Stage 3 Cancer: Definition, Diagnosis, Treatment, Prognosis
Diagnosed With Colon Cancer At 7 Months Pregnant: How This Mom Navigated Treatment
While six months pregnant, Amanda Webb felt healthy and strong as she carried on her usual routine of running and biking.
But a few weeks later, her life took a turn she never expected.
Because she was 36 years old, she was considered an advanced age for pregnancy, which meant her doctors recommended genetic screening of the baby. The results initially suggested Trisomy 13, a rare chromosome abnormality in the baby.
"Babies don't typically live longer than a week with that and have severe medical issues, so for about a week, we grappled with the potential that we might have to terminate a wanted pregnancy," Webb told Healthline.
However, a follow-up test of her amniotic fluid showed that the baby was healthy. Her doctors informed her that sometimes cancer cells in a woman can cause false positives in a genetic screening test.
Because a few years earlier Webb was diagnosed with stage IA malignant melanoma after having a mole removed, her doctors ordered further testing.
She went to a melanoma clinic for a more in-depth mole check, but nothing concerning showed up. For extra precaution, the clinic ordered an MRI, which detected tumors on Webb's liver.
"Initially, they thought they were benign and possibly grew during pregnancy, but then things started to get really expedited," Webb said.
She was referred to a high risk obstetrician who admitted her to the hospital for a few days, so she could quickly undergo a CT scan, ultrasound, colonoscopy, and biopsy.
On May 20, 2021, at 31 weeks pregnant, just shy of her 37th birthday, Webb was diagnosed with stage 4 colon cancer.
While a previous history of several cancers is associated with colon cancer, malignant melanoma is not a common one, said Carla Justiniano, MD, a colorectal surgeon at the University of Cincinnati Cancer Center and assistant professor at the University of Cincinnati College of Medicine.
"Being pregnant is really what found the cancer," Webb said.
Because Webb was far enough into her pregnancy, her doctors assured her that she could undergo the same treatment plan that she would if she weren't pregnant.
"I didn't have to do what some pregnant women with cancer have to do in making a decision of starting treatment while pregnant, or finishing out the pregnancy first, or not finishing the pregnancy," said Webb.
Unlike women who are not pregnant, she received her first three chemotherapy treatments while staying in the hospital under the care of antepartum staff who monitored the baby.
"Then I had my C-section to deliver Levi at about 37 weeks," she said.
Three weeks after her son was born, Webb had five more rounds of chemotherapy and then surgery, which removed the entire right lobe of her liver and 20% of her colon. She then underwent five more rounds of chemotherapy.
"I feel really lucky and am absolutely amazed at what [my doctors] were able to accomplish in a matter of seven months," said Webb.
"I was undergoing treatment for months before I knew that a lot of people with stage 4 diagnosis aren't treated to be cured when it comes to colorectal cancer; a lot of them are on chemo for life."
After finishing treatment while being a new mom, Webb said the adjustment to her new reality was more than she expected.
"I thought after finishing treatment it would kind of be a flip of the switch, and things would go back to the way they were, and that was a joke on me," she said.
"After finishing treatment and being so used to being in fight mode, you're released back into civilian life, but cancer is all the sudden a huge part of who you are. It was difficult to navigate that and unpack the trauma."
She found comfort on social media by following different nonprofits affiliated with colorectal cancer. Stories from others going through cancer, as well as survivors, brought her hope.
"I wasn't ready to be transparent on social media about what I was going through…but it was such a huge motivator for me to see these people who had gone through the good, bad, and the ugly," said Webb.
When the organization Fight Colorectal Cancer (Fight CRC) hosted a local northern California hike, she went.
"I just felt like those are my people. Worst club; best members," she said.
In 2023, she went with Fight CRC to Washington DC, to participate in the Call-on Congress, which pushes policymakers to make changes regarding colorectal cancer.
After she returned, she became a 2023–2024 ambassador for the organization. Since then, she went back to DC, led an annual colorectal cancer awareness run with her local run club, and shared her story to spread awareness.
