Colon cancer is becoming more common in pregnancy: 2 women recall signs that doctors dismissed
Yasmine Garjales’ fifth pregnancy was tough. From the start, she experienced hyperemesis gravidarum, severe nausea and vomiting during pregnancy. When she was about five months pregnant, the then 30-year-old noticed blood in her stool. Alarmed, she informed her doctors.
“I kept mentioning it over and over to the gynecologist to the primary care physicians, but they both thought that it might be hemorrhoids because of my age,” Garjales, 32, of Columbus, tells TODAY.com. “I had no symptoms of hemorrhoids like the itching or burning — none of that. I only had the bleeding and the thin stools.”
This persisted throughout her pregnancy, and then three weeks after giving birth, doctors finally performed a colonoscopy and immediately found a tumor and she was diagnosed with stage 3 colon cancer in April 2022.
“They gaslighted me,” she says. “They seemed to have the same inclination that it would be hemorrhoids but unfortunately that wasn’t the case.”
As cases of colorectal cancer in young people increase, doctors are seeing more pregnant women present with the cancer, too. Diagnosing it can be tricky because some of the changes that occur with pregnancy, such as hemorrhoids, mimic symptoms of colon cancer.
“In the old days we said, ‘No, you’re too young (for colon cancer),’” Dr. John Marshall, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University, who wasn’t involved in Garjales’ care, tells TODAY.com. “You have to think about colorectal cancer and so if you see someone who’s pregnant who’s had a change in bowel habits, you need to prove that it’s not colon cancer.”
Changes in pregnancy
Several years ago, Garjales’ grandmother died of colon cancer, and when Garjales noticed blood in her stool, she worried she had colon cancer, too. While she kept telling her doctors about the changes prior to delivery, it wasn’t until after she gave birth that doctors ran tests to get to the bottom of her symptoms. The day she had the baby, she experienced what she thought was a “gallbladder attack.”
“Fast forward, I kept bleeding—like daily after I gave birth—in my stool,” she explains.
After three weeks of bleeding, she returned to the hospital where doctors admitted her and performed a colonoscopy the next day. They discovered a 3-centimeter tumor that the doctor determined was cancerous.
“I was so upset because this is the same doctor right before I went to sleep that told me, ‘Don’t worry about it,’” Grajales recalls. “The first thing I thought about was my children.”
She felt frustrated that she told her doctors throughout pregnancy and after about the symptoms she experienced and they dismissed them and she was ultimately right.
After the biopsy results returned and she underwent a scan to see if the cancer spread, she had surgery to remove the mass and 42 lymph nodes. Only one was cancerous. Then she underwent chemotherapy, which she calls “the worst experience of my life.” While her grandmother also had colon cancer, test results revealed there was not a genetic link between their cancers.
Not an isolated case
Alyssa Kelly, then 38, had lived with irritable bowel syndrome since her 20s. While pregnant with her son in 2021, she noticed she looked smaller than other moms-to-be.
“I wasn’t gaining any weight through my pregnancy...,” the now 41-year-old from the Auroa, Illinois, tells TODAY.com. She experienced abdominal pain, too. At the time, she wondered if they were simply a part of having IBS and being pregnant. When she was 28 weeks pregnant with her son, she went for a routine ultrasound and afterward a team of eight doctors came into her room. She knew something was wrong.
“They found I had stage 4 colon cancer,” she says.
There was a tumor growing in her abdomen, doctors discovered. And her growing baby was pressed up against it, likely contributing to the pain she experienced.
“They said it was the tumor growing,” she says. “I had no idea.”
Doctors considered delivering Kelly’s baby early, but she carried him to full term. She started chemotherapy while pregnant to try to shrink the tumors. Local doctors were wary about performing surgery on Kelly to remove the cancer, but she received a second opinion from doctors in California who believed the tumor was operable. They removed the tumor, resected her part of liver and part of her colon, performed a hysterectomy and took out lymph nodes.
Almost three years later, Kelly has been through 52 rounds of chemotherapy and has had two more surgeries, including an ileostomy — a surgical opening in the abdomen to allow waste to leave the body if the colon or rectum isn't functioning normally — and having it reversed.
