It pays to be an advocate for your own health. Diagnosed with colorectal cancer at just 26, underscoring a troubling trend - Kyle McEwen Show Determined to find answers, McEwen made an appointment with Michael Albertson, MD, a UCLA gastroenterologist who ordered a colonoscopy, a procedure that’s rare for a patient so young. It turned out that McEwen had an adenocarcinoma – a malignant tumor in his rectum. “Even I could look at the images and tell that something wasn’t right,” he said. “There was this black object that obviously did not belong there.” McEwen’s diagnosis underscored a trend that doctors have been tracking in recent years: More younger people are developing colorectal cancer. The problem has become so pronounced that the U.S. Preventive Services Task Force in 2021 lowered the recommended age for colorectal cancer screenings to 45. The American Cancer Society estimates there will be 106,180 new cases of colon cancer and 44,850 new cases of rectal cancer in the U.S. in 2022. McEwen is now undergoing treatment from a multidisciplinary team at UCLA Health. Following radiation, chemotherapy and surgery, he’s optimistic that he can win the battle against colorectal cancer and look forward to a healthy future. "I’m definitely glad that I pushed for my own health, when something just didn't feel right," he said. "It has been an awful lot to go through, that's for sure. But I am one of the lucky ones, and I feel really grateful to have had a whole team that was so dedicated to immediately taking care of this for me." For such a serious condition, it takes a team of physicians to execute the best possible treatment, said UCLA's Kevork Kazanjian, MD, a colorectal surgery specialist treating McEwen. "Obviously, the dramatic aspect that really stands out in Kyle's case of colorectal cancer is his young age," Dr. Kazanjian said. Doctors such as Kazanjian are searching for an explanation as to why cases are on the increase among younger people. "Our traditional thought that colorectal cancers only afflict older patients is just not the case anymore," Kazanjian said. "What we do know is that these cancers really don't care how young or old you are. Kyle is pretty much on the extreme younger end of this phenomenon.” That added to the shock McEwen felt when he initially was diagnosed. Stunned by the news "It rocked my world,” he said. “When you are young, you just don’t think that something this serious is going to happen to you. It definitely makes you feel your mortality, and my imagination kind of ran wild with all of the disturbing possibilities.” His parents were also stunned. “There was a really long and awkward silence because they did not know what to say,” McEwen said. “When I got home that day and told my husband, I just started crying because I had no idea what was going to happen with all of this,” he said. “But he helped me get through it every step of the way. Support from your family and friends is so priceless." The treatment McEwen began his treatment at UCLA Health in 2021. One advantage of his age was that he could tolerate treatment better than many older patients. "They basically compressed a month of radiation treatments into five days for me," he said. Ann C. Raldow, MD, a member of the Jonsson Comprehensive Cancer Center and the gastrointestinal radiation oncologist who treated McEwen, said his treatment program involved three phases. The first two phases consisted of radiation and then chemotherapy, to shrink the tumor and pave the way for the third phase of surgery to successfully remove it. Though McEwen dreaded the side effects of radiation and chemotherapy, he was impressed with how quickly and effectively his treatments progressed. "The doctors told me I would just have to fight through it so we could kill the cancer, so that’s what I did.,” he said. Dr. Raldow said radiation treatments have become increasingly refined in recent years to minimize the negative impacts on the patient’s health while improving the focus on killing cancer cells. "The radiation itself is very targeted, so that we can radiate the cancer and spare the healthy tissue," Dr. Raldow said. "This technology is constantly advancing." Sidharth R. Anand, MD, a member of the Jonsson Comprehensive Cancer Center, was the gastrointestinal medical oncologist who treated McEwen. He said the doctors were pleased with the outcome. "Kyle tolerated his treatment, called ‘Total Neoadjuvant Therapy,’ well,” Dr. Anand said. “Though he had a lot of anxiety around his diagnosis and treatment, he demonstrated remarkable courage throughout. We also involved our Simms Mann integrative oncology team in his care as part of a whole team effort.” The next step for McEwen will be another surgery to reconnect his plumbing from the ileostomy, an opening doctors made in his abdominal wall to drain intestinal wastes. "Surprisingly, that part was not as bad to deal with as