"For me, talking about it helps," Webb said. "I'm not one to be front and center…but if getting on the stage makes people aware that this can happen to young people and pregnant women that consider themselves healthy, then I'll do it."
With the American Cancer Society (ACS) reporting that colorectal cancer is now the leading cause of cancer death in men under 50 years old and the second leading cause of cancer death in women under 50, Webb takes to heart spreading awareness about early detection and benefits of early colonoscopies.
"The issue with the early onset group is it's tough for us to get the access to the screenings when we have symptoms," she said. "People are getting diagnosed with IBS, and for some reason, a lot of people are being gaslighted by primary care providers instead of sent for a colonoscopy because everyone thinks it's still in that older age group, and then we're diagnosed at later stages."
In the years leading up to her diagnosis, she experienced minor symptoms, such as frequent bowel movements and not feeling like she fully emptied her bowel. She chalked these up to being a runner and having a high metabolism. When she brought the symptoms up to her primary care doctor, they suggested she cut out dairy.
"You have to be your own advocate. You know yourself better than anyone else. Don't take 'no' for an answer if you think you should have that colonoscopy," she said. "It's the poop cancer that people don't want to talk about, but we shouldn't have to have digestive issues, something can be done about it."
Colonoscopy still remains the standard of care and can be lifesaving, said Cathy Eng,MD, director of Fight CRC and director of the Young Adults Cancers Program at the Vanderbilt-Ingram Cancer Center.
"[Remember] 45 is the new screening age," she told Healthline. "If you have a first-degree relative, please start screening 10 years earlier than your relative's diagnosis. Also important for others to learn about their family history."
However, she added that while many people think colorectal cancer is hereditary, the majority of cases are sporadic.
"[This] is likely explained by a birth cohort effect where only persons born after the 1950s experienced the increasing rates of colorectal cancer, meaning these people have had different exposures to foods and environmental factors that impact the microbiome and inflammation in their colon, which are thereby thought to drive carcinogenesis," Justiniano told Healthline.
Because early-stage colon cancer often doesn't show any symptoms, she stressed the importance of screening.
"Patients with a diagnosis, especially when caught at screening, are often in disbelief because they feel fine, but in fact, many colon cancer patients are caught early and have zero symptoms, which highlights the importance of a screening colonoscopy," she said.
When caught early, colon cancer is often curable.
"There are many cancers that we cannot screen for, but colorectal cancer is not one of those, and thus we should be appreciative of that and take advantage of it," said Justiniano.
"If patients got their colonoscopies as per guidelines, the incidence of advanced or late-stage colorectal cancer among patients older than 45 should be much lower than it is now, and therefore survival would be much better."
Fight CRC offers a free, medically-reviewed colorectal cancer screening quiz, which can help assess your risk. It also provides guidance on how to discuss screening options with your doctor.
What To Know About Melanoma
Melanoma is a type of skin cancer. Risk factors include overexposure to the sun, having fair skin, and a family history of melanoma, among others.
Receiving an early diagnosis and getting prompt treatment can improve the outlook for people with melanoma.
For this reason, people should keep track of any changing or growing moles. Using adequate protection against sun exposure can help a person reduce the risk of the majority of melanomas.
This article covers the symptoms of melanoma, how a doctor would diagnose it, and ways to treat it. It also explains how best to prevent melanoma.
Melanoma is a type of skin cancer that occurs when pigment-producing cells called melanocytes mutate and begin to divide uncontrollably.
According to the American Cancer Society (ACS), although it is much less common than other types of skin cancer, it can be more dangerous as it is more likely to spread to other parts of the body.
Melanoma can develop anywhere on the body. In those with light skin, it is more likely to develop on:
However, melanoma can also occur:
The ACS estimates that there will be about 100,640 new cases of melanoma in 2024. They also estimate that around 8,290 people will die due to melanoma in 2024.
TypesThere are four main types of melanoma, which include:
In its early stages, melanoma can be challenging to detect. It is essential to check the skin for any signs of change.
Alterations in the appearance of the skin are vital indicators of melanoma. Doctors use them in the diagnostic process.
