37-Year-Old Father of Two Thought Hemorrhoids Were Holding Back His Marathon Training—Until He Discovered It Was Stage 2 Colon Cancer

As a marathon runner, Johnson, 37, was preparing for another marathon. The non-smoking vegetarian felt as though he was doing everything he could to be in tip-top shape – something that had become routine for him. However, during that stretch of time, he began noticing blood in his stool.

“I was finding blood in my stools pretty regularly, which was new for me,” Johnson said.

He told his wife before bringing the anomaly to his doctor. Among his tests was a colonoscopy, which helps screen for colon cancer.

A colonoscopy involves a long, thin tube attached to a camera to examine the colon and rectum. If no polyps are discovered, the next screening won’t be needed for ten years. Polyps are small growths in the colon that are not yet cancerous but can potentially develop into cancer.

“When we see a polyp, we actually physically take the polyp out through the colonoscope,”  Dr. Zuri Murrell, a colorectal cancer surgeon and Director of the Cedars-Sinai Colorectal Cancer Center, explained.

WATCH: Understanding the Function of the Colon and the Rectum

“What does that mean? That means we basically put a wire through with a little bit of a flange at the end, and we pull the polyp out. Now, note there is no pain with that. Inside the colon, there are no pain fibers. So, there’s no pain,” Dr. Murrell added.

Colon cancer is very treatable and curable if caught early. Colon cancer screenings can involve at-home tests such as Cologuard, but a colonoscopy is more effective, according to SurvivorNet experts.

Johnson’s test results completely stunned him as he was still under the impression that his intensive training had caused a mere case of hemorrhoids. However, his doctor told him he had stage 2 colon cancer.

WATCH: Understanding Stages 1, 2, and 3 Colon Cancer

Patients with stage two colon cancer have larger tumors than stage one patients; however, the tumor is still confined to the colon wall.

“It really depends on kind of the depth of the tumor into the colon wall and the risk that it has to spread,” Colorectal Surgeon and Surgical Oncologist Dr. Heather Yeo explains to SurvivorNet.

“If it has bad features– for example, if when they look at the pathology slides under the microscope, if they see that it’s involving some of the vessels nearby, then that is a higher risk factor. Then, those patients might be more likely to benefit from chemotherapy,” Dr. Yeo continued.

Upon learning the stunning news, Johnson questioned his next steps, most notably, how to tell his wife.

“How do I tell my wife?’ All I thought about was them two and how this was going to affect them,” Johnson said.

Johnson says he needed 25 rounds of radiation treatments and eight rounds of chemotherapy after that, spanning several months. He explained he approached his intense treatment regimen like he does his marathon training.

“I was very determined, and I was very focused, just like training for a marathon. I was actually training for that treatment. I was training for that whole recovery process.”

WATCH: First Line Chemotherapy for Colon Cancer

“The most common treatment for colorectal cancer, the most common chemotherapy is a 5-FU-based chemotherapy mixed with Oxaliplatin, typically known as FOLFOX. The 5-FU can be given in two ways. It can be given in the hospital as an IV infusion. Or it can be given as an oral dosing,” Dr. Yeo explained.

Dr. Yeo adds that colon cancer patients undergoing chemotherapy may experience side effects related to their GI tract, such as gastrointestinal disturbances and diarrhea.”

Other side effects patients may face include decreased white blood cell count, mouth sores, and fatigue.

After about six months of rigorous treatment, Johnson received the news he and his wife had been praying for. His test results revealed that there was no evidence of disease. Johnson says he and his wife cried with excitement.

“We just hugged and cried,” he said.

After battling colon cancer, he’s using every avenue he has to spread colon cancer awareness to make the subject easier to discuss.

“That’s a big part of why I like to share these details and share regularly – it’s all about just having the conversation and de-stigmatizing the conversation about blood in your stools or bowel movements or hemorrhoids,” Johnson said.

Colon Cancer Warning Signs

The most poignant signature of colon cancer is a change in bowel habits. Changes in the size or shape of bowel movements may cause constipation or diarrhea. A change in stool color, particularly black or tarry stools, can indicate bleeding from a tumor deep in the colon.

WATCH: Colon cancer symptoms.

Other symptoms can be harder to pinpoint, such as abdominal pain and unintentional weight loss. Finally, some tumors bleed a small amount over a long period, resulting in anemia (low red blood cell count) that is picked up on blood work.

Colon Cancer Cases Rising in Adults Under 50—Screening Rates Are Climbing Too, Especially Among 45-49 Year Olds

The average age at which people are diagnosed with colon cancer is 68 for men and 72 for women, according to the American Cancer Society.

However, the National Cancer Institute reports that since the 1990s, colorectal cancer cases have been rising among adults younger than 50. Research published in CA: A Cancer Journal for Clinicians found that cases in people younger than 55 “increased from 11% in 1995 to 20% in 2019.”

“We know rates are increasing in young people, but it’s alarming to see how rapidly the whole patient population is shifting younger, despite shrinking numbers in the overall population,” cancer epidemiologist and lead study author Rebecca Siegel said.

