We don’t hear much about women and colorectal cancer, but it happens. And sometimes it happens earlier than even medical professionals would expect. Really early.
Hard to believe? Ask attorney Tawny Mack of Atlanta.
She was a senior at Georgia Southern University when she first saw blood in her stool and suspected something might be wrong.
Mack did all the right things. She immediately saw a doctor, but was told she most likely had hemorrhoids.
If it happened again, the doctor told her, see your primary care physician.
“I don’t remember having another episode for a while, but in the fall of 2009, I had a major bleeding episode,” Mack said. “It scared me so much I went to the emergency room.”
This time, after running some tests, a doctor concluded Mack had ulcerative colitis and, after recommending she do an elimination diet to determine what food she’d eaten to trigger the bleeding, discharged her.
At home, she logged onto the Internet to find out everything there is about colitis and figured the doctor was spot on.
She watched her diet and concluded red pasta sauce was the culprit.
But four years later in 2013, after graduating from law school and accepting a job at a Savannah firm, there was more blood and more often. Again, without performing a physical exam, her doctor dismissed Mack’s suspicions.
“From then until 2015, I’d see him for various reasons and bring up my continued bleeding,” she said. “He’d suggest a fiber supplement and hemorrhoid cream. I did all of those things, but my symptoms never went away.”
By then, Mack was 28. That and the fact that she was physically active, her doctor assured her, ruled her out for cancer.
But the bleeding continued and she began experiencing abdominal pain. A fourth doctor also ruled out cancer, told Mack that she had ulcerative colitis, jotted down the name of a fiber supplement and handed it to her.
If you'd like a colonoscopy, I'll do it but you'll have to wait, he told her.
Mack, feeling belittled, left his office in tears.
When they finally called to schedule the colonoscopy, the earliest appointment available was sometime around Christmas. Mack decided to wait until the new year because she had not met her insurance deductible. She focused instead on pursuing job opportunities in Atlanta.
It was June when she finally followed up.
Two weeks later when she awoke from her colonoscopy, the news was bad. There was a large mass in Mack’s colon and rectum.
As horrible as this might sound, it’s not all that unusual. It’s also a classic example of why we must be our own health advocates.
According to a 2016 Colon Cancer Alliance study on young-onset colorectal cancer patients, 82 percent of participants were initially misdiagnosed before ultimately being diagnosed with colorectal cancer. Thirty-nine percent were misdiagnosed with hemorrhoids like Mack. And like Mack, 44 percent of the study's participants felt that their diagnosis was delayed due to their age.
Young adults, in fact, are being diagnosed with colorectal cancer at an alarming rate. And yet, the standard age to begin screening for colorectal cancer is 50.
Tawny Mack was just 21 when the first symptoms appeared.
Fourteen days after her diagnosis on June 28, 2016, Mack’s surgeon removed her tumor, 47 lymph nodes, almost all of her rectum, and a decent amount of her colon. On July 17, she had an emergency surgery because of an anastomotic leak. Mack awoke from that surgery with an ileostomy. Ultimately, doctors determined she had stage 3C colorectal cancer, which required six months of chemotherapy.
She finished the treatment in February, but there was more bad news in May. Doctors found a mass in front of Mack’s aorta and suspicious lymph nodes right below her thoracic inlet.
“It stumped everyone because colorectal cancer normally spreads to ovaries, liver, lungs, bone and brain,” Mack said.
When they took the mass out in June, tests showed it was Hodgkin’s lymphoma. Mack had to undergo another two months of chemotherapy followed by radiation treatments, which she finished on Oct. 18.
“I have a family history of Hodgkin’s, but no history or genetic markers of colorectal cancer. The good news is that because I’m being watched so closely for colorectal cancer recurrence, they caught lymphoma at its earliest stage.”
She says all of this as if she’s talking about a day in the office but then concedes “the world is a terrifying place for me right now.”
“I live in constant fear of colorectal cancer occurrence,” she said.
Mack is 31 now. She’s married and has a good support network.
That’s why, when she stumbled upon the Colon Cancer Alliance’s website during her recovery last year, she knew she had to participate in the nonprofit’s Undy Run/Walk, held annually to raise awareness about colorectal cancer and funds to promote prevention and connect patients to treatment.
“When you’re diagnosed with cancer, so many people want to help you,” she said. “I thought this was a way for people who wanted to help to contribute to a cause that I think is very important.”
She and 11 of her closest friends participated again last Saturday, raising more than $2,500.
“If detected early enough, colorectal cancer is no big deal. It’s very important to put this on the radar,” Mack said. “My peers should listen to their bodies, take themselves seriously and never be afraid to push back or question what a physician is telling them.
“We consider them experts because they have devoted so much of their lives to treating people. We don’t want to be disrespectful, but we have to remember that doctors are human beings. They make mistakes. If they’re unwilling to figure out the root cause of your health issue, it’s OK to get a second opinion or third or fourth.”
Please. Listen to her.
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Credit: Jason Getz / Jason.Getz@ajc.com