The “Hows” and “Whys”

Bring on the bandages, pressure the wound
It’s a bright, bright red that colors us in
Good for the invalids, downers, and killers
In sick, sick beds and silicone drips

Buzzing towards me
Spirit awakens
A once lived glitch
And that’s how it gets in…

Frightened Rabbit (feat. Julien Baker) “How it gets in”

Why Me?

The thought that this disease- cancer- could strike anyone we know at any moment is completely terrifying.  Fear gives us an innate incentive to try to find ways to distance ourselves from it as much as possible.  We begin to think that it must have been that person’s lifestyle that caused it.  Or maybe their genetics.  Whatever it is, usually falls to some way to make ourselves feel better that it won’t happen to us.  “It affected this other person, but it won’t affect me, because….” 
 
I will readily admit that prior to this happening, I was one of the few who had never been touched closely by cancer.  And because of that, I didn’t feel especially vulnerable.  I would have never formed these words in my head or my mouth, but on some level I just never thought of it as something that would affect me.
 

Why Colon Cancer?

 
When I turned 40 last April, I went in for my first annual physical since, well the year after my youngest son was born (he is 8).  I’ve never been a huge fan of going to the doctor, and once I was through all of the child-rearing years, necessitating frequent appointments with OBGYNs, I just drifted away. 
 
But here’s a truth.  I wasn’t feeling great, and 40 is a milestone age.  It’s time to go in and get my numbers run, and to get all of the recommended screenings.  They did a PAP to screen for cervical cancer, and I received an order to go in and get a mammogram. 
 
Aren’t those the types of cancer (the lady part kind) that are supposed to happen to women as they approach middle age?  My PAP came back clear, but some “abnormalities” were found in my mammogram, so I had to go back for an ultrasound.  Thankfully, they turned out to only be cysts.  Yay, cysty boobs!
 
Colon Cancer was a surprise.  But it shouldn’t have been.  I should have taken the care to talk to my doctor about changes happening to my body and health over the last 2-3 years.  But I didn’t want to sound like I was exaggerating or over-stating what were a collection of minor annoyances.  And besides, I was pretty sure they were due to ageing and stress.
 
The truth is Colon Cancer should have been on my radar.  It’s been dramatically on the rise for people under at younger ages:
 
“Once age is taken into account, those born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to people born around 1950, when risk was lowest….
 
The study found that for adults ages 20 to 39, colon cancer incidence rates increased by 1% to 2% per year through 2013. In adults 40 to 54, rates increased by 0.5% to 1% per year from the mid-1990s through 2013.”
 

Am I to blame for this?

While the study above lists several known risk factors, the truth is that researchers haven’t been able to tie down a single cause for the steep increase:

“Gastroenterologist Robin Mendelsohn helped spearhead an investigation of patient records and found that over the last decade, MSK treated nearly 4,000 people with colorectal cancer who were under 50 years old.

But this trove of data raises as many questions as it answers. “We know risk factors for colorectal cancer include obesity, smoking, and alcohol consumption,” says Dr. Mendelsohn. “But the younger patients we treated actually had lower rates of risk factors, including obesity, smoking, and drinking, than their peers who did not develop cancer.”

Concerns about the Western diet, high in animal fats and sugar, have also proven difficult to pin down. This is in part because colorectal cancer among younger people is rising all over the world, including in Europe, Asia, and Africa, where typical diets vary.”


Why did I get Colon Cancer?  Good damn question. Let’s take a look at my stats against the known risk factors.

Diet

My eating habits are somewhere down the middle.  I’ve never eaten a lot of fruits and vegetables, but I do eat some, mostly spinach, broccoli and peppers.  Perhaps that played a factor.  I enjoy sweets in moderation.  I enjoy meat, but have never over-indulged in red meats.  As a child and up through college I ate a lot of processed food. 
 
I’ve cut back on that significantly over the last 5 years- ironically the same period my colon tumor decided to covertly emerge and grow.  Having kids means that I probably had more fast food than I should have for the sake of convenience.  But I ate healthy foods as well.  In the past several years, I’ve eaten a lot of whole grains, nuts, coffee, green tea, hummus and avocado. 

My blood pressure has always been low.  My cholesterol has always been normal.
 

Exercise

I’ve been in and out of exercise programs over the last 10 years.  Step aerobics and spinning were my favorites for a while.  In my last job, where my tumor sprouted wings, I dialed this back to walking and light yoga.  I tried to walk every day at lunch and do some form of short light exercise before work. 

