Young colorectal cancer patient promotes colonoscopies, awareness of rising rates in young adults

Sometimes, in a moment of calm between the shrieks and giggles of a holiday with young kids, a mother might see future holidays stretching out before her – years and years of shared memories, of her children growing into parents themselves and of her future grandchildren running and playing around her.

For a time last year, Adriel Nutter didn’t dare imagine those scenes. She could scarcely allow herself to think about the next Christmas.

At age 36, with a diagnosis of stage 4 colorectal cancer, Nutter’s future was suddenly hazy.

Now, after surgery to remove 11 inches of her colon and a slice of her liver where the cancer had spread to, as well as a long course of chemo, there are no more signs of the cancer. Nutter is ready to celebrate. In years past, she wasn’t much for Valentine’s Day, she said. But this year? Pink and red all over the house. St. Patrick’s Day, the Masters Tournament, the Kentucky Derby – Nutter is celebrating them all.

She’s also spreading the word about the importance of colonoscopies and about the rising rates of colorectal cancer in younger adults.

“I'm an extremely modest person in terms of what I share with other people. So talking about colonoscopies is so far outside of what I would have ever done in 2021,” she said. “Now that people want to talk to me about their colonoscopies, it’s so cool. People that I haven't talked to since high school send me Facebook messages like, ‘Today's the day I get my colonoscopy.’ I get so excited, and I send all the emojis and say, ‘Tell me how it went!’”

Colorectal cancer rates increasing in young adults

Nutter is one of about 19,000 people under the age of 50 diagnosed with colorectal cancer each year. Rates of colorectal cancer in younger adults have been rising for a while now – an American Cancer Society report published this month states that 20% of colorectal cancer cases are now in people under the age of 55. The reason for the increase isn’t entirely clear, although obesity and Americanized, ultra-processed foods have been suggested as potential factors. Younger adults also tend to be diagnosed at later stages, when the cancer is more advanced.

The increased risk for younger adults will stay with them as they age, the American Cancer Society warns. Colorectal cancer rates in older adults had been decreasing, thanks to increased screening and fewer people smoking, but those rates are likely to start increasing again as this more at-risk group grows older.

Colonoscopies are a useful tool because doctors can see and remove polyps that could become cancer. The U.S. Preventive Services Task Force recommended in 2021 that colorectal cancer screening begin at age 45 instead of age 50. So far, though, only 20% of adults between the ages of 45 and 49 and half of adults between the ages of 50 and 54 have had some type of colorectal cancer screening, whether a colonoscopy or a stool test.

Symptoms finally add up

Looking back, Nutter can see that there were signs that something was seriously wrong. Over the course of several years, she had stopped eating first red meat, then all meat, then pasta sauces made from tomatoes and other acidic foods, then dairy, because the foods upset her stomach so much.

"It wasn't like I missed those foods because they were slowly leaving one at a time. And I just felt like, ‘Well, this is good for me because now I'm really healthy because I'm eating all these vegetables and fruits, and I'm the healthiest I've ever been,’” she said. “And in reality, I was actually going the opposite direction and had no idea.”

She was tired, too – so lethargic that it was hard to do anything with her kids.

 

“In hindsight, I can see now that there was a turning point where I stopped doing a lot of the things that I had done before,” she said.

Yet her doctors seemed to think that what she was feeling was normal for a woman in her thirties who was a wife, mother and small business owner.

“My biggest regret is not feeling good about what I was being told and not feeling sure but just assuming, ‘What do I know?’ That’s definitely my biggest regret. I think if I would have gone with my gut in the beginning, I wouldn't have gotten to stage 4. And that's super unfortunate.

“But now I make decisions on every gut feeling. Now I make rash decisions on a whim if I feel like it's the right choice because I know now that I should have trusted myself more in the beginning than I did,” she laughed.

Colorectal cancer diagnosis

Nutter’s symptoms came to a head on Jan. 14, 2022. The day started normally. She woke up with a bit of back pain, but because she works from home as a wedding planner, she decided she’d just sit in bed and work. But she kept feeling worse and worse.

“Within an hour, I was sick to the point that I didn't feel like I could walk,” she said. She went to the bathroom, thinking that vomiting might make her feel better, and ended up on the bathroom floor, frantic with pain. She called her husband, who rushed home and drove her straight to their local hospital’s emergency department.

“At that point, I was in pain beyond being able to vocalize what was happening,” she recalled.

She was admitted overnight, and the following morning, she had a colonoscopy, which revealed the cancer in her colon.

The surgeon at her local hospital referred her to colorectal cancer surgeon Virgilio George, M.D., at MUSC Hollings Cancer Center.

“Of course, my mom did what your mom does and called MD Anderson and Cleveland Clinic and every hospital that would answer the phone within 24 hours. But in that time, I told my husband that it was important to me that I stayed near my kids and him,” Nutter said.

