Pinpointing pain: Is it cancer or cancer treatment?
While Pregnant, She Developed Hemorrhoids That Never Went Away. It Was A Sign Of Cancer
When Kristina Kelly was pregnant with her second daughter in 2022, she developed "terrible hemorrhoids." At first, she didn't worry too much about them because she knew they commonly occur during pregnancy. When they didn't go away months after she gave birth, she visited her doctor who ordered a colonoscopy. Kelly was stunned by the result —she had colorectal cancer.
"The doctor said, 'We found a four-centimeter mass in your rectum that I'm pretty sure is cancer. It looks cancerous but we won't know for sure until pathology comes back. But I want you to be prepared,'" the 37-year-old from Atlanta tells TODAY.Com. "The scary thing is that at the time I was 36 — it would have been nine years before I ever had a screening colonoscopy discover it."
Pregnancy and lingering symptomsKelly didn't have hemorrhoids during her first pregnancy, but she wasn't too surprised when she got them during her second one. She knew they were a common, but uncomfortable part of pregnancy.
When Kristina Kelly finished chemotherapy to treat her stage 3 colorectal cancer, she rang the bell and then celebrated with husband Sean. She still needs to undergo radiation so she's not finished with treatment, but her tumor is responding well so far.Courtesy Kristina Kelly"I had really bad hemorrhoids like painful, bad bleeding when I went to the bathroom," she says. "I got all the medication for it, and it helped a little bit. But they never really went away." She delivered her daughter, Siena, and began navigating life as a mom of a newborn and toddler. Still, the hemorrhoids persisted. About 10 months postpartum she visited the doctor for another issue and mentioned she still had hemorrhoids.
"(My doctor) was like, 'Oh, let's get rid of them. No one wants to deal with that,'" Kelly recalls. "I just simply asked her, 'Can I get a colonoscopy? I just want to make sure everything's OK.'"
Kelly asked for "peace of mind," and didn't think the test would reveal anything new. Her doctor agreed. But the day before her colonoscopy, she learned it would cost $600 because she wasn't yet at the age for colonoscopy screenings.
"I'm very grateful that I had the money to pay for that because I realize that people don't just have that sitting around," she says. "That colonoscopy saved my life ... And not everybody has the opportunity to do so."
Her doctor immediately noticed the mass that looked cancerous. She had her test on a Friday and worried all weekend wondering what the pathology results would reveal.
"It was the longest wait of my life that weekend. I would just stare at my daughters and cry, not knowing is this cancer? How far has it spread?" Kelly says. "Pathology came back as cancer."
The doctors suspected that the tumor created extra pressure that contributed to her lingering hemorrhoids.
"We did more digging into the causes of my hemorrhoids, and it turns out it was my tumor," she says.
The cancer only infiltrated one lymph node and did not spread to any of the nearby organs, making it a stage 3 diagnosis. Still, the doctors wanted Kelly to start chemotherapy quickly because they didn't want it to grow elsewhere. She completed nine rounds of chemotherapy infusions and will soon start radiation.
"I feel incredibly grateful," she says. "The treatments are working; my tumor is shrinking. My blood work is improving."
Before Kristina Kelly had her chemotherapy port placed, she spent the evening holding her youngest daughter Siena. She wouldn't be able to hold her for a few weeks as she recovered for sugery.Courtesy Kristina Kelly Colorectal cancer in younger peopleMore young people like Kelly are being diagnosed with colorectal cancer and experts remain unsure as to why this trend occurs.
"If you went back to not that long ago, in the '90s, only one out of five colorectal cancers are being diagnosed in people under the age of 55," Dr. William Dahut, chief scientific officer for the American Cancer Society, told TODAY.Com in 2023. "It went from 11% to 20%. That's a big change in a relatively small period of time."
Screening recommendations now encourage people to start colonoscopies at age 45 to try to capture some of these young patients though some develop the cancer prior to the start of screening. That's why understanding the symptoms can be important. They include:
Many people feel awkward addressing their bowel habits, even with their doctors. But experts agree that they should talk to their doctors about any symptoms they notice.
