Thinking back to her week-long stay in the hospital, one memory stands out to Laura Jambrovic amidst the endless tests, beeping of machines, sleepless nights and morphine-dulled pain—her toenails, painted pink.
She had had them done for her graduation from McMaster University just two weeks prior. Now, they were peeking out from the too-short blanket on her gurney as the hospital orderly wheeled her through the halls for yet another test, singing gently to her in Italian.
Before being admitted to the hospital early in the morning on Friday, June 24, 2016, after spending the night vomiting and in severe abdominal distress, Laura had spent most of the previous year dealing with debilitating cramping, bloating, irregular bowel movements and numerous fruitless visits to doctors.
A weekend of tests revealed the source of Laura’s pain—a tumour in the lower colon so large that her doctors called it a “complete obstruction.” Surgeons removed a thirty-centimetre portion of her colon and performed an emergency colostomy—a procedure that brings one end of the colon through an opening in the abdominal wall, where a bag is attached to collect stool. The tumour and a cluster of the surrounding lymph nodes were sent for testing.
Ten days later the results came back.
I had to attend a wedding that weekend and the doctors didn’t know what was wrong with Laura yet so Dad told me not to worry.
“Try and have fun,” he said. “I’ll keep you posted.”
I knew she had been dealing with a lot of discomfort for the past year and part of me was happy that at least now she might finally get some answers.
Laura and I have always been close despite our age difference. She is three years younger than I am, but we’ve always looked and acted so similarly people have often assumed us to be twins.
As the older sibling, I was always giving Laura guidance and advice, but for the first time in my life I couldn’t tell her I knew what she was feeling, I couldn’t say: “Don’t worry, I’ve been there and it will get better.”
All I could think was: “Why couldn’t it be me?”
During her treatment and recovery, Laura and I spoke at length about her illness.
“In hindsight, there were signs I had problems stretching back before high school,” she told me. For years, she took Metamucil to combat irregular bowel movements, and she struggled with constipation and cramping throughout the years, but she always attributed it to diet.
By June, 2015, her symptoms worsened － cramping became severe and she had blood in her stool. At times, the pain grew so bad, she didn’t want to get out of bed. Multiple blood and stool sample tests revealed nothing conclusive, but doctors suspected irritable bowel syndrome (IBS).
A health and fitness buff, Laura became even more conscious of her diet, keeping a food diary to try and find a pattern between what she ate and her symptoms, but no pattern emerged and she began to despair.
At one point, feeling “trapped and hopeless,” after leaving another unsuccessful doctor’s appointment, Laura broke down. While waiting for the bus she needed to take her home, she spied a nearby dumpster and hid behind it so no one would see her cry.
Cancer was never even mentioned until her trip to the emergency room.
The technical name for Laura’s diagnosis is low grade colonic adenocarcinoma in the sigmoid colon. The colon, also known as the large intestine or bowel, is a muscular tube measuring about 1.5 metres long that dehydrates the leftover remains passed along by the stomach and small intestine, turning it into stool.
Sometimes the cells lining the colon or rectum become abnormal, forming non-cancerous tumours or growths called polyps. Not all polyps turn into colorectal cancer, but colorectal cancer almost always develops from a polyp. When a cancerous polyp gets large enough, cancer cells can then grow into the organ wall, gaining access to blood and lymph vessels, enabling it to spread.
The days following Laura’s trip to the emergency room in June 2016 were an emotional whirlwind. My drive home was a blur of barely-contained panic, but the twin, haunted looks my parents gave me when I walked in the front door will be with me until the day I die.
As the days passed, crushing fear, sadness and pain gave way only to frustration, anger, guilt and self-pity. We agonized over the events of the previous years—could we have done more? How could this have happened? How does a seemingly healthy 22-year-old get a disease like this? And perhaps most important: Why wasn’t it caught earlier?
Cases like Laura’s are so unusual that her surgeon told her she is the youngest colorectal cancer patient he had ever operated on.
However; a recent Canadian study, Trends in colorectal cancer incidence and related lifestyle risk factors in 15–49-year-olds in Canada, 1969–2010, shows that while overall colorectal cancer incidence rates in Canada have declined slightly since the mid-90s, incidence rates in those aged 15–49 have actually increased, especially in the 15–29 age group, “in whom the incidence rate increased 6.7% per year between 1997 and 2010.”
Dr. Prithwish De, co-author of the study and the Director of Surveillance and Cancer Registry at Cancer Care Ontario, said the increased rates of young-onset colorectal cancer were “surprising” because it is typically thought of as being an older person’s disease. He calls the study’s results “alarming.”
Ultimately, testing revealed that Laura does not have any known genetic markers associated with young-onset colorectal cancer, but about 30% of young-onset cases develop in those with a family history of the disease or genetic disposition, and both the U.S. Preventative Services Task Force and the Canadian Task Force on Preventive Health Care recommend regular screening beginning at the age of 40 for these high-risk individuals.
