Pappou says that “over the past few decades, there’s been a rise in this cancer among younger people.” At just 44 years old at the time of diagnosis and a competitive swimmer, Osterberg was one of these younger people. He didn’t fit the typical profile for colon cancer patient, as the disease tends to be more common among older adults who don’t eat healthfully, are overweight or obese and don’t exercise enough.
But Osterberg’s experience regarding a lack of warning signs and specific symptoms of the disease is quite common. Many people diagnosed with colon cancer experience no symptoms, and this is one reason why the disease is often diagnosed in later stages.
“A lot of times you may not have symptoms at all, and if you have them, the most common ones are changes in bowel habits or changes in the consistency of your stool that lasts for more than a few weeks,” Maddipatla says. Such symptoms, as Osterberg experienced, are easily overlooked as being the result of eating something unusual or a bit of indigestion. Most people wouldn’t make the leap to connect a bit of constipation to colon cancer right away.
Pappou lists early signs of colorectal cancer as being:
The problem is that when symptoms are overlooked or incorrectly ascribed to another condition, such as a viral infection or irritable bowel syndrome, that affords the cancer more time to grow, and it can progress to later stages before being detected. The American Cancer Society reports that “only 39 percent of CRC patients are diagnosed with localized-stage disease (the earliest stage that has not spread to nearby tissues) for which the five-year survival rate is 90 percent; survival declines to 71 percent and 14 percent for patients diagnosed with regional and distant stages respectively.”
It’s clear that diagnosing colon cancer early aids in survival, but with so few symptoms noticeable in the early stages, this is a challenging proposition. Enter screening.
Why Is Screening for Colon Cancer Important?
The American Cancer Society recommends starting regular colorectal cancer screening at age 45, a recommendation that Pappou says the ACS recently lowered from age 50 to help address the rise in younger people being diagnosed with this form of cancer. The ACS says adults should continue routine screening through age of 75 if you’re in good health with a life expectancy of more than 10 years. For people aged 75 to 85, your doctor can advise you as to whether continued screening makes sense. People over age 85 are not recommended to continue having regular colorectal cancer screening.
These screening tests can be conducted as a stool-based test that looks for signs of cancer in a person’s stool, or via a colonoscopy or sigmoidoscopy – both visual tests that insert a camera into the colon to look for polyps. Pappou calls colonoscopy “the gold-standard for screening,” and describes it as a “same-day, outpatient procedure. People have to receive a bowel preparation,” which means drinking a powerful laxative solution to clean the bowels so that the doctor can see the internal lining of the colon. That preparation “is usually well tolerated, but it’s usually the most bothersome part of the preparation.” The quality of the test results is dependent on how good a look the doctor can get at the colon, so it’s important to follow orders for readying your colon for a colonoscopy, no matter how unpleasant it might be.
Can I Prevent Colon Cancer?
“The miraculous thing about colonoscopy is that it’s the only test that we have in the 21st century that can prevent you from getting cancer,” Pappou says. “All the other screening tools that we have – mammograms, cervical pap smears and ultrasounds – are good at finding cancer early. But they can’t prevent it. This is the only cancer that we know we can prevent from forming because if the (doctor) finds polyps, they can remove them before they turn into cancer.” Pappou says this has been proven via epidemiological studies. “People who get their polyps removed get far, far less cancer. It works.”
He says it can take 10 years for a polyp to turn cancerous, so colon cancer typically takes a long time to develop. This is why screening, especially at a younger age, can be particularly useful. “I had mine done at age 35, and that’s my personal recommendation. It’s a prophylactic test. We do say an ounce of prevention is worth a pound of cure,” so he recommends getting started early if you can with colorectal screening.
Maddipatla agrees. “I tell my patients to get the screening early.” In particular, people who have a personal history with cancer, colon cancer, polyps or a family history of colon cancer should be screened regularly.
For all patients, Maddipatla says, “I also tell them to follow a healthy diet, which includes fruits, vegetables and whole grains. Also, get enough exercise and maintain weight,” because being obese or overweight has been linked to a higher risk of developing colorectal cancer.