"Patients don't necessarily bring up the symptoms," Dr. David Liska, director of the Young-Onset Colorectal Cancer Center at the Cleveland Clinic, told TODAY.Com in 2023. "It's a topic that people aren't comfortable talking about."
Sharing her storyWhen Kelly completes radiation, her medical team will evaluate whether she also needs to undergo surgery. She feels grateful for the support of her husband, Sean, and her children, Wren, 3, and Siena, 18 months, who motivated her when treatment felt grueling. She hopes others learn from her experience.
"I knew something wasn't right and it had been going on for so long that I had to speak up and advocate for myself," Kelly says. "I talked to so many women who all had hemorrhoids. It's a very common thing and no one talks about it … people just deal with it."
Kristina Kelly wanted to share her experience with stage 3 colorectal cancer to raise awareness so other young people with bowel symptoms will speak to their doctor for possible early diagnosis.Courtesy Kristina KellyKelly encourages others with any troubling bowel symptoms to speak to their doctor about them and not just suffer in silence. While she considered waiting to tell her story until her treatment ended, she knew that raising awareness about early detection could make a tremendous difference for someone else.
"Sharing my story might save someone's life," she says. "This is not something that anybody should have to go through and unfortunately it's happening more and more to younger people."
Liquid Biopsy Has Mixed Performance For Predicting Colon Cancer Outcomes
SAN FRANCISCO -- In separate studies, liquid biopsy produced mixed results for guiding colon cancer treatment.
Adjuvant chemotherapy guided by postoperative circulating tumor (ct) DNA did not lead to higher rates of DNA clearance as compared with patients who did not get chemotherapy. However, ctDNA did show promise for identifying patients with molecular residual disease (MRD) that might benefit from chemotherapy. Additionally, patients who had sustained ctDNA clearance had superior disease-free survival (DFS) as compared with patients who had transient clearance, which was associated with better DFS as compared with no clearance.
In the first study, three of seven patients with detectable ctDNA subsequently had clearance during observation, as compared with one of 11 patients assigned to chemotherapy. The study ended for futility after an interim analysis.
"Using the selected ctDNA assay in this clinically low-risk population, we did not observe an improvement in ctDNA clearance with 6 months of adjuvant chemotherapy, relative to surveillance in this colon cancer population who had detectable ctDNA at baseline," said Van K. Morris, MD, of MD Anderson Cancer Center in Houston, at the Gastrointestinal Cancers Symposium.
"We saw steady enrollment across the conduct of the study, and we believe that this precedent confirms that prospective randomized, controlled trials assessing circulating tumor DNA as an integral biomarker and as a surrogate for minimal residual disease are not only feasible but remain necessary for us to test and confirm clinically relevant hypotheses in oncology," he added.
In future studies, investigators should bank extra blood samples to take into account the continuous evolution and improvements in ctDNA methodologies and assay performances, he added.
In the second study, patients who were ctDNA-positive (+) after surgery but had ctDNA clearance 6 months after adjuvant chemotherapy had a 24-month DFS of 90%. A patient's ctDNA status outperformed clinicopathologic factors for predicting DFS, said Hiroki Yukami, MD, of Osaka Medical and Pharmaceutical University in Japan.
Despite the mixed results from the two studies, ctDNA remains the most powerful prognostic factor for recurrence in colorectal cancer, said invited discussant Aparna Parikh, MD, of Mass General Cancer Center in Boston.
"The tests may change, but the questions remain," she said. "It's critically important to adapt to improving technologies, but as we are demonstrating clinical utility at the same time, we can't wait. There is tremendous opportunity for a better test. We need to start harmonizing the timing of testing. Clearance will be necessary but not sufficient, at least, not yet."
Parikh agreed with Morris that storing samples will be needed in order to compare tests.