Undergoing chemotherapy while pregnant was “the most difficult thing,” she says. Kelly will most likely always have cancer. Right now, she’s taking a break from chemotherapy but if her scans show that the cancer has spread, she will have to start it again.
“They’re really keeping their eyes on a lot of things,” she says.
Colorectal cancer and pregnancy
Doctors have noticed that for the past 15 years the type of people developing colon cancer has changed, Marshall says. Now more people in their 30s and 40s are being diagnosed with it, according to past TODAY.com reporting.
“The trend is increasing,” Marshall says. “The belief was that bad behaviors — not having the proper diet, not being the right weight, having … some sort of genetic correlation — caused it. But honestly as we’ve watched this evolve, it doesn’t flow with that.”
Marshall says often young patients are fit, active and eat heathy foods and shun processed and fast foods and do not have a family history. While their behaviors might not be contributing to the rise in colon cancer, experts have noticed younger patients have tumors that appear in “a similar location.” Marshall explains that the colon is shaped like a question mark and historically colon cancers could appear in any part of it. This differs in younger people.
“Almost all of these cancers, 90% … are arising in the bottom part of the of the question mark that last little curve,” he explains. “They’re in what’s called the rectosigmoid area and so it’s clearly a phenomenon that’s unique.”
While there are theories as to why it’s occurring more in these groups, experts are still investigating this trend. More cases of young people with colon cancer means that it is appearing in pregnant people, too.
“You’ve got two things that can overlap. You’ve got a young group of 30- and 40-year-olds who get pregnant, a time of joy, but also a time of health changes,” Marshall says. “You have shifting symptoms that occur because of pregnancy that can overlap with a much rarer thing of having colon cancer.”
Pregnancy can cause hemorrhoids and bowel changes, for example, for many.
Symptoms of colon cancer include:
Changes in bowel habits
Changes in quality of stool, such as being thinner
Rectal bleeding
Fatigue
Anemia
Marshall says that pregnant people should absolutely mention any bowel changes to their doctors as Garjales and Kelly did.
“Don’t be ashamed to talk about it. There’s still a lot of hesitancy in mentioning your bowels to your doctor, mentioning blood,” he says. “Some of it’s out of personal embarrassment but make sure they know about it so they can give it the proper attention.”
Often doctors can perform an examination to see if someone has hemorrhoids.
Marshall stresses the importance of “increasing awareness for everyone and putting that in the minds of the physician,” he says. If you feel like your doctors aren't taking you seriously or dismissing your symptoms, you can ask whether their diagnosis is differential — whether your symptoms match more than one condition.
Life today
Grappling with an incurable cancer feels difficult at times for Kelly. She agrees to all the surgeries and chemotherapies to “keep going and keep myself alive.”
“I had my good days and bad days,” she says. “(I've) just got to be patient with myself ... to take one step at a time.”
She enjoys time with her son, Colin, who will be 3 in August. She credits her husband, Chris, and family with helping her get through cancer treatment and raising a baby. Kelly is focused on “being very happy with having a son and having my husband.”
Grajales is currently cancer-free and is undergoing monitoring, which feels challenging.
“The anxiety that comes with these scans, the PTSD, the depression, it’s drowning,” she says. “You would think after you finish chemotherapy, and you hear ‘clear’ life will just go back to normal. But it’s absolutely (gut-wrenching) and so scary to wait.”
While navigating the mental health difficulties of surviving cancer feels tough, Grajales also embraces life in a way she didn’t before cancer. She enjoys taking her children to the water park or Disney or simply spend the day with them.
“I need to value life and appreciate the day that is given to me,” she says. “God gave me a second chance and I must embrace it … and spread my story to get to help so many other people.”
Both women hopes to raise awareness of colon cancer with the Colorectal Cancer Alliance. For her part, Grajales encourage others to speak up if they notice new symptoms or health problems.
“Don’t stop,” she says. “Keep telling them something is wrong. Get the test that you need.”
This article was originally published on TODAY.com