I thought it would be," McEwen said of the ileostomy. "I was not looking forward to it, but it really hasn't been a problem. Of course, I am looking forward to the reattachment surgery and being done with all that." Dr. Anand said he will then monitor his patient for five years, and "extremely closely for two to three years,” watching for any signs of cancer returning. He will use lab tests such as tumor markers and CT scans, as well as a relatively new technology called circulating tumor DNA (ctDNA). The teamwork of physicians involved in McEwen's treatment is typical of the multidisciplinary approach UCLA uses to treat cancer patients, Dr. Kazanjian said. "Often the process will involve physicians that the patient never sees, but who are involved in the diagnosis and treatment that we pursue for the best outcome for the patient," he said. He said he tells patients to think long-term about beating their cancer and for future prevention, especially recommending healthier diet choices and exercise. "We try to tell them that the process of treatment is a marathon, not a sprint," Dr. Kazanjian said. "It's a journey, a multi-step process, where you don't just go in and get one thing fixed and you're done." Dr. Anand, Dr. Raldow and Dr. Kazanjian all recommend the "Mediterranean diet," with more fresh vegetables, and less meat and processed foods than typically found in the American diet. Advocate for yourself Dr. Kazanjian encourages patients to be assertive, like McEwen was, insisting that they get answers from their doctors.“ It pays to be your own advocate, when you know that something just does not feel right with your health,” he said. McEwen recommends that everyone, regardless of age, lean toward finding out the cause of any pain or other symptoms – and seek help from medical professionals. “When I first started researching my symptoms, Google became my best friend and worst enemy,” he said. “I imagined all kinds of diseases, especially anything that any family members had gone through. But honestly, it’s very hard to diagnose yourself. It is better to have really good doctors help you to figure out the problem.” Despite the ordeal of the treatment that was to come, McEwen said that after his cancer diagnosis sunk in, he could find some calm in knowing that the root of his pain could be addressed medically and that eventually he would find relief. "Yeah, it's scary to think about having a serious medical issue, but it's always better to find out and know what it is than to be left in the dark," he said. "What I found out is that the technology has come so far, and the treatments for cancer are so amazing, that it might not be as bad as your worst fears.” Laker for a Day- Marisa Peters Meet Marisa Peters, wife and mother of 3, and Head of People at a new tech start-up - VideoAmp. Over a year ago, Marisa was diagnosed with stage 3 colorectal cancer following a checkup related to other health complications. With the support of her family, her organization and UCLA Health, Marisa is on her way to living her best life. Thank you for being an inspiration to us all! Devin Dillon is the perfect example of why colorectal cancer screenings are now recommended beginning at age 45 In the first three months of 2022, Devin Dillon underwent her first colonoscopy at UCLA Health, found out she had colon cancer and learned after surgery that she was cured. Dillon, 48, credits her early diagnosis and excellent outcome to the expanded eligibility for colon cancer screening adopted last year. Guidelines in the U.S. now recommend an initial colonoscopy at age 45 instead of 50. “I’m sort of the reason they now have the screening earlier,” she said. “It’s because younger people between 45 and 50 are developing colon cancer and may not have any symptoms or risk factors.” That was the case for Dillon, superintendent of PreK-12 Operations for UCLA. “I don’t have any family history of it,” she said. “I don’t have any of the pre-indicators. I’m not overweight. I work out every day. I try to eat really healthy. I’m not a smoker. I don’t drink. I do CrossFit.” When Dillon had her annual physical in October 2021, her UCLA Health primary care physician explained that she was now eligible for colon cancer screening. “I hadn’t really thought about it,” she said. “I’ve always kept up with mammograms and that sort of thing. It wasn’t in my awareness.” Last May, the U.S. Preventive Services Task Force issued a new recommendation that colon cancer screening for people at average risk should start at age 45. Colon cancer is the third leading cause of cancer death in men and women. A family history of colon cancer as well as obesity, diabetes, smoking and heavy alcohol use are risk factors. Rates of colon cancer are higher among the Black and Native American populations. Dillon’s doctor told her she could opt for an annual stool sample test to look for blood or undergo a