Taking Control of Your Cancer Journey
- Country singer Joshua Ray Walker, 34, is pursuing significant weight loss as part of his cancer journey, sharing weekly progress updates with fans for accountability.
- Diagnosed with colon cancer in 2023 and later learning it spread to his lungs, amid ongoing treatment, Walker is using Instagram to document lifestyle changes and thank supporters following his health challenges, including fellow country music star Jelly Roll, who also underwent dramatic weight loss.
- Stage 4 colon cancer can vary widely in how far it spreads, making treatment highly individualized; experts emphasize the importance of determining the right sequence of chemotherapy and surgery.
- “A stage 4 can be one tiny spot on the liver, or it could be 100 spots throughout the abdomen, and obviously those patients are going to be treated differently,” explains Dr. Daniel Labow at Mount Sinai Health System.
- “If a tumor is very large, chemotherapy can sometimes shrink it enough to make surgery safer and more effective. We also consider chemotherapy first in the small number of cases where the cancer has already spread beyond the colon,” medical oncologist Dr. Paul Oberstein explains.
- The Centers for Disease Control and Prevention (CDC) says, “Being overweight or having obesity is linked with a higher risk of getting 13 types of cancer.” Some of these cancers include breast, colon, ovarian, and stomach (gastric).
- The American Cancer Society notes that colon cancer is typically diagnosed around age 68 in men and 72 in women, yet the National Cancer Institute reports a steady rise in cases among adults under 50 since the 1990s.
- “It is likely a combination of factors, including diet and genetics as well as access to care and some environmental factors,” Colorectal Surgeon and Surgical Oncologist Dr. Heather Yeo, on the early onset of cancer in younger adults.
Walker was diagnosed with colon cancer in 2023, and a year later learned it had spread to his lungs. Now, he’s sharing his efforts to take better care of himself with the same honesty he brings to his music.
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Stage 4 colon cancer means the disease has spread beyond the colon to other organs. The liver, lungs, and peritoneum—the lining of the abdomen—are the most common sites of metastasis. Because the extent of spread varies widely, treatment plans must be tailored to each individual.
“A stage 4 can be one tiny spot on the liver, or it could be 100 spots throughout the abdomen, and obviously those patients are going to be treated differently,” explains Dr. Daniel Labow, Chief of the Surgical Oncology Division at Mount Sinai Health System.
“Effective chemotherapy and effective surgery are both important for the best possible outcome, and part of the job is figuring out which one should come first.”
WATCH: Not All Metastatic Colon Cancer Patients Are the Same
Among the thousands who wished him support was fellow country music star Jelly Roll, who also lost a considerable amount of weight in recent years.
“You can do it, brother. I believe in you. Let’s go! Hit me if you need anything,” Jelly Roll said in the comments section.
Cancer Risk and Obesity
Bodyweight can be a sensitive subject for many people on any given day. However, among cancer patients whose treatment and diagnosis may influence their weight, the numbers on the scale fuel an already emotional journey.
The Centers for Disease Control and Prevention (CDC) says, “Being overweight or having obesity is linked with a higher risk of getting 13 types of cancer.”
Research published in the journal “Cancers” says that “Obesity also increases the risk of dying from cancer and may influence the treatment choices. About 4–8% of all cancers are attributed to obesity.”
Some of the cancers associated with being overweight or obese include:
- Colon
- Breast
- Ovarian
- Esophagus
- Pancreatic
- Multiple myeloma
- Endometrial
- Liver
WATCH: Living a healthy lifestyle.
According to the National Cancer Institute (NCI), fat tissue “produces excess amounts of estrogen,” which is associated with an increased risk of certain cancers, including breast, ovarian, and endometrial cancer. The NCI says a person who is severely obese is “7 times” more likely to be diagnosed with endometrial cancer.
Obesity is associated with high levels of insulin, which can lead to colon, kidney, prostate, and endometrial cancer.
Obesity can affect cancer survivors in various ways, including the chance of cancer recurrence and overall quality of life.
To learn more about your ideal healthy weight, determine your body mass index (BMI).
Body weight that exceeds what the body mass index deems appropriate for your weight and height can help determine body fat content. Although your BMI can help you learn if you are at a healthy weight, underweight, overweight, or obese, other factors may contribute to your overall health.
The NCI analyzed several studies to observe the impact of physical activity on overall cancer risk. The NCI says that “higher levels of physical activity are linked to lower risk of several types of cancer.”
Regular exercise, a balanced diet, and managing stress are some ways people can practice leading a healthy life. For cancer survivors, a healthier lifestyle alongside getting regular checks for recurrence may improve their quality of life.
Joshua’s Colon Cancer Journey Was Nearly Misdiagnosed
“My pre-surgery diagnosis was incorrect,” Walker said in a 2023 Instagram post revealing his initial diagnosis.