The surgeon had given them George’s cell phone number and, although they felt a bit odd about calling a doctor’s cell phone, they decided to reach out.

“At this point, it was Saturday afternoon, the day I came home from the hospital. It was funny because you could hear music blaring in the background. He asked my husband to hold on, and he turned the music down, and he spent about 45 minutes on the phone with my husband, just explaining what he knew and didn't know and what information he had gotten because it had only been, at that point, not even 12 hours since my colonoscopy and this referral.

“One of the things that was really alarming for me was that the first hospital told me that it was only in my colon, and that it was a very easy surgery. Dr. George was very honest that he didn't have that answer for us, and that he wasn't going to promise us that that was the case that it hadn't spread anywhere else. So we appreciated the honesty a lot.

“His willingness to talk to us was all the reassurance I needed. So I canceled all the appointments that my mom had set up at all the other hospitals. And I was like, ‘Something is telling me that this is where I'm supposed to be. And he's the doctor I need,’” Nutter said.

Multidisciplinary care

Multidisciplinary care is at the core of how Hollings approaches cases, George said. That means a treatment plan isn’t based on one doctor’s opinion. Radiation oncologists, medical oncologists, pathologists, radiologists and surgeons all come together to develop a plan. In Nutter’s case, that included both colorectal cancer and hepatobiliary surgeons because her cancer had spread to the liver.

“That’s a phenomenal resource that we can provide to our patients coming to MUSC. These days, care is tailored according to the cancer and according to the patient,” George said.

Hollings has the only rectal cancer program in the state to have earned accreditation through the National Accreditation Program for Rectal Cancer, which requires commitment to multidisciplinary care and adherence to evidence-based standards. Following this approach means improved outcomes for patients, George said.

 

Nutter was scheduled for surgery the week after her colonoscopy. She was naturally nervous, but the staff at Ashley River Tower, one of the MUSC Health hospitals in downtown Charleston, put her at ease.

“I just walked in, and I was like, ‘I don't know where I'm supposed to be or who I'm supposed to talk to.’ And the sweet women at the desk in Ashley River Tower were like, ‘We know exactly who you are.’ It was incredible. It was amazing,” she said.

The surgery was successful in removing the tumor. To kill off any cancer cells that might be circulating in her blood, Nutter embarked on a chemotherapy regimen for eight months.

Despite her medical treatment, Nutter was determined to continue with daily life.

“I did not tell anybody at first, for a lot of reasons. I did not want people to think that I couldn't do my job. And there were probably days that I shouldn't have been doing my job,” she said. “But I have a really fun job, and it brings a lot of happiness to people's lives and mine.”

“I didn't reschedule one single meeting, and I didn't miss a single wedding for the whole year, which was hard because during the chemo, I had neuropathy and brain fog. My job is a very physical job on wedding days, and it relies on my memory a lot. But I have a really great team of people who work for me, and they just stepped up and helped me,” she added.

 

Because she had severe allergic reactions to the chemotherapy taken intravenously, she relied on oral chemotherapy for most of her treatment plan, under the supervision of oncologist Paul O’Brien, M.D., and oncology physician assistant Andrew Brewer, PA. They worked with her to plan her treatments so that she could keep up with family life.

“I think I needed to show my kids that our life was not going to stop. We kept traveling. We just did it by car,” she said. “We went to Disney, and we went to Florida, paddleboarding with the manatees, and we did a lot of things while I was still taking chemo pills. I just kept working and kept going.”

Now, she is cancer-free.

“I feel good. I feel healthier. I think I didn't realize how sick I was. I was likely, in hindsight, sick for years,” she said.

Not only does she feel better, but the Texas native is back to eating barbeque and all of her favorites.

Preventing colorectal cancer

Researchers aren’t sure why rates of colorectal cancer are increasing in younger adults. But there are some things that people can do on an individual level to reduce their risks, George said.

• Eat a diet high in fiber.
• Eliminate or decrease red meat in your diet.
• Decrease the amount of processed food in your diet.
• Get physical activity.
• Don’t smoke. If you do smoke, Hollings can help you to quit.
• Follow the screening guidelines – average-risk people should begin colorectal cancer screening at age 45.

Family history and personal health history can affect what is recommended for an individual. For example, Nutter’s children will need to begin colorectal cancer screening at age 26 – 10 years before the age at which their mother was diagnosed.

Nutter is grateful that she found her way to George and the rest of the team at Hollings. She began sharing her story on Facebook while she was in treatment and was surprised by the number of people who commented that they knew someone going through something similar. That’s made her want to share her story even more.

“I felt like, ‘There are probably people who need to hear that people can have stage 4 cancer and survive,’” she said.

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