Athletic, slim and vivacious, Courtney Nelson had all the boxes checked.
“I always considered myself super healthy. When you check the box, it was ‘My health is awesome.’ You know, I eat right. I exercise at least five times a week. I had no reason to believe that I was not healthy,” she said.
“I don’t drink a lot. I don’t smoke. I take care of myself. Why would this be something I was concerned about? Colon cancer just isn’t something you talk about when you’re my age.”
Now Nelson believes that should change. For her 39th birthday last October, she had a colonoscopy, and she got back the best gift ever. There was no sign of the colon cancer that had struck her down the year before. Her way of paying her good fortune forward is to let others know of new trends in colorectal cancers.
The big picture, for men and women combined, is that colon cancer is the second leading cause of cancer-related deaths. A 2017 study found that even though the risk of dying of colon and rectal cancers has been declining in the population overall, there is a segment in the past decade that has experienced a slight increase. That is among adults in ages 20 to 54.
Her colorectal surgeon Virgilio George, M.D., of the Hollings Cancer Center at the Medical University of South Carolina, said it’s an alarming trend and that he’s even had a patient as young as 18. He estimates around 10 percent of new colon cancer patients are under 50. Because screening isn’t recommended until 50, this means patients can slip through the cracks and be misdiagnosed.
“Be aware and if you notice symptoms such as change in bowel movement, bleeding, pain, weight loss, talk to your doctor to be referred for a colonoscopy. This is what can help us to cure the cancer. Colonoscopies were previously a very difficult procedure. These days it’s very simple and it could save your life.”
Stroke of Luck
Looking back, Nelson realizes her story could have had a much different ending. Like many other adults under 50, she originally was misdiagnosed. She was on a fun, girls’ trip to Belgium, when she started having digestive issues, including some pain and constipation she attributed to jet lag. She ignored it, but when the pain worsened, she decided to see a doctor in Belgium. The doctor agreed it probably was travel related or maybe colitis. The pain improved so Nelson waited until she got home to check with her primary care doctor.
“We discussed the option of further testing and exploring what was going on, but I didn’t really see the point. I assumed I was healthy since I was so young, didn’t have any family history, so it really wasn’t something I was concerned about.”
A month later, Nelson woke in the middle of the night in excruciating pain. She had the same symptoms, except they were ten times worse. “I knew something was wrong but didn’t even consider it could have been cancer. I went to Urgent Care and explained what had happened in Europe and figured it was just another attack.”
The doctor was skeptical and scheduled a CT scan. He gave her a prescription and called her while she was en route to the pharmacy to tell her it was likely a more serious issue than she thought and that it might require surgery. Nelson, a former pharmacy graduate of MUSC, decided to come downtown to MUSC’s Emergency Department. “I have a super high pain tolerance. It takes a lot for me to go to the hospital, so when I came here and was telling them what was happening at the ER they were like, ‘No way, you’re standing here and not writhing around in pain.’”
They did their own scan, immediately admitted her and she had surgery the next day. It was in recovery that Nelson learned what had happened was an intussusception, a serious condition in which part of the intestine slides into an adjacent part of the intestine in what is known as a "telescoping" effect. What was causing it was a tumor. Nelson had stage 2 colon cancer.
George, who ended up removing one-third of her colon, said if it’s caught early, it usually can be cured by surgery. “She is fit, young and healthy, so I was surprised,” he said.
Nelson was shocked to learn the news. “He explained it was stage 2, and he felt that he had gotten it all and, while it floored me, it didn’t really destroy me. You know I had full confidence. It was just going to be one more thing that I had been through, but that it wasn’t going to destroy me. There was a reason things lined up as they had, and God had a plan for me.”
Nelson said she wish she had known that colon cancer was on the rise for younger adults. “I knew I would have a colonoscopy at 50 because that’s what you do.” She wants younger adults, even those who eat well and exercise, to be aware of what the symptoms are and to have them in the back of their minds. She caught hers just in time. She almost had a full obstruction, she said.
“I don’t think the experience has really changed me, maybe made me more aware that I’m not invincible. Even though I consider myself healthy, that can change, and there are things that I shouldn’t blow off,” she said, adding that women her age tend to be the caretakers and can neglect warning signs. A military wife and mother of two, she was worried about packing for her next move when she got the news that she needed to take this seriously.
One of the hardest challenges for Nelson was taking off nine weeks to recover. She went from running miles a day to train for marathons to not even walking. She’s now back to about 6 miles in her training and her prognosis looks good. Military life has taught her to adapt to change well and learn to roll with what life sends her way.
“We often don’t take time to focus on ourselves and listening to our own bodies since we are so busy with the 15 other hats we are wearing. Because we are so young it’s not something we worry about until our 50’s, if that, but I think it’s important to pay attention to the little things... changes in bowel movements or even urinary movements, which you wouldn’t relate to colon cancer necessarily, but when you have a tumor growing in your body, they do all sorts of things.”
Even Young People Should Be Aware of Symptoms
Drs. Brenda Hoffman, M.D. and Virgilio George, M.D., share their top tips.
- It's the second leading cause of cancer-related deaths in both men and women in the U.S.
- Colon cancer can happen at any age. It can easily be misdiagnosed and can be confused with other illness, especially in young patients.
- Notice any chronic changes in bowel movements, constipation and diarrhea, and other symptoms such as bleeding, pain and weight loss. Talk to your doctor to be referred for a colonoscopy.
- Get screened. This detects not only the cancer, but the polyps that develop into cancer.
- Average risk screening should begin at age 50. Some groups, such as African Americans, may need to consider being screened sooner (The American College of Gastroenterology recommends starting at age 45). Cystic Fibrosis patients also are at higher risk.
- If you have a family history, a brother or sister, father or mother with colon cancer, you will need to begin screening at an earlier age. The general rule is to start 10 years earlier than the age they had it. If you have multiple family members who’ve had colon cancer or uterine, breast or pancreatic, that may put you at really high risk. Let your doctor know about that history.
- No one knows why rates are rising in younger adults. It’s likely a combination of factors, including diets with more processed food, higher rates of obesity and sedentary lifestyles. Another factor being studied is antibiotic use in people when there were younger. This can alter the body’s microbiome, in a way that may increase your risk.