A person can look out for the following signs:
The ACS offers pictures of different skin cancers to help a person learn how to distinguish between normal and cancerous moles.
ABCDE examinationThe ABCDE examination of moles is an important method for revealing potentially cancerous lesions. It describes five characteristics to check for in a mole that can help a person either confirm or rule out melanoma:
The stage of cancer at diagnosis will indicate how far it has already spread and what kind of treatment will be suitable.
One method of assigning a stage to melanoma describes the cancer in five stages, from 0 to 4:
The more advanced a cancer is, the harder it is to treat and the worse the outlook becomes.
Read more about late-stage melanoma.
Research into the exact causes of melanoma is ongoing. However, scientists do know that people with certain skin types are more prone to developing melanoma.
The following factors may also contribute to an increased risk of skin cancer:
The risk of melanoma is much higher for people with lighter skin color, red or blonde hair, blue or green eyes, or skin that burns easily.
Other risk factors include:
Of these risk factors, only sun exposure and sunburn are avoidable. Avoiding overexposure to the sun and preventing sunburn can significantly lower the risk of skin cancer. Tanning beds are also a source of damaging ultraviolet (UV) rays.
A person can detect the early signs of melanoma themselves by regularly examining existing moles and other colored blemishes and freckles.
People should have their backs checked regularly, as it may be harder to see moles in this area. A partner, family member, friend, or doctor can help check the back and other areas that are hard to see without assistance.
Any changes in the skin's appearance require further examination by a doctor.
Some apps claim to help a person identify and track changing moles. However, many are not reliable.
Learn more about apps for detecting skin cancer.
Clinical testsDoctors and dermatologists may use microscopic or photographic tools to examine a lesion in more detail.
If they suspect skin cancer, they will have a dermatologist biopsy the lesion to determine whether or not it is cancerous.
A biopsy is a procedure wherein a medical professional takes a sample of a lesion and sends it for examination in the laboratory.
The treatment of skin cancer is similar to that of other cancers. However, unlike many cancers inside the body, it is easier to access the cancerous tissue and remove it completely. For this reason, surgery is the main treatment option for melanoma.
Surgery involves removing the lesion and some of the non-cancerous tissue around it. When the surgeon removes the lesion, they send it to pathology to determine the extent of the involvement of the cancer, and to make sure that they have removed all of it.
If melanoma covers a large area of skin, a skin graft may be necessary.
If there is a risk that the cancer has spread to the lymph nodes, a doctor may request a lymph node biopsy.
They may also recommend radiation therapy for treating melanoma.
Melanoma may metastasize, or spread, to other organs. If this happens, a doctor will request treatments depending on where the melanoma has spread, including:
Although there is no sure way to prevent melanoma, the most important way is to limit ultraviolet (UV) exposure. To do this, a person can:
It is essential to apply sunscreen with an SPF of 30 or higher. The American Academy of Dermatology recommends the following:
Learn more about choosing the best sunscreen.
What about vitamin D?The American Academy of Dermatology (AAD) does not currently recommend sun exposure (or tanning) for the purpose of obtaining vitamin D.
Instead, they suggest that healthy adults obtain vitamin D from a diet that includes foods naturally rich in vitamin D or foods and drinks fortified with vitamin D.
Can changing my diet help prevent melanoma?According to 2023 research the effects of nutrients in reducing the risk of melanoma is not clear.
A 2021 article states that it is not currently possible to formulate recommendations for or against any specific diet or foods to help prevent melanoma.
Melanoma is an aggressive type of cancer that can be dangerous when it spreads. However, people who identify a lesion early can have a very good outlook.
The ACS have calculated the 5 year relative survival rates for melanoma. These compare the likelihood that a person with melanoma will survive for 5 years with that of a person without cancer.
The 5-year relative survival rate for melanoma is as follows:
Is melanoma curable?The Skin Cancer Foundation states that melanoma is usually curable if it is found and treated early.
It is important to monitor any changing moles and seek medical attention for any that are changing, irregular, growing, or bleeding.
Melanoma is a type of skin cancer that develops when the pigment-producing cells mutate and divide uncontrollably.