Walker was first told the cancer “appeared” to have moved into his lungs amid follow-up testing, meaning the cancer would have been at an advanced stage and thus more challenging to treat.
However, Walker underwent a biopsy on his lungs, which found that his lungs were “cancer-free.”
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The Texas singer-songwriter was then diagnosed with Stage 3B colon cancer.
Stage 3 cancer means it’s begun to spread beyond its point of origin within the body. Colon or colorectal cancer affects your large intestine (colon) or the end of your intestine (rectum). He completed six months of chemotherapy, which helped him reach a stage where doctors could not find any “discernible amount of cancer anywhere” in his body.
WATCH: Stage Three Means Cancer Has Spread Outside the Colon Wall
“For stage 3, I’d say the traditional standard of care is fairly uniform, which is surgery, followed by chemotherapy,” Dr. Labow explained to SurvivorNet.
Dr. Labow adds that patients with stage 3 are often cured, with both surgery and chemotherapy.
In September 2024, Walker’s cancer advanced to stage 4 after it spread to his lungs.
“Sometimes with different chemotherapy and surgical treatment, you can get patients to have a complete cure,” Dr. Heather Yeo, a Colorectal Surgeon and Surgical Oncologist at Weill Cornell Medicine and NewYork-Presbyterian.
“A chance of survival is lower than stage 3, but we still get cures even in stage four patients,” Dr. Yeo adds.
Chemo for Colon Cancer
“There are two main situations where we use chemotherapy before surgery,” explains Dr. Paul Oberstein, a medical oncologist specializing in gastrointestinal cancers.
“If a tumor is very large, chemotherapy can sometimes shrink it enough to make surgery safer and more effective. We also consider chemotherapy first in the small number of cases where the cancer has already spread beyond the colon.”
Chemotherapy is a well-established and extensively studied treatment for colorectal cancer, and it has been shown to improve survival. The standard regimen is called FOLFOX, though doctors may add medications such as irinotecan (FOLFIRI) or cetuximab depending on how the tumor responds and the specific characteristics of each patient’s cancer. We’ll explore these options in more detail later.
WATCH: Chemotherapy Before Colon Cancer Surgery
In some situations, surgery isn’t possible because not all tumors can be removed. When that happens, the focus of treatment shifts to controlling the disease—slowing or stopping its growth, preventing further spread, and reducing symptoms.
“The reality for most people with metastatic colon cancer is that surgery isn’t an option, meaning the cancer can’t be completely removed,” Dr. Oberstein says.
He notes that patients with inoperable metastatic disease will live with their cancer long‑term. “Our role is to partner with them—using chemotherapy or other emerging treatments—to keep the cancer controlled for as long as possible while minimizing side effects. For many, that means moving through a series of treatments over time.”
Expert Resources on Colorectal Cancer
People Under 50 Diagnosed With Cancer
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.”
WATCH: Debunking misconceptions about colon cancer.
“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.
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.
Coping With an Advanced Colon Cancer Diagnosis
“The first-line (initial treatment) chemotherapy for metastatic colon cancer, if they’ve not seen any other chemotherapy before, is the standard FOLFOX,” Dr. Yeo explained to SurvivorNet.
“Most colon cancers do respond to FOLFOX. If you respond really well, then we keep you on that until you stop responding really well. But if after a few cycles your disease has progressed, that’s when we think about adding additional chemotherapies,” Dr. Yeo continued.
WATCH: Managing Metastatic Colon Cancer
The cancer starts when abnormal lumps called polyps grow in the colon or rectum. If you don’t have these polyps removed, they can sometimes change into cancer. It takes up to 10 years for a colon polyp to become a full-blown cancer, according to SurvivorNet experts.
“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: When to get a colonoscopy
Most colon cancers can be prevented if people are regularly screened. The screening usually involves a colonoscopy, in which a long, thin tube attached to a camera examines the colon and rectum. If no polyps are discovered, the following screening won’t be needed for about ten years.
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.
More on Colon Cancer
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.
The cancer starts when abnormal lumps called polyps grow in the colon or rectum. It takes up to 10 years for a colon polyp to become full-blown cancer, according to SurvivorNet experts.
The American Gastrointestinal Association lowered the recommended initial age for colorectal screening from 50 to 45. However, experts recommend screening earlier for some people who may be at an increased risk of developing colon cancer, such as those with a family history of the disease.
WATCH: Debunking misconceptions about colon cancer.
The most poignant signature of colon cancer includes a change in bowel habits. This may include constipation or diarrhea due to changes in the size or shape of bowel movements. A change in stool color, particularly black or tarry stools, can indicate bleeding from a tumor that lies deep in the colon.
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 of time, resulting in anemia (low red blood cell count) that is picked up on blood work.
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?
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