colonoscopy for the first time. If the stool sample finds blood, patients need to follow up with a colonoscopy. “I just thought that I would do the colonoscopy because it sounded like if you went in and had a negative result, it would be good for 10 years and that sounded better to me than having to do something every year,” Dillon said. Dillon scheduled a colonoscopy for early January with Adrienne Lenhart, MD, a UCLA Health gastroenterologist based in Torrance. Dr. Lenhart said the aim of the revised guidelines was to catch more cancers at an earlier stage and to help prevent early onset colon cancer. “Our primary goal with screening colonoscopies is to prevent the development of colon cancers as well as deaths from colon cancer,” Dr. Lenhart said. “If we detect colon polyps, which are benign, precancerous growths in the colon, we can remove them during the colonoscopy and prevent colon cancer from developing. Screening colonoscopies can also help identify colon cancers at the earlier stage where treatment is more favorable and potentially curable.” During Dillon’s procedure, Dr. Lenhart removed 10 small polyps, which all turned out to be benign. She also found a larger growth, which needed to be removed two weeks later by a different specialist, in a procedure called endoscopic submucosal dissection (ESD). The biopsy results came back showing cancer. “To find out I had cancer was really surprising and just shocking,” she said. “I felt really good going into the colonoscopy,” she said before her March surgery. “I feel really good now. I don’t have any symptoms. I don’t feel sick. I feel perfectly fine.” As colon cancer advances, Dr. Lenhart said, symptoms may include gastrointestinal bleeding, bowel obstruction, nausea, weight loss and constipation or diarrhea. “Polyps and early cancer can often be asymptomatic,” she said. “The point is to be able to detect things early. Not all patients are going to have GI symptoms.” Dillon underwent a laparoscopic partial colectomy in early March to remove 12 inches of her colon as well as 48 lymph nodes to see if the cancer had spread. Her surgeon, Dr. Jonathan C. King, surgical oncology, made the incision at the site of her old Caesarean section scar, plus two additional incisions. She spent four days at UCLA Santa Monica Medical Center. “I had really amazing care,” she said. “I just really appreciate the care the doctors, nurses and nursing assistants gave to me in that time.” Waiting for the pathology results was really difficult, she said. “You’re sort of preparing yourself for the worst-case scenario or needing additional treatment or surgery or chemo or radiation,” she said. “You go through all the different scenarios in your mind.” Two weeks later, she found out that she was cancer-free and needed no further treatment. “Just hearing the news was such a big relief,” Dillon said. “I just feel relieved and also grateful that I do have such good medical care and that I took the time to do the screening.” Dr. Lenhart said she can’t say for sure what would have happened if Dillon had waited until age 50 for an initial colonoscopy. But she said based on the progression of colon cancer, a delay could have resulted in symptoms or the cancer could have spread elsewhere. “Since we detected her cancer very early, there was no evidence of metastasis or spread,” she said. “The cancer was able to be completely removed with the surgery and that may not have been the case.” Dr. Lenhart said Dillon will need another colonoscopy in a year. If everything looks good, she would have another in three years and then at five-year intervals. “If we keep up with surveillance guidelines, I think the overall likelihood of recurrence is low,” Dr. Lenhart said. Dillon, who will return to work April 4, said the experience of going from not knowing she had cancer to survivorship has been a whirlwind. As she shares her experience, she said she hopes others will get colonoscopies starting at 45. “You just don’t know until you have the screening done,” she said. “If you’re fine, you don’t have to do it again for 10 years. Even if you might feel great on the outside, you don’t really know what’s going on inside your body until you get this done.” UCLA Health patient overcame her fears to get screened for colon cancer - Gloria Riley
