For freelance artist Joshua Sanchez of Harlem, New York, trips to the bathroom became increasingly concerning after the 38-year-old started noticing blood in his stool. He initially thought he had a simple case of hemorrhoids — a common association people make when they experience this symptom. But it turned out to be the first signs of something far more serious: stage 4 colon cancer.
Sanchez first noticed the blood appearing more frequently in 2021, prompting him to go see his doctor to make sure it wasn’t anything more serious than benign — albeit painful — hemorrhoids. He underwent an endoscopy and a colonoscopy, and the tests revealed the freelance artist had good reason to be concerned, as two masses were detected in his colon and liver. Biopsies taken afterwards confirmed he had stage 4 colon cancer that metastasized and spread to his liver.
Colon Cancer Basics
Colon cancer, or colorectal cancer, is a type of cancer that affects your large intestine (colon) or the end of your intestine (rectum). It is the third-most common cancer in people of both genders in the United States, excluding skin cancers, according to the American Cancer Society. The cancer starts when abnormal lumps calledpolypsgrow in the colon or rectum. If you don’t have these polyps removed, they can sometimes become cancerous. It takes up to 10 years for a colon polyp to become a full-blown cancer, according to SurvivorNet experts.
Colon cancer stagingtakes into account the depth of the tumor in the colon, and whether the cancer has spread to the lymph nodes or to other organs, such as the liver or lungs.
- Stage 1 cancers are those in which the tumor has only penetrated the superficial layers of the colon, and haven’t gotten into the deeper layers
- Stage 2 cancers involve the deeper layers of the colon wall
- Stage 3 cancers have spread to the lymph nodes around the colon
- Stage 4cancershave spread to other organs, such as the liver, lungs, or peritoneal cavity (the space in your abdomen that holds your intestines, stomach, and liver)
Most colon cancers can be prevented if people are regularly screened beginning at age 45. The screening usually involves acolonoscopy,in which a long thin tube attached to a camera is used to examine the colon and rectum. If no polyps are discovered, the next screening won’t be needed for about 10 years.
“We know that colon cancers can be prevented when polyps are found early,” Dr. Heather Yeo toldSurvivorNet.
“Lowering the screening age helps somewhat with this, but access to care is a real problem,” Yeo added.
Sanchez is considered young to develop colon cancer. As we mentioned, screening is recommended to begin at 45. But there is a concerning trend of more and more young people developing colorectal cancer.
“In contrast to decreasing CRC [colorectal cancer] incidence in older adults, rates have been increasing in adults aged 20–39 years since the mid-1980s and in those aged 40–54 years since the mid-1990s,” read a recently published report. “From 2011 through 2019, rates increased by 1.9% per year in people younger than 50 years and in those aged 50–54 years.
Plus, the research found an increase in people being diagnosed at more advanced stages than in the mid 1990s, before there was widespread screening.
Colon Cancer Signs and Symptoms
Despite the growing trend of more young people diagnosed with colon cancer, people older than 50 years old still are at the greatest risk, with this age group making up about 90% of the cases.
Other risk factors of developing colon cancer include:
- Having inflammatory bowel disease.
- Having a family history of colon cancer.
- Not exercising very often.
- Eating a diet high in meat.
- Being overweight or obese.
- Using excessive alcohol and tobacco.
Colon cancer symptoms and warning signs include:
- Change in bowel movement
- Bloody stool
- Diarrhea, constipation or feeling the bowel does not empty completely
- Unexplained weight loss
- Constant abdominal pain or cramps
In the case of hemorrhoids, which are swollen veins in your anus that can develop inside your rectum or under the skin around the anus, they can produce bleeding during bowel movements. According to Mayo Clinic, they can also be itchy, painful and produce swelling around your anus. However, hemorrhoids are quite common, as nearly three out of four adults will experience them, and they usually aren’t dangerous. They are often effectively treated at home with medications but, in severe cases, doctors can perform surgery to remove the hemorrhoids. Symptoms typically resolve in a few days.
If you notice concerning symptoms or changes to your body, or symptoms you may have attribute to one condition don’t resolve over time, it’s important to discuss them with your doctor promptly.
WATCH: Craig Melvin’s message about colon cancer prevention.
Colon Cancer Treatment
Your doctor has many ways to treat colon cancer, which may include:
- Radiation therapy
- Targeted therapy
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.
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.
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 yourfirst treatment.Chemotherapyhas been very well studied for colorectal cancer, and it is known to improve survival.
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.
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.
Sanchez’ Special Cancer Treatment
After Sanchez’ tumors were discovered, he had to prepare for immediate surgery to remove them, which was followed by three weeks of intense chemotherapy. The cancer warrior described chemo after the surgery as tough because it made him weak. Sanchez, who is deaf, relies on his hands and arms to communicate, but due to his weakened state, he could barely move his arms.
“I couldn’t communicate at all. I was having a really tough time in the hospital,” he said.
After his initial treatment, the cancer warrior was released from the hospital, but scans revealed the tumor on his liver had spread and he had multiple lesions on his liver that needed more treatment. His doctors opted for targeted radiation to try and kill off the remaining cancer cells. However, this too proved challenging because Sanchez needed specific instructions from doctors on how to breathe, a key component to the treatment.
“As somebody is breathing, your liver is actually moving up and down. Your liver sits right under your diaphragm, so it moves quite a bit when you breathe,” Sanchez’s radiology oncologist, Dr. Karyn Goodman, explained.
“If we want to really be pinpointed with their radiation in a deliberate and very targeted way, we have to take into account that the liver is moving and the tumor is moving,” Dr. Goodman added.
Usually, doctors would use an intercom to communicate with the patient for the radiation treatment but since Sanchez is deaf the intercom couldn’t be used effectively. However, he still needed breathing instructions for the treatment to work. The radiation exposure risk meant Sanchez’ interpreter could not be in the room to relay the breathing instructions, leaving doctors to come up with a creative way to give Sanchez the necessary breathing instructions.
Doctors on hand had Sanchez put on special virtual reality goggles to see his interpreter in a neighboring room give him the required breathing instructions using Zoom.
“The patient’s in the room, they’re getting treated so they get exposed to the radiation that not only goes to the tumor, but also there’s a lot of scattered radiation that is very low doses and minimum but it’s still … not insignificant,” Vishruta Dumane, an associate professor of radiation oncology at Mount Sinai, explained to “TODAY”.
“I know in the deaf community you’ll typically see people that might not know about communication access…a lot of people are afraid, or they give up or they don’t know about alternatives out there,” Sanchez said.
The alternative treatment method worked as Sanchez was able to get the targeted radiation.
Sanchez is choosing to share his cancer journey to help motivate other people with disabilities battling a disease to keep fighting and know there are alternatives available to them. He also says within the Latino community opening up about an illness is not easy to do and hopes his story motivates others to be honest and open about their health care.
“We’re Latino so we don’t really focus on our health and we don’t talk about that and we don’t discuss vulnerabilities very often. So it’s a serious thing that needs to be communicated more,” he said.
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Kavontae Smalls is a writer and reporter for SurvivorNet. Read More