In addition, he says “there are some studies showing that taking a baby aspirin daily could be helpful.” Long-term, low-dose aspirin use has been shown to lower the rate of precancerous colorectal polyps by as much as 50 percent, according to some studies. Aspirin reduces inflammation in the body, which can reduce the chances that genetic mutations will occur that could lead to cancer. Talk to your primary care provider about whether adding a daily aspirin is right for your situation.
Pappou adds that avoiding certain foods and actions can also reduce your risk of developing colon cancer. Specifically, avoid:
Smoking
While screening and making healthy lifestyle choices can help, there’s still a genetic component to colorectal cancer, “but it’s not the answer for everyone. A lot of cases are associated with activity and diet,” Pappou says.
Still, he says “we’re not meant to last forever and some mechanisms are prone to breaking down.” The colon is one part of the body that seems likely to suffer the consequences of age. But he says “the most important thing you can do to prevent cancer is regular physical exercise. Just 30 minutes of walking every day or something low-energy like indoor biking” can make a difference. You don’t have to become a marathon runner or a fitness fool – just incorporating more movement into your daily routine is enough to offer benefits, Pappou says.
Speak Up
Osterberg says he’s grateful he had a relationship with his primary care doctor. “I don't really know what caused my PCP to think we ought to do a CT scan to rule some things out, but at least some of it was probably based on the existing relationship we had," he says. "He’s been my PCP for perhaps 20 years now, and there was probably something about how I was conveying things – perhaps my own gut (pardon the pun) suggesting something was more than a winter virus that caused him to have a bit of an instinct” to run additional tests.
This instinct may well have saved Osterberg’s life. “If, for example, I had gone into an urgent care clinic with the exact same symptoms, I might have been sent away with more of a ‘it’s just a persistent virus’ sort of diagnosis. Then I might have presented in the emergency department several months later with a bowel obstruction from the tumor, and things would have been a lot worse.”
LOOKING BACK, THERE were a few vague signs that something was wrong. So says Rick Osterberg, 45, who was declared cancer-free in December 2018 after a long year of aggressive treatment for stage 3 colon cancer. In the summer of 2017, about six months before he was diagnosed, he struggled with constipation while on vacation in London. “It largely resolved when we got home, so I attributed it to travel and unfamiliar food.”
Then, in September 2017, about three months prior to the cancer diagnosis, he had more mild constipation and gastrointestinal cramping. It was bad enough to send him to the doctor, but given that he’d had an “occasionally sensitive stomach for decades,” the discomfort was chalked up to a mild case of irritable bowel syndrome. Osterberg was advised to take fiber supplements, which helped enough that “I considered it resolved.”
But then in December 2017, Osterberg says he developed a low-grade fever – 99.5 degrees Fahrenheit – “and was feeling a bit off.” He went to the doctor and was told, “quite reasonably,” that it was “likely a seasonal virus of some kind that I was fighting off.”
The doctor did bloodwork, which turned up no red flags. “He advised that I come back if things didn’t improve in a couple weeks. They didn’t improve, so I was back two weeks later with symptoms unchanged.” Additional bloodwork showed nothing alarming, he says. Although a test for mononucleosis, a common viral infection that causes low-grade fever and fatigue, came back negative, the doctor still suspected a persistent viral infection. “But he had another instinct that said to rule out bigger things. He said that he was going to order a CT scan so that we could rule out a whole bunch of ‘scary stuff’ if only so that it would make me less anxious about ‘scary stuff,’” Osterberg recalls.
That CT scan, as it happened, turned up something scary. The doctor told Osterberg there was a mass in his sigmoid colon, the part of the large intestine closest to the rectum and anus. He was immediately scheduled for a colonoscopy – a procedure in which a doctor threads a camera into the colon to have a look at what’s inside. The growth was cancerous and had begun to spread, so Osterberg was diagnosed with stage 3 colon cancer, a serious but treatable disease.
How Does Colon Cancer Start?
