Sisters Receive Young-Onset Colorectal Cancer Diagnosis Less Than One Year Apart

Groggy from a 6-hour surgery, Heather Russell was desperate to know the outcome of her operation.

If Cleveland Clinic colorectal surgeon Michael A. Valente, DO, was able to preserve her lower rectum during the surgery to remove her remaining cancer, a temporary ileostomy pouch would be on the right side of her abdomen.

If it were on the left side, that meant he would not have been able to save enough of the rectum and a colostomy pouch would be needed for the rest of Heather’s life. She was 35 years old at the time.

Heather, now 40, a mom to three young boys and the Economic Development Administrator for the city of Green, Ohio, recalls her husband telling her it was on the right.

That revelation was a major victory during her struggle with colorectal cancer, which affects the colon and/or rectum in the digestive system. Soon after, she was on the phone to share the news with her younger sister, Courtney Vigars, who a year earlier, at 27 years old, had experienced her own colorectal cancer journey.

“As sisters, we were already close to begin with,” says Courtney, now 33, who is a school counselor and track and field coach at Jackson High School in Massillon, Ohio. “But this just further solidified our bond. We had wonderful support from our family and friends, but only Heather and I really knew how we felt and what we were going through.”

While it’s unusual for two young siblings with no family history of the disease to face it simultaneously, the prevalence of people under 50 contracting colorectal cancer has risen significantly in the last decade, according to Courtney’s colorectal surgeon David Liska, MD.

“In the U.S., we’re seeing incidences of colorectal cancer in people under age 50 going up about 2% every year. Now, it’s the number one cause of cancer deaths in men under 50, and the number two cause in women under 50, after breast cancer,” explains Dr. Liska, who is chair of the Department of Colorectal Surgery and director of the Center for Young-Onset Colorectal Cancer

“The idea that someone is ‘too young to get cancer’ is unfortunately no longer true, and we need to make more people, including doctors, aware of that,” states Suneel Kamath, MD, a colorectal cancer specialist and member of the Center for Young-Onset Colorectal Cancer.

That dramatic rise prompted Cleveland Clinic to form the Center for Young-Onset Colorectal Cancer, which is dedicated to the care of patients diagnosed before the age of 50. Its multidisciplinary team provides young patients facing colorectal cancer with coordinated, comprehensive and individualized care with the goal of optimizing outcomes, quality of life and psycho-social wellbeing.

Initially in 2019, when Courtney noticed blood in her stool, she wasn’t worried. She figured it would go away. She attributed it to stress, as she was preparing for a July wedding.

“I didn’t want to think something was wrong, especially right before the wedding,” Courtney admits. “I was young, fit, in good shape, things were going well for me. Blood in my stool was the only symptom I had.”

Assured by her primary care physician at another hospital that the cause was likely hemorrhoids, Courtney felt relieved except the bleeding continued, more often and heavier.

After a colonoscopy revealed a mass in her rectum, Courtney scheduled a CT scan the day of her wedding rehearsal. While she wouldn’t get the results of the scan and a biopsy for several days, she was determined to have a joyful wedding followed by a 10-day honeymoon in Jamaica.

“I wanted to enjoy this happy time, because I didn’t know what my future would hold when I came back,” Courtney explains.

Doctors at another local hospital diagnosed Courtney with stage 3 colorectal cancer, with a tumor in her rectum. Her care team at the time recommended immediate surgery to remove the aggressively growing tumor in her rectum. Following a minimally invasive transanal surgery, which did not require an ostomy, her surgeons were concerned they may not have been able to remove every trace of cancer. Her doctors referred her to Cleveland Clinic.

The multidisciplinary team that thoroughly examined her at the Center for Young-Onset Colorectal Cancer recommended radiation followed by chemotherapy with the hope any remaining microscopic cancer cells would be eliminated without additional surgery.

Courtney underwent 28 days of radiation followed by four months of chemotherapy. The treatment was effective, but the intense therapies took their toll.

“I was in survival mode,” explains Courtney, who benefitted from mental health treatment during this time. “From the beginning, I kept myself in a positive mindset. With help from my spouse, my family and my school community, I never let myself falter. I told myself I had to get through it to beat cancer.”

Meanwhile, in late 2019, Heather began experiencing blood in and thinning of her stool. She, too, was told by a local doctor it was likely hemorrhoids and not to worry.

For several months, even as her symptoms worsened, she delayed getting a colonoscopy. But at Courtney’s persistent urging, she scheduled the procedure for March 11, 2020, on her 35^th birthday.

“Even while watching Courtney deal with her cancer, I kept thinking ‘there is no way this could happen to two siblings at the same time’,” Heather states. “If not for her, I don’t know if I would have sought help when I did. I feel like my life would have ended up very differently.”

The results of the colonoscopy revealed she, too, had stage 3 colorectal cancer – a mass in her rectum, the lower part of the large intestine. Heather immediately decided Cleveland Clinic would be her choice for treatment.

She underwent radiation followed by chemotherapy, which greatly reduced but did not fully eliminate her tumor.

According to Dr. Kamath, the total neoadjuvant therapy approach has proven to improve outcomes for patients and in some cases can eliminate the tumor without the need for surgery. “For those who do require surgery, the total neoadjuvant therapy approach can increase the odds of fully removing the tumor and reduce the extent of surgery, thereby reducing the need for a colostomy bag on a permanent, lifelong basis.”

Both sisters have recovered well and are in their fifth year of remission. While some side effects remain, healthy eating and exercise have enabled them to return to their lives. They urge others who have symptoms to get them checked out and insist on getting to the root cause, which may require a procedure like a colonoscopy.

“While the majority of people with blood in their stool don’t have cancer, it should be followed up on quickly,” notes Dr. Kamath. “When these symptoms persist for weeks or months, it’s sometimes not a benign cause.”

Adds Heather, “People are losing their lives when they find out too late they have cancer. Colon cancer does not discriminate with age. Know your body and if something is wrong, advocate for yourself.”