For Canadians at an average risk, screening is recommended for people aged 50 to 74. Despite rising young-onset incidence rates, screening is not recommended for average-risk individuals under 50.
Diagnosis is tricky in young people like Laura, because of the similarity of colorectal cancer symptoms to other, less serious, gastrointestinal problems like IBS, or an iflammatory bowel diseaese (IBD), such as Crohn’s or ulcerative colitis. Further complicating diagnosis, Canada also has one of the highest rates of IBS, with five million－predominately female－Canadians currently suffering.
Dr. De believes that a team effort is required to combat delayed diagnosis.
“The healthcare community definitely needs to be more aware of the rise in colorectal cancers in young people,” Dr. De said. And “symptoms need to be communicated more clearly,” but there also needs to be greater vigilance among young people.
In the weeks immediately following her June 2016 surgery, Laura did her best to keep her spirits up. Her physical and mental wounds were still raw, however, and the reading she did on treatment side-effects and long-term survival rates were depressing. The week-long stay in the hospital was hard on her body, causing her to drop from a muscular 142lbs to a too-lean 130lbs. The incisions in her abdomen were tender and she had no energy, often growing light-headed and occasionally fainting.
The colostomy bag was inconvenient and made her feel unattractive, but what really weighed on her, especially at first, was the idea that she might never be able to push herself in the gym like she used to. For her, the gym is a sanctuary where she can clear her head, and especially in the initial few weeks of post-op shock, thoughts that that had been taken from her were especially crushing.
“I hid my gym stuff. It [was] just so hard to look at,” she told me when we sat down that summer to formally discuss her illness. “The hardest part to come to terms with was not being able to do things I love.”
The year following Laura’s diagnosis has been a roller coaster. After the initial panicked days and weeks, I buried myself in research, hoping that an understanding of why and how this had happened would be cathartic.
Meanwhile, Laura began her treatments. Prior to chemotherapy, she underwent oocyte cryopreservation—the process of freezing and storing her eggs—to guard against any potential fertility issues caused by treatment.
Fears that treatment would be unsuccessful－or that it would be successful, but with terrible side-effects－kept her awake at night. More than once she caught herself staring at her long, blonde-streaked hair, anxious that she might lose it.
The worst part for me was knowing that she was going to have to deal with these side effects without knowing until treatment was finished whether it worked or not.
But Laura was determined to regain a degree of control. Within a few months of beginning her twice-monthly chemotherapy treatments, she returned to the gym despite frequent bone-deep weariness. When her hair started falling out she cut it short and was able to donate it to other cancer patients. She even joined a dog-fostering group.
Slowly, a feeling of normalcy began to return.
Before I knew it, it was February 2017, and Laura had her final dose of chemotherapy. We waited, breath held, for the results of her follow-up colonoscopy. And then we got the results.
No sign of disease. Her colon, at least, was clear.
The vice grip on my heart I had forgotten was there, released, and I felt like I could finally begin to relax again. A few weeks later, she adopted a puppy, fulfilling a lifelong dream, and towards the end of April she had surgery to reverse her colostomy. When I visited her at the hospital, she had a big grin on her face. The mood could not have been more different from her initial visit. Laura kept feeling at her side, not quite believing that she was whole once again.
“I can’t believe it’s finally gone,” she said. “It feels so weird.”
It wasn’t all good news － a follow-up CT scan done around the same time as the colonoscopy revealed a couple of small spots on her liver and a lung that doctors wanted to keep an eye on. We were nervous, of course, but after all the worry and frustration of the previous year, this felt minor. Laura returned to her part-time job and began planning a trip with a friend, pending the results of her next follow-up appointment.
On July 20, 2017, she was given the all-clear from her surgeon. The spot on her liver is nothing to worry about, and though they are going to keep an eye on her lung, there was no reason she should not go on her trip. Just three weeks later, she was on a plane to Amsterdam.
When I woke up one morning to a series of frantic Facebook messages from Laura detailing her misadventures with the German train system, I couldn’t help it － I laughed. A similar awakening prior to her diagnosis would have given me fits, but now it feels so good to be able to give her advice from my own experiences again.
“Don’t worry, Laura. I’ve been there and it will get better.”
David J, Laura’s brother
“I promised myself that if I survived I would live—really live. I regretted letting fear hold me back, and vowed to give life everything I had if I made it out of this journey alive. I have since applied to nursing programs and am anxiously/ eagerly awaiting a reply. It is my hope to one day work as a paediatric ostomy care nurse. I have also gone backpacking across Europe, and plan to visit Southeast Asia next year. I never would have done these things had I not had cancer – for that I am incredibly thankful. Cancer did not teach me to be fearless, but to go on despite fear. ”