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Oncology (General Cancer)/24 yr old female concerned with colon cancer

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QUESTION: Hi there,

I know that I'm rather young to be worried about cancer of the colon which typically presents itself in patients much older than myself but I've been fretting for weeks about the progression of my symptoms. As mentioned above, I'm 24 years old, 5'7", 160 lbs, and in decent enough health.

Over a year ago, I began seeing my doctor to discuss some gastrointestinal discomfort, namely very intense bloating (to the point where I appeared 5 months pregnant), very uncomfortable cramping in my lower abdomen, and loose stools. We did a ton of tests, and roughly three months ago it was discovered following a biopsy sample from a colonoscopy that I have ulcerative colitis (resulting in a few side issues such as vitamin B12 deficiency and pernicius anemia). They did not seem to notice much in the colonoscopy, but my paperwork did note that I had at least one polyp removed. I have since been taking a daily multivitamin, a daily B12 supplement, and an iron supplement and have been prescribed Asacol. Up until recently, I had loose stools or worse, diarrhea for over a year.

In the last 2-3 months, I've noticed my symptoms altering and am becoming slightly worried. A few days per week, I have days where I feel as though I hardly leave the bathroom. Some mornings I'll go to the toilet 9 times in the span of 3 or 4 hours, and I end up bleeding after the 3rd or 4th bowel movement. The pain at this point is awful and on multiple occasions I've left the washroom in tears or have vomited from the discomfort. It feels as though I'm passing daggers. The pain feels as though it's coming from inside the rectum.

Also, I've begun feeling extremely tender around the tail bone region. It feels as though I've bruised it rather badly, but no discolouration is visible. It lasts for a few days and subsides for a few more before coming back. I haven't fallen or otherwise done anything that would damage that area.

For the first time in almost as long as I can remember, I no longer have loose stools. This began two weeks ago. In fact, I've grown rather constipated. I've wondered if the pain and blood is caused by hemorrhoids but I'd always heard that they came from straining during a BM, which I never have up until very recently. The pain and blood came long before I ever became constipated for the first time in over a year. I can't see any hemorrhoids if I look. I now always feel like I have to have a BM, but when I try to go, nothing happens, and I don't want to strain in case I have internal hemorrhoids. Even when I do have a BM, I never feel "finished". My stools are always flat on at least two sides.

I have not experienced any weight loss. For the past three months, my period has been arriving early and I have been experiencing breakthrough bleeding. I've developed a rash on my upper arms and recently developed a yeast infection (which I'm wondering could be a result of taking new medication?). I kind of feel like my body is in distress at this point, as my period is always predictable.

Am I worrying over nothing? Is this just a case of hemorrhoids? I know I had a colonoscopy 3+ months ago, but everything has gotten much worse since then and I worry that something has developed in the time since that colonoscopy. There is a history of breast cancer, colon cancer, and bowel disease in my family. Do I have reason to be worried?

ANSWER: I hope you are taking the asacol.  Your symptoms sound like active ulcerative colitis.  You may have to take a course of steroids or raise the asacol dose.  The problem with UC is that patients need to learn to manage their symptoms with medications and diet.  In very severe cases, colectomy is indicated.  As for cancer, it takes about five years for a polyp to become cancer.  If you get a colonoscopy now and then, you shouldn't get cancer, since the polyps will be removed in time.  However, that's not to say that the UC isn't a serious problem. Blood, diarrhea, constipation, a feeling of never emptying the colon -- these are all symptoms of active UC.  You also may have hemorrhoids, or a rectal fissure, both of which can cause the symptoms you describe.  Don't worry about cancer; you had a colonoscopy three months ago.  But do find a good physician or nurse practioner who can coach you through the learning phase so that you can manage your own disease.  
The risk over 30 years for patients with UC to get cancer is about 15%;  with asacol, it seems to be much less, as long as the agent is taken regularly.  
Hope this helps.  

---------- FOLLOW-UP ----------

QUESTION: Thank you for answering my question, this helps me feel more at ease.

I am indeed taking the Asacol, but unfortunately have never felt worse. I have stopped having BMs completely now. I have some tests coming up for other things, including parasites and an ultrasound for gall stones.

It's early days yet, and so I'm having some trouble managing my symptoms. I keep a constant food diary and can't seem to find any rhyme or reason for my flareups.

In the last few weeks, it has come to light that my father is undergoing tests for colon cancer. He didn't tell me until now so as not to worry me.

Do I have a greater risk of colorectal cancer if he does have it along with rampant colon and breast cancer on my mother's side? There is also colon cancer in my significant other's side of the family and I'm worried about what kind of chances our future children will have of developing bowel disease or colon cancer.

Answer
Your risk of colon cancer is higher than a normal person with UC because of your family history.  Talk to your doctor about getting genetic testing.  The testing should be performed first on someone who had colon cancer; then the defect would be known, and the test could be done on you.  Colon cancer tends to be more common in people who have hereditary breast cancer so I'd get those tests done, especially if your father has it.  As for risk to children, yes, if you and your s.o. both have a family history of colon cancer, that would probably increase the risk.  But the risk would be increased more if you had one of the known genetic markers.  UC can also run in families.  Hope this helps.  

Oncology (General Cancer)

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Donald Higby, M.D.

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I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

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I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

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American Society of Clinical Oncology

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New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

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MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

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America's Best Physicians, last 14 years

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