At 35, her then-doctor recommended early colorectal screening. “My doctor was saying that as Black people, particularly as a Black woman, those tests were not designed with us in mind and so we likely needed to [be screened] sooner,” Riley recalls. “In fact, he told me that he knew of a young lady who was around my age who had colon cancer and died. But I still didn't do anything.” Colorectal cancer is the third-leading cause of cancer-related deaths. Compared to white people, Black people have a 20% higher incidence of colorectal cancer, are more likely to develop it at a younger age and be diagnosed further along in their illness. This disparity is due to systemic racism in healthcare, social determinants of health including housing, income and access to food, medical co-morbidities, access and utilization of health insurance, and more. Riley began seeing Dr. Mafi in 2016, when she was 50 years old. In the past, 50 was the recommended age to begin colonoscopy screening. New guidelines issued in 2020 have updated the age to 45. Riley shared with Dr. Mafi her fears of experiencing a loss of control from being sedated. “Gloria was very rationally worried about potential complications of the colonoscopy itself because it is an invasive procedure,” Dr. Mafi says, “Many patients have different reasons for their hesitancy. You have to really try to understand the root cause.” Dr. Mafi also highlighted the importance of trust-building. “Developing trust is not easy and takes time,” he says. “It’s not something you can earn through words only, either. Our actions play an important role.” For four years, Dr. Mafi brought up the importance of colorectal cancer screening with Riley. He made himself available to her and shared statistics and data with her. “I knew it could happen to me, but fear had a strong hold on me to where I didn’t follow through” Riley says. Then in 2020, something “just clicked,” she says. Dr. Mafi’s patience and urging helped Riley feel reassured and she trusted his medical advice. “I got to the point where I was afraid, but I knew I was going to go through with it anyway. I trusted my doctors.” Gastroenterologist Wendy Ho, MD, prescribed Riley the laxative preparation drink and explained the procedure in detail beforehand, which helped assuage Riley’s fears, she says. On the day of the procedure, Riley asked the nurses to hold her hand. “The anesthesiologist counted with me and the next thing I remember I was waking up,” she recalls. In that moment, Riley felt proud of herself. She was eager to let Dr. Mafi know she finally followed through with the procedure and to thank him for encouraging her to have it, providing medical data on the importance and for being so patient with her – answering all of her questions leading up to it. “I truly cannot thank him enough,” Riley says. She had put the screening off for nearly 15 years and she was finally on the other side of it. Next came the bad news: She had a large cancerous polyp that was removed during the screening. When Dr. Mafi received a notification that Riley had undergone the procedure, he knew what a big deal this was for her and sent her a note to ask how she was feeling. “She wrote back right away and mentioned she was appreciative of my urging because they did end up finding a high-risk adenoma (polyp),” Dr. Mafi says. “I was really happy to learn she had been screened and had the polyp successfully removed. Had she not, the conversation could have instead been about her cancer spreading.” Riley says if she could go back in time, she would have had the screening, “a lot sooner.” “I could have full blown cancer right now,” she says. “I think about it all the time. And right after [my procedure] is when Chadwick Boseman died. He was a lot younger than me.” Six months after the surgery, Riley had another screening. “I wasn’t as afraid as I was the first time,” she says. There were no signs of cancer. Her next screening will take place in five years. Riley has advice for other patients: Don't wait for symptoms to develop because it could be too late. “It doesn't matter if you eat healthy or not. It doesn't matter if no one in your family has ever had it. It doesn't matter what type of lifestyle you’re living. It's still important to get screened because you could be the first in your family.” Ready for "all clear" - Porchia Toussaint Polyps in the colon can potentially become colon cancer. “They said to repeat getting a colonoscopy every five years,” Toussaint says. “It’s preventive care, since colon cancer is slow-growing. My brother and I now go for regular colonoscopies. I think you should get tested, especially if it runs in your family. I have my colonoscopy next week and hopefully, they say it’s all clear and to come back in five years.” Listen to your body - Cameron Kalunian Kalunian underwent colorectal surgery in late 2019, with Jonathan Sack, MD, who found a tumor and treated it. Kalunian was declared in remission within a month. Because Kalunian took quick action upon seeing symptoms, his colon cancer was identified in stage 1. “They did my surgery laparoscopically, so I only have a tiny scar on my abdomen. I was impressed with how cutting-edge all the technology at UCLA Health was,” he says. “My anesthesiologist, rather than putting me on a morphine drip or IV for pain medication, gave me a spinal tap. So I had a lesser dosage of medicine, which meant I was less likely to have complications. I was home three days after the surgery and was back at work within two