"As a community, we should absolutely encourage, and sort of demand, that this happens," she said. "We need larger prospective cohorts with strategies to facilitate efficiency. There is still tremendous opportunity for following the biology of MRD and continuing onward."
COBRA Study
Morris reported interim findings from the phase II/III COBRA study to evaluate ctDNA as a predictive marker for adjuvant chemotherapy in stage II colon cancer. The study included patients with stage IIA colon cancer for whom the treating physician decided adjuvant chemotherapy was not necessary.
Patients were randomized to active surveillance (standard of care) or to ctDNA assay-directed chemotherapy. Patients with detectable ctDNA received 6 months of adjuvant chemotherapy, and those who were ctDNA- entered active surveillance. Investigators chose the Guardant LUNAR tumor-agnostic assay that incorporates both mutation/genomic and methylation/epigenomic markers for ctDNA detection.
Data analysis included 635 patients, 16 of whom tested ctDNA+ -- seven assigned to active surveillance and nine to adjuvant chemotherapy. Six months after baseline detection of ctDNA, 43% of those assigned to active surveillance had ctDNA clearance as compared with 11% of those randomized to chemotherapy. The p-value of 0.98 exceeded the prespecified significance level of 0.35, leading to early termination of the trial for futility.
GALAXY Trial: Key Findings
Yukami reported an updated analysis of the GALAXY trial, including 24-month DFS. The analysis included 2,998 patients with pathological stage I-IV colon cancer and postoperative ctDNA status available. Investigators chose the Natera Signatera assay for ctDNA detection. Assessment of ctDNA status occurred between 2 and 10 weeks after surgery (MRD window).
An analysis of all patients irrespective of disease stage showed a 24-month DFS of 85.9% for patients with ctDNA- status versus 28.9% for ctDNA+ patients (HR 10.53, 95% CI 8.74-12.69, P<0.0001). A separate analysis of patients with stage II/III disease yielded a 24-month PFS of 89.2% for the ctDNA- group and 33.5% for the ctDNA+ group (HR 12.95, 95% CI 9.46-15.34, P<0.0001).
"CT-DNA positivity in the MRD window is predictive of inferior DFS," said Yukami.
Investigators stratified patients according to ctDNA clearance status: sustained, transient, and no clearance. Patients who had sustained clearance had yet to reach median DFS, as compared with a median of 9 months for patients with transient clearance and 3.5 months for no clearance. The 24-month DFS was 90.1% with sustained clearance, 2.3% with transient clearance, and 2.0% with persistently ctDNA+ status (P<0.0001).
Among patients with transient ctDNA clearance, 98% had reversion to ctDNA+ status within 18 months after surgery, said Yukami. Patients who had ctDNA clearance or a reduction in mean tumor molecules (MTM)/mL 6 months after adjuvant chemotherapy had superior DFS (HR 6.72, 95% CI 384-11.76, P<0.0001, HR 2.41, 95% CI 1.42-4.09, P=0.001).
Clearance of ctDNA at 6 months was associated with a 24-month DFS of 57.1% versus not-estimable for ctDNA+ patients. Patients with MTM/mL reductions of 50-100% at 6 months had a 24-month DFS of 51.1% versus 29.0% for reductions of 0-50%.
"CT-DNA status during surveillance is significantly associated with DFS," said Yukami. "Reduction in ctDNA concentration [MTM/mL] at 6 months can also be used to predict clinical outcomes. CT-DNA guided adjuvant strategies will further be established by the ongoing randomized interventional VEGA and ALTAIR clinical trials."
Charles Bankhead is senior editor for oncology and also covers urology, dermatology, and ophthalmology. He joined MedPage Today in 2007. Follow
Disclosures
The COBRA trial was supported by the NIH and Guardant Health.
Morris disclosed relationships with Incyte, Regeneron, Bicara Therapeutics, BioNTech, Bristol Myers Squibb, EMD Serono, Novartis, and Pfizer.
The GALAXY study was supported by the Japan Agency for Medical Research and Development, the National Research and Development Agency, the National Cancer Center, and Alpha-A.