Around 2 years ago, I tried a couch to 5k running program with my husband and was shocked to discover that my stamina was not what it used to be, and I could not ramp myself up to the higher levels.  I felt like a failure, as that had never happened to me.  Back to light am yoga.  I wasn’t a world class athlete, but I was moderately active.  And yes, I put on weight over the last several years.  This was another thing that I blamed on stress and not having the patience to not eat what I wanted as a way of coping with it.
 

Smoking/Drinking/Obesity

I’ve never smoked.  I do drink, and probably more than the recommended guidelines, but I’ve never been dependent.  Obesity?  Well, I will admit that my weight has crept up over the last 5-10 years (getting older, stress eating, exercise issues above).  I likely fall into the “overweight” category, but I’m not obese.

Conclusions?

I can’t help but think that while I’ve been far from perfect, I’m also pretty far from sitting at home eating take-out, smoking and drinking all day. 
 
Did some of the flaws above give me cancer?  Perhaps.  Perhaps not.  The truth is I don’t know. 
 
Here’s what I do know.  I know people who smoke who don’t have cancer.  I know people who don’t eat ANY vegetables and a ton of processed foods and don’t get cancer.  I know people who drink or have drunk a LOT more alcohol than I do and haven’t gotten cancer.  I know people who lead sedentary lives and never exercise at all that don’t have cancer.
 

What about Genetics?

 
Does the answer lie in genetic causes?  Perhaps.  The genomic testing on my tumor did not reveal evidence of a BRAF mutation or flag any of the commonly known genetic causes such as lynch syndrome. 
 
I did find a BRCA 1 mutation in my raw data file from one of those online testing companies.  I found my mutation linked to a study that linked it to a significant increase of early-onset colorectal cancer in women: 
 
“A recent prospective study of 7015 women with a BRCA1 or BRCA2 mutation identified significant fivefold increased risk of colorectal cancer among BRCA1 mutation carriers younger than 50 years but not in women with a BRCA2 mutation or in older women. Based on this evidence, women with BRCA1 mutations should be counseled about their increased risk for early-onset colorectal cancer, and offered colonoscopy at 3- to 5-year intervals between the ages of 40 and 50 years, and should follow population guidelines thereafter.”
 
 
Is this my smoking gun?  Maybe.  My guess is that it set the stage, and then somehow got “turned on” by something else through the wonders of epigenetics. 
 
 
But that’s just a guess.  Once again, I don’t know.
 
And so here we are.  Colon Cancer at 40.  Colon Cancer that has metastasised at 40.  45 is a stretch goal, with less than even odds.  50 is a long-shot.  55 would be overcoming great odds.  Not impossible, but also not very likely.
 
Do genetics play a factor?  Yes.  Does lifestyle play a factor?  Yes.  Do environmental factors come into play as well?  Yes.  But it is also so much more random and complicated than just those things.
 
About two months ago, I was sitting in a chair at the cancer center, rattling off my birthdate as usual.  Afterwards, they had the older gentlemen next to me rattle off his birth date next.  Mine was 1978.  His was 1938. 
 
This guy had lived my 40 years of life already by the same year I was born, and here we were sitting in side-by-side chairs getting the same treatment! 
 
I imagine that this man’s family was scared for him, but all I could think about?  What I wouldn’t give to have those extra 40 years that this man was lucky enough to receive. 
 
Was that the right thought?  Probably not.  But it was a deeply human one.

4 thoughts on “The “Hows” and “Whys”

  1. I haven’t checked for the same mutations yet, but one thing’s for sure – I’m getting a colonoscopy & anything else you recommend I get as soon as I turn 40! But even then, I agree that there’s no way of really knowing anything when it comes to cancer.

    Liked by 1 person

  2. I’m an editor at WhatIsEpigenetics and this popped up on my radar. My heart goes out to you, and wish you all the best. Interesting that you are considering a genetic counselor, I hope you discover what you are looking for. There has been indication that a tradtionally heavy Western Diet (high carbs, saturated fats) could cause gut bacteria to influence gene expression, potentially leading to colon cancer (source: https://www.whatisepigenetics.com/diet-and-good-gut-bacteria-could-epigenetically-change-your-gene-expression/). All the best.

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    1. That’s interesting! Ironically, I’ve actually reduced my carb consumption over the past 5+ years, and have never been a particularly high consumer of saturated fats. I was even taking pre and probiotics in the year or two before my diagnosis because I wasn’t feeling as good and trying to get healthy. I then thought that some of my symptoms were actually related to the probiotics, contributing to my blowing them off. I wonder whether factors as far back as my “Ramen noodles and canned food” diet in college nearly 20 years ago or my “Ravioli and Lipton soup” diet as a child were enough to seal the deal? What about factors as far back as prenatal (German measles and appendicitis + premature birth couldn’t have been great)? There are just so many factors to consider..

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