Colon cancer, also sometimes called colorectal cancer, usually starts out as a noncancerous growth called a polyp inside the inner lining of the colon, also known as the large intestine and a major component of the digestive tract. Together, the colon and the rectum form the large intestine, a long tube that extracts nutrients from mostly digested food and moves waste products to the anus for excretion.
Dr. Sreeram Maddipatla, a medical oncologist/hematologist for the Liver Center and Pancreas Center at Orlando Health UF Health Cancer Center, says polyps naturally occur over time. “These are a small lump of cells that forms on the lining of the colon. Most colon polyps are harmless, but some of them may develop into cancer.” Hyperplastic polyps are benign and don’t usually pose a threat, but are often removed because they can grow and cause obstructions. But another type of polyp, called adenomas or adenomatous polyps, can turn cancerous and need to be removed.
Polyps form for a variety of reasons related to genetics, not eating enough fiber, eating a diet high in red meat and other risk factors. “Over time, certain mutations will happen in the lining of the colon that will form these polyps. It takes five or 10 years for polyps to turn into cancer,” Maddipatla says. Polyps are more common in older adults and when they turn cancerous, they can become deadly.
“Colon cancer is the third most commonly diagnosed cancer in both men and women, says Dr. Emmanouil P. Pappou, a colorectal surgeon at Memorial Sloan Kettering Cancer Center in New York. “It affects roughly about 1 out of 20 people in the United States. We have about 145,000 cases of large intestinal cancer every year and about 50,000 people succumb to this cancer, accounting for roughly 8 percent of all cancer deaths, so it’s a significant issue,” he says.
In the past, colorectal cancer was most often found in older adults, but Pappou says that “over the past few decades, there’s been a rise in this cancer among younger people.” At just 44 years old at the time of diagnosis and a competitive swimmer, Osterberg was one of these younger people. He didn’t fit the typical profile for colon cancer patient, as the disease tends to be more common among older adults who don’t eat healthfully, are overweight or obese and don’t exercise enough.
But Osterberg’s experience regarding a lack of warning signs and specific symptoms of the disease is quite common. Many people diagnosed with colon cancer experience no symptoms, and this is one reason why the disease is often diagnosed in later stages.
“A lot of times you may not have symptoms at all, and if you have them, the most common ones are changes in bowel habits or changes in the consistency of your stool that lasts for more than a few weeks,” Maddipatla says. Such symptoms, as Osterberg experienced, are easily overlooked as being the result of eating something unusual or a bit of indigestion. Most people wouldn’t make the leap to connect a bit of constipation to colon cancer right away.
Pappou lists early signs of colorectal cancer as being:
- Constipation
- Changes in bowel habits
- Diarrhea
- Blood in stool
- A narrowing or change in girth of the stool
- A feeling of incomplete evacuation
- Cramping pains
- Fatigue
- Unexplained weight loss
The problem is that when symptoms are overlooked or incorrectly ascribed to another condition, such as a viral infection or irritable bowel syndrome, that affords the cancer more time to grow, and it can progress to later stages before being detected. The American Cancer Society reports that “only 39 percent of CRC patients are diagnosed with localized-stage disease (the earliest stage that has not spread to nearby tissues) for which the five-year survival rate is 90 percent; survival declines to 71 percent and 14 percent for patients diagnosed with regional and distant stages respectively.”
It’s clear that diagnosing colon cancer early aids in survival, but with so few symptoms noticeable in the early stages, this is a challenging proposition. Enter screening.
Why Is Screening for Colon Cancer Important?
The American Cancer Society recommends starting regular colorectal cancer screening at age 45, a recommendation that Pappou says the ACS recently lowered from age 50 to help address the rise in younger people being diagnosed with this form of cancer. The ACS says adults should continue routine screening through age of 75 if you’re in good health with a life expectancy of more than 10 years. For people aged 75 to 85, your doctor can advise you as to whether continued screening makes sense. People over age 85 are not recommended to continue having regular colorectal cancer screening.