Yukami disclosed having no relevant relationships with industry.
Parikh disclosed relationships with Pfizer, Seagen, AbbVie, Array Biopharma, Taiho Oncology, and Bayer HealthCare.
Primary Source
Gastrointestinal Cancers Symposium
Source Reference: Morris VK, et al "Phase II results of circulating tumor DNA as a predictive biomarker in adjuvant chemotherapy in patients with stage II colon cancer: NRG-GI005 (COBRA) phase II/III study" GiCS 2024; Abstract 5.
Secondary Source
Gastrointestinal Cancers Symposium
Source Reference: Yukami H, et al "Circulating tumor DNA (ctDNA) dynamics in colorectal cancer (CRC) patients with molecular residual disease: Updated analysis from GALAXY study in the CIRCULATE-JAPAN" GiCs 2024;Abstract 6.
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Co-workers Organizing Fundraiser For 32-year-old Claremore Mom Fighting Stage 4 Colon Cancer
TULSA, Okla. — A Tulsa business is rallying to support one of its own, a 32-year-old mom from Claremore who's fighting metastatic stage four colon cancer.
FOX23 met with Jordan Henry, who works as a medical assistant for Tulsa Dermatology to learn more about how the doctors and staff are rallying behind her.
Henry said this journey actually started with an unexpected diagnosis back in July after she went in for a colonoscopy.
"It was a shock, did not expect it at all," she said.
Henry said what began with stomach issues, resulted in the discovery of a 2.5-inch tumor in her colon.
The married mother of a 3-year-old daughter named Hadlee, says she underwent eight rounds of chemotherapy.
She was prepped for surgery to remove the tumor in her colon, when her surgeon made another discovery, spots on her liver.
She and her husband flew to MD Anderson in Houston, Texas, for a second opinion as far as how to proceed.
"I was supposed to be cancer free, I was supposed to wake up cancer free," she recalled. "That was everybody's impression."
Instead, she's preparing to undergo a clinical trial in Oklahoma City next week with a new drug as part of a chemotherapy regimen.
Her oncologist told her she is a surgical candidate to have the cancer removed from her liver and her colon.
His prognosis?
"'We're going to get this out and we think that we have a plan and we think that you're curable,'" she recalled.
"I mean that's the hope," she noted. "That they can get rid of it and I can live cancer free without the fear of it coming back."
She'll return to MD Anderson in Houston for the surgery.
Jordan's not on this journey alone. Her colleagues at work, dressed in "Her fight is my fight" t-shirts are launching a second fundraiser for her right now. They organized one after they found out she had colon cancer.
Regan Geisinger, a certified dermatology tech, is one of the organizers.
"It's hard being a mom to a 3-year-old, let alone a mom working and having to fight for her life right now," Geisinger said.
And it's not just the financial support that matters, the staff and the doctors are very supportive of their colleague.
"We just try to be there as much as we can for her always, 24/ 7, anytime," Geisinger said. "If she wants to come into work, she can come into work. If she doesn't want to come into work, that's fine."
"Whatever she needs us to do, we're going to do for her," she added.
Jordan said this journey has given her a new outlook on life.
"That life is short, I mean life is very short," she said. "Take every moment that you can to enjoy life."
She said she's determined to beat cancer.
She also said being a mother has strengthened her resolve.
"My baby, my baby girl, my 3-year-old, she's my fighting grace for everything, I want to be there when she…for all the things, I've got to get through this so I can."
Her message to others is that 32-years old is not too young to have stage four colon cancer. And don't ignore the symptoms.
She had experienced stomach pain, diarrhea, constipation and blood in her stool before meeting with a GI specialist.
Regular screening, beginning at age 45, is the key to preventing colorectal cancer and finding it early according to the CDC.
To learn more about colon cancer click here.
For more information on how you can help with fundraising efforts for Jordan Henry, you can reach out to Kellie Kirby at Kelliek@tulsadermatology.Com or Regan Geisinger at regan@tulsadermatology.Com .
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