WATCH: Understanding the Function of the Colon and the Rectum

Researchers are still trying to determine why younger people are being diagnosed in more significant numbers. Some experts point to risk factors, which include obesity, physical inactivity, and smoking, as a possible explanation for the increase.

“We don’t know for sure why we are seeing earlier onset and death from colon cancer,” Dr. Yeo told SurvivorNet.

“It is likely a combination of factors, including diet and genetics as well as access to care and some environmental factors,” Dr. Yeo added.

A new study published in the peer-reviewed medical journal JAMA Network examined colorectal cancer screening rates between 2016 and 2023. Researchers conducting the study analyzed more than 7.8 million colorectal cancer screenings conducted at more than 1,350 hospitals throughout the United States.

A point of note from the study was that the rate of colorectal cancer screenings appeared to correlate with guideline changes from the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) for people at average risk to begin screening at age 45.

• CRC screenings among adults aged 45–49 increased nearly tenfold, from 2.9% to 17.8% of all screenings between 2016 and 2023.
• Monthly screening volume for this age group rose 955%, compared to a 46% increase among adults aged 50–75.
• The surge reflects rapid guideline adoption in hospital settings and early uptake even before the USPSTF changes.

The findings from the study highlight the impact of hospitals following recommended screening guidelines for their patients. It’s important to note that the study does not account for at-home colorectal screenings.

What Treatment Options Exist for Colon Cancer?

“There are a lot of advances being made in colorectal cancer,” Dr. Yeo previously told SurvivorNet.

Colon cancer treatment is more targeted, meaning doctors often test for specific changes or genetic mutations that cause cancer growth.

Biomarkers are key to tailoring specific treatments. Biomarkers are molecular patterns becoming more commonly used in colon cancer diagnosis, prognosis, and management. According to the National Cancer Institute, a biomarker is “a biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or a condition or disease,” such as cancer.

“In colon cancer, we’re starting to look more and more at people’s biomarkers, so we’re starting to take the cancers, sequence them, understand where the different mutations are to figure out whether or not someone has a normal gene here or an abnormal gene,” Dr. Yeo explained.

“Those are the areas that people want to be able to target a little bit more. We’re getting close to more of what we would call precision medicine, meaning we can start looking at people’s genetic mutations and think about how they might respond to different drugs.”

There are different types of biomarkers, including DNA, proteins, and genetic mutations found in blood, tumor tissue, or other body fluids. The biomarkers most commonly used in colon cancer management are:

Genetic mutations within the tumor, such as MMR/MSI, KRAS, BRAF, and HER2
Bloodstream carcinoembryonic antigen (CEA)

CEA is a protein produced by most tumor cells (but not all) and can be picked up in the bloodstream. High CEA levels do not establish a colon cancer diagnosis. However, higher CEA levels correlate with a worse prognosis and potential metastasis. Carcinoembryonic antigen is important for post-treatment follow-up to ensure the cancer hasn’t returned. Be sure to check with your doctor before treatment starts to ensure a CEA blood sample has been obtained.

More on Treating Colon Cancer

Surgery and chemotherapy are common approaches to colorectal cancer.

Some examples of Food and Drug Administration (FDA) approved chemotherapy drug treatments include:

• FOLFOX: leucovorin, 5-FU, and oxaliplatin (Eloxatin)
• FOLFIRI: leucovorin, 5-FU, and irinotecan (Camptosar)
• CAPEOX or CAPOX: capecitabine (Xeloda) and oxaliplatin
• FOLFOXIRI: leucovorin, 5-FU, oxaliplatin, and irinotecan
• Trifluridine and tipiracil (Lonsurf)

WATCH: Understanding Your Options with Metastatic Colon Cancer

Among metastatic colon cancer patients, multiple treatment options exist, including surgical and non-surgical options.

One treatment option includes an oral treatment called Fruquintinib, which is a targeted therapy for adults who have metastatic colorectal cancer and have tried other treatments. Results from a trial published last year showed the drug improved overall survival and progression-free survival, which measures the amount of time before the cancer returns or spreads. It works by blocking the growth of blood vessels, which increases tumor growth.

Once you get to the metastatic setting, many patients “just run out of options,” Jennifer Elliott, head of solid tumors at Takeda, explained to SurvivorNet at the ASCO Annual Meeting. So it was critically important for Takeda to do this deal to in-license fruquintinib. We hope to give patients another option.”

Fruquintinib has been approved in China since 2018 and was originally developed by the Chinese biopharmaceutical company HUTCHMED. Takeda Oncology acquired the exclusive worldwide license for the drug outside of mainland China, Hong Kong, and Macau in January 2023.

Questions to Ask Your Doctor

If you are facing a colon cancer diagnosis, here are some questions you may ask your doctor.

• What are my treatment options based on my diagnosis?
• If I’m worried about managing the costs of cancer care, who can help me?
• What support services are available to me? To my family?
• Could this treatment affect my sex life? If so, how and for how long?
• What are the risks and possible side effects of treatment.

Learn more about SurvivorNet's rigorous medical review process.

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