weeks of my surgery. Every aspect of the care I received was thorough and reassuring. I felt the comprehensive care and felt that my interests were being taken care of.” Initially, Kalunian says, he assumed because he was young there was no way he could have colon cancer. “I didn’t have a family history, but I had seen in the media that there is a higher prevalence of early-onset colon cancer,” he says. “I think there are a lot of stigmas associated with the testing. Ultimately, it wasn’t a big deal. I think, now, I’ve had four colonoscopies and you get better at it each time. You know what to expect and it’s not scary. The most important thing is, if you have symptoms to follow up on them. Listen to your body. Blood in the stool is something to pay attention to and take very seriously.” Just do it - James
Weatherall James took medication for six months before undergoing a CT scan. Sighing with relief, he says, “It showed no signs of lingering cancer! While I was technically in remission, they said I should have only a small party. I'll have to return every six months for new CT scans. If after three years my scan is still clear, then I should have a little bigger party. If after five years my scan is still clear, then I should throw a big party! In my book, I owe it to my primary care physician, Dr. Benjamin Waterman for pressuring me to get my colonoscopy. Had I continued to procrastinate, I don’t know how quickly my tumor would have grown. Every time I meet my contemporaries, I’m not shy about talking about colonoscopies. I didn’t have any symptoms, so my colonoscopy was considered a screening test. From that standpoint, it was a successful screening. It saved my life. When your doctor tells you it’s time for a colonoscopy, just do it.” Ride on - Stephane Strouk After a successful colorectal surgery, Stephane resumed life with an ostomy bag. He reveals, “The ostomy bag was the most difficult part for me. I’m on a motorcycle every day, no matter what. I have different motorcycles, and some of them I couldn’t ride because the bag would explode. I was back on my bike 10 days after my surgery. I went to radiation with my bike as much as I could. After seven or eight months, they removed the ostomy bag and reattached everything. It took maybe a year to adapt, but now everything is working. It’s wonderful. I live every day. I wake up in the morning, see the blue sky, ride by UCLA Health and thank my doctors. They made everything so easy.” The
home FIT test led to a colonoscopy and a new appreciation for colorectal cancer screening - Fuad Afifi “She was in her early 60s,” he says. “A very vibrant, outgoing person. Very athletic.” They had no family history of colorectal cancer, he adds. Colorectal cancer is the third most commonly diagnosed cancer in men and women in the United States. The American Cancer Society estimates nearly 105,000 new cases of colon cancer and more than 45,000 cases of rectal cancer will be diagnosed in 2021.There are often no symptoms of colorectal cancer until the disease has progressed. “If you don’t feel symptoms, you think that you’re OK,” Afifi says. Before undergoing his first colonoscopy this year, Afifi previously opted for the fecal immunochemical test, or FIT, a non-invasive at-home test that requires laboratory submission of a tiny stool sample to be analyzed for traces of blood. The FIT must be performed annually. “It’s better to have any screening as opposed to no screening,” says Kevin Ghassemi, MD, a gastroenterologist with UCLA Health. “The fecal immunochemical test is a very reasonable test to look for blood in the colon, which, if present, will highlight the need for colonoscopy.” Afifi did the FIT in 2018 and again in 2020. The first time, the results were negative for blood. But last year, they came back positive, indicating further exam was needed. Around the same time, his sister died. “She was diagnosed six months ago and it had already metastasized to the liver,” Afifi says. “That gave me a clue. It helped me put some sense into it. And I decided I really wanted to do the colonoscopy.” Colonoscopy requires dietary preparation beforehand to clean out the colon and sedation during the procedure. The exam uses a tiny camera on a scope to view the colon and remove any polyps, which are growths on the colon lining that can sometimes become cancerous. Polyps do not generally cause symptoms, Dr. Ghassemi says, and they don’t always bleed, “which is why the stool test does have some limitations.” In Afifi’s case, though, the FIT led to a colonoscopy, which in turn led to the discovery of polyps. “It was really a blessing that he decided to get this form of screening,” Dr. Ghassemi says. Dr. Ghassemi removed five pre-cancerous polyps during Afifi’s exam. “I’m glad I did it,” Afifi says. “That’s what I know.” Now that he’s experienced a colonoscopy, Afifi calls it “a very simple procedure.” “It opened my