These screening tests can be conducted as a stool-based test that looks for signs of cancer in a person’s stool, or via a colonoscopy or sigmoidoscopy – both visual tests that insert a camera into the colon to look for polyps. Pappou calls colonoscopy “the gold-standard for screening,” and describes it as a “same-day, outpatient procedure. People have to receive a bowel preparation,” which means drinking a powerful laxative solution to clean the bowels so that the doctor can see the internal lining of the colon. That preparation “is usually well tolerated, but it’s usually the most bothersome part of the preparation.” The quality of the test results is dependent on how good a look the doctor can get at the colon, so it’s important to follow orders for readying your colon for a colonoscopy, no matter how unpleasant it might be.
Can I Prevent Colon Cancer?
“The miraculous thing about colonoscopy is that it’s the only test that we have in the 21st century that can prevent you from getting cancer,” Pappou says. “All the other screening tools that we have – mammograms, cervical pap smears and ultrasounds – are good at finding cancer early. But they can’t prevent it. This is the only cancer that we know we can prevent from forming because if the (doctor) finds polyps, they can remove them before they turn into cancer.” Pappou says this has been proven via epidemiological studies. “People who get their polyps removed get far, far less cancer. It works.”
He says it can take 10 years for a polyp to turn cancerous, so colon cancer typically takes a long time to develop. This is why screening, especially at a younger age, can be particularly useful. “I had mine done at age 35, and that’s my personal recommendation. It’s a prophylactic test. We do say an ounce of prevention is worth a pound of cure,” so he recommends getting started early if you can with colorectal screening.
Maddipatla agrees. “I tell my patients to get the screening early.” In particular, people who have a personal history with cancer, colon cancer, polyps or a family history of colon cancer should be screened regularly.
For all patients, Maddipatla says, “I also tell them to follow a healthy diet, which includes fruits, vegetables and whole grains. Also, get enough exercise and maintain weight,” because being obese or overweight has been linked to a higher risk of developing colorectal cancer.
In addition, he says “there are some studies showing that taking a baby aspirin daily could be helpful.” Long-term, low-dose aspirin use has been shown to lower the rate of precancerous colorectal polyps by as much as 50 percent, according to some studies. Aspirin reduces inflammation in the body, which can reduce the chances that genetic mutations will occur that could lead to cancer. Talk to your primary care provider about whether adding a daily aspirin is right for your situation.
Pappou adds that avoiding certain foods and actions can also reduce your risk of developing colon cancer. Specifically, avoid:
Smoking
- Drinking excessive amounts of alcohol
- Eating excessive amounts of red meat
- Consuming excessive amounts of calories
- Drinking sugary and carbonated drinks
While screening and making healthy lifestyle choices can help, there’s still a genetic component to colorectal cancer, “but it’s not the answer for everyone. A lot of cases are associated with activity and diet,” Pappou says.
Still, he says “we’re not meant to last forever and some mechanisms are prone to breaking down.” The colon is one part of the body that seems likely to suffer the consequences of age. But he says “the most important thing you can do to prevent cancer is regular physical exercise. Just 30 minutes of walking every day or something low-energy like indoor biking” can make a difference. You don’t have to become a marathon runner or a fitness fool – just incorporating more movement into your daily routine is enough to offer benefits, Pappou says.
Speak Up
Osterberg says he’s grateful he had a relationship with his primary care doctor. “I don't really know what caused my PCP to think we ought to do a CT scan to rule some things out, but at least some of it was probably based on the existing relationship we had," he says. "He’s been my PCP for perhaps 20 years now, and there was probably something about how I was conveying things – perhaps my own gut (pardon the pun) suggesting something was more than a winter virus that caused him to have a bit of an instinct” to run additional tests.
This instinct may well have saved Osterberg’s life. “If, for example, I had gone into an urgent care clinic with the exact same symptoms, I might have been sent away with more of a ‘it’s just a persistent virus’ sort of diagnosis. Then I might have presented in the emergency department several months later with a bowel obstruction from the tumor, and things would have been a lot worse.”
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