Living With Metastatic Colorectal Cancer
- Mary-Beth Cleator, a 31-year-old mother of three, was misdiagnosed with pelvic inflammatory disease and endometriosis — delaying the discovery of her stage 4 bowel cancer (also called colon cancer), which may have gone undetected for up to two years.
- Despite repeated hospital visits and worsening symptoms, Cleator followed medical guidance until severe bowel obstruction and weight loss led to a proper diagnosis. Her cancer had already spread to her liver, bones, and abdomen.
- 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.
- Surgery and chemotherapy are common approaches to colorectal cancer among metastatic colon cancer patients; multiple treatment options exist, including surgical and non-surgical options as well as clinical trials.
- Colorectal screenings are recommended to begin around age 45. However, people at increased risk – such as having a family history of the disease – may want to screen sooner. Discussing your screening options with your doctor is recommended.
“It made me feel angry,” Cleator told the Nottingham Post.
WATCH: How Are Endometrial Cancer and Endometriosis Different?
“Endometriosis is the term for whenever those endometrial cells… are outside of their normal place,” explained Dr. Bobbie Rimel, OB/GYN and oncologist at Cedars-Sinai. “It is a benign condition.”
WATCH: Coping With a Metastatic Colon Cancer Diagnosis
Cleator’s turning point came earlier this year when she experienced severe bowel blockage and rapid weight loss — symptoms that finally prompted deeper investigation. That’s when doctors confirmed stage 4 bowel cancer, which had already spread to her liver, bones, and abdomen.
“There are different types of bowel obstruction,” said Dr. Heather Yeo, colorectal surgeon and surgical oncologist.
WATCH: Treating a Bowel Obstruction Caused by Colon Cancer
“When it’s due to cancer, it’s often a more aggressive form that’s spread. Large bowel obstruction is a surgical emergency,” Yeo explained further.
Her doctors apologized, acknowledging that bowel cancer can sometimes resemble endometriosis in its early stages. But for Cleator, the apology didn’t erase the missed opportunities for earlier intervention.
Now, she’s exploring clinical trials and advanced treatments to improve her quality of life while living with metastatic disease. For most patients with stage 4 colorectal cancer, chemotherapy remains the cornerstone of care — with regimens like FOLFOX, FOLFIRI, and targeted therapies such as cetuximab offering hope for extended survival.
“There are multiple treatment options available,” Dr. Yeo noted, “depending on the location and extent of disease, and the patient’s overall health.”
Cleator’s story is a powerful reminder of the importance of listening to patients — and the cost of assumptions. Her fight continues, not just for herself, but for her family and many other patients who may be overlooked.
Expert Resources on Colorectal Cancer
What Treatment Options Exist for Colon Cancer?
“There are a lot of advances being made in colorectal cancer,” Dr. Heather Yeo, a colorectal surgeon at Weill Cornell Medicine, 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.
WATCH: Understanding the Function of the Colon and the Rectum
“Those are the areas that people want to be able to target a little bit more. We’re getting close to more 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 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.
Understanding 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 a 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 having 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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