eyes, actually,” he says. “Because a lot of people don’t want to do it, either because of some personal reason or they don’t want to drink the things to clear the colon. People might consider colonoscopy an invasive surgical procedure or a personal thing, and there’s a lot of people who don’t want to expose themselves to that.” Despite evidence that screening reduces colorectal cancer cases and deaths, screening participation in the U.S. among adults 50 and older was only 67% before the pandemic, with even lower rates among people of color. Rates of colorectal cancer are higher among Black Americans than among whites. Black people are 20% more likely to be diagnosed with the disease and 40% more likely to die from it. Current recommendations call for screening to begin at age 50, though the U.S. Preventive Services Task Force is recommending the age be lowered to 45 due to an increased incidence of colorectal cancer in younger people. Those with a family history of the disease should begin screening even earlier. For those hesitant to have a colonoscopy, the FIT might be a good place to start, Dr. Ghassemi notes. But Afifi now swears by the more thorough exam. “It’s awareness,” he says. “You have to be aware of your body. And you have to remove the fear. I’m not afraid of dying, but I am afraid of not taking the right precautions and doing what’s necessary to keep this body going.” Afifi says he hopes sharing his experience might prevent others from needlessly suffering the loss of a loved one, as he did with his sister. “I think she died unnecessarily,” he says. “I am doing this in her memory, because if I can save one life with my story, it means we save humanity.” Keeping U connected through post-surgery app - Anne Lin, MD “I focus a lot of energy on treating the patient as a whole person,” explains Dr. Anne Lin, a colon and rectal surgeon at Ronald Reagan UCLA Medical Center. “When I meet patients, often they already have the diagnosis of colon cancer. I talk to them about the next steps in their care. I tell them about the operation and what care will be like during their hospitalization and after their surgery. We have been using an app to help patients with their transition out of the hospital. We try to connect with patients with us during this vulnerable post-discharge time using a remote monitoring application.” Dr. Lin developed the monitoring app with UCLA Health as a way to allow patients to send messages directly to their physician. She further explains, “We, the doctors, curate the questions sent for that particular patient and their problems. The patients have daily tasks, they can take photos of their wounds, and we are alerted of any early warning signs of an infection. The goal of the app is to enable patients to be more active participants in their care. It helps patients be more comfortable with the entire recovery process, and they’re empowered to improve their health. We’ve dramatically reduced emergency department visits and readmissions through the use of this app. It’s been a really wonderful thing because the patients feel connected to us. I feel like I have an understanding of where my patients are, and it helps me feel more comfortable about releasing them. In a hospital, they’re monitored really well, but then they go home and there is no monitoring. Knowing there will continue to be an exchange makes me feel very comfortable.” Second opinion helped save my colon - Linda Kama'ila Any dietary and lifestyle changes a patient is willing to make can be hugely beneficial to theirhHealth - Nancee Jaffe, MS, RDN Removing Early Colon Cancers Endoscopically - Adarsh M. Thaker, MD You'd Be Crazy Not To Start Screening at 50 - Walter Fraser A Small Price to Pay - Tina Storage, MD An Uncommon Bruin - Fola May, MD, PhD, MPhil How did you notice you have colon cancer?Signs and symptoms of colon cancer include: A persistent change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool. Rectal bleeding or blood in your stool. Persistent abdominal discomfort, such as cramps, gas or pain.
What are the symptoms of stage 1 colon cancer?Early symptoms of colon cancer might include blood in the stool; persistent problems in defecating (long-lasting diarrhea or constipation); feelings of cramping, distension or pain in the area of the bowel; or a persistent decrease in the size of the stool.
Do symptoms of colon cancer come on suddenly?Colorectal cancer might not cause symptoms right away. In fact, many of the symptoms of colorectal cancer can also be caused by other problems, such as infection, hemorrhoids, irritable bowel syndrome, or inflammatory bowel disease. It's important to get checked if you have any of following problems.
Where is colon cancer pain usually felt?Many cases of colon cancer have no symptoms. If there are symptoms, the following may indicate colon cancer: Abdominal pain and tenderness in the lower abdomen.
|