Although less common than other types of skin cancer, it can be dangerous as it is likely to spread to other parts of the body.
A person should speak with a doctor if they notice any new moles or any changes to current moles.
I'm Not Dead Yet! I've Got Cancer And Am Learning To Cope
First Person is a daily personal piece submitted by readers. Have a story to tell? See our guidelines at tgam.Ca/essayguide.
Open this photo in gallery:Illustration by Drew Shannon
I have cancer. I'm going to die. Those are the first two lines in the journal my doctor told me to start. On a Saturday morning in September, I went for a run and later in the afternoon that same GP phoned me while I was buying my groceries and said, "You have metastatic Melanoma, Stage 4.″ What happened to Stages 1, 2 and 3, I wondered?
What is the first thing you think about after hearing that information? My husband is older, he's supposed to die first, not me. And then, I haven't cleaned up all those boxes in the basement yet! There's a lot of junk down there that I don't want the kids to have to go through. That's probably not the first thing most people think about but it did cross my mind.
Most people will get cancer if they live long enough. I'm in my 70s, that's not long enough. So how does one navigate this new world, this new club you didn't ask to join? The hard part is telling your family and friends. Once you get through that and a lot of tears, cancer is a fascinating experience, well, maybe not fascinating but intriguing. I am lucky in the fact that my cancer – melanoma – is not really painful. Unfortunately, it is one of the most deadly cancers.
But where did this melanoma come from? Ten years ago I had a mole removed, a huge chunk of my back taken out, lymph nodes were removed and saw a dermatologist often for follow-up appointments. I did that but still got metastatic melanoma. Growing up I loved to lie in the sun, I wore no sunscreen in those days. Now we know better.
I decided that I would share my treatment with those who wanted to know what was happening. Being a retired teacher, it seemed like the most educational and sensible thing to do. I sent out pictures of me receiving immunotherapy. This is a fairly new treatment for melanoma and encourages my immune system to attack the cancer cells. (I wonder where those cells go once they are attacked?) There were tumours on my back like golf balls and now they are gone. Yeah!
The first month before treatment I was subject to three different kinds of scans so doctors could find out where the cancer is located. Mine is in my lungs, thyroid, right femur, brain and who knows where else. Radiation was scheduled on the knee and the brain since immunotherapy doesn't work so well in those areas. I wondered how it was possible to radiate the base of my skull. Technicians built a mask of my face, then clamped me onto a table. Even though I cannot move, I'm asked if I can turn slightly to the left. I think I looked left but nothing more, and the radiation device rotates around my head. After five treatments I got to take my mask home. I'm trying to see how I can use it for next Halloween.
Once others know you have cancer they want to come visit, wish you well, send positive thoughts, healing energy, offer prayers and make food (before you die). There should be a guide to follow when dealing with friends with cancer. My husband would sometimes act as a "gatekeeper" in the first few weeks in case I was tired. As it turns out I loved the company and well-wishers, especially since I was feeling really good.
The food delivery was the most interesting. Some of my teacher friends offered to provide me with a meal train. Unfortunately, they didn't quite explain what was involved. I didn't know when the food was arriving, and I usually already had dinner made. No problem. That meal became the next day's dinner. A big hug to the wonderful friend who brought the dinner she was already making herself and dropped it off right at dinner time.
So here I am into the third month of treatment and I am feeling no side effects (only a rash), I am walking daily, cooking meals and even vacuuming. I haven't yet emptied any of those boxes in the basement but it is on my list. The oncologist says things are going well. The care at the Cancer Clinic has been excellent and the warm blankets are the best.
I think about MAID, Medical Assistance in Dying. This is a biggie. I felt it was something I should do before I wasn't able to make the decision. Remember cancer is in my brain. I talked with my doctor and the form is filled out. I am dying but maybe not quite yet. There's no deadline to use MAID. It is there if I need it.
When I checked with Dr. Google, I learned a patient with Stage 4 melanoma can live at least five years. I just renewed my passport and went for the 10-year option. You never know …
Mary Gidney lives in Victoria.
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