Patient Perspectives: Healthy Father Diagnosed with Colorectal Cancer at 43—With Zero Warning Signs

Podcast Transcript

Dr. Scott Steele: Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Dr. Scott Steele: Hi again, everyone, and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, president of main campus and colorectal surgeon here at the Cleveland Clinic in beautiful Cleveland, Ohio. It's always good to have another guest that's been on the show before, and so I'm very pleased to welcome back Dr. AJ Keshinro, who's a colorectal surgeon on our west side here at the Cleveland Clinic. And today, it is actually with one of my favorite types of episodes that we have, looking into a Cleveland Clinic patient story. And I'm very pleased to welcome Mr. Timothy, aka Tim, Beckner, who is a recent young-onset colorectal cancer patient that we have the pleasure of caring for here at the Cleveland Clinic. AJ, Tim, welcome to Butts & Guts.

Dr. Ajaratu (AJ) Keshinro: Thank you, Dr. Steele. It's great to be back.

Tim Beckner: Thanks for having us.

Dr. Scott Steele: Fantastic. And so, as I said, today we're going to talk a little bit about young-onset colorectal cancer. And just for a little bit of background into this, the American Cancer Society reports rates of colorectal cancer in people younger than 55 years old to be increasing by 1% to 2% each year since the mid-1990s. And when you put that into perspective, it is decreasing in so many of the other age ranges, just unfortunately not in this one. In fact, according to the Colorectal Cancer Alliance, colorectal cancer is now the leading cause of cancer-related death in men under 50 and the second-leading cause of women of the same age group. Consider that fact for just a moment.

Dr. Scott Steele: So to combat this alarming trend, the US Preventative Services Task Force lowered the age at which it recommends colorectal cancer screening from 50 years down to 45. So it's important to understand, colorectal cancer does come with warning signs, and knowing what those are are key to catching cancer early and increasing the chances of a successful outcome. So as I said, today, we are joined by Mr. Tim Beckner, a recent colorectal cancer patient here at the Cleveland Clinic, who we're excited to have on the podcast today to share more about his treatment and advice he can share to our listening population out there about his experience. And also, as I said before, Dr. AJ Keshinro, colorectal surgeon here at the Cleveland Clinic who helped treat Tim and works with colorectal cancer patients daily within our Digestive Disease Institute. So Tim, just give us a little bit of background. Where are you from? What do you do? How did it come to the point that you're here on this podcast?

Tim Beckner: I'm from Cleveland, Ohio. Born and raised in the West Park area. Moved out to Avon two years ago. I'm vice president for Climate-Tech HVAC out of North Ridgeville. I've been married for 13 years, two kids, a 22-year-old and a seven-year-old. And the way that I got to meet Dr. Keshinro, honestly, was just on a follow-up for a mild case of diverticulitis. So that was the first time I got to meet Dr. Keshinro, and that's how I'm ending up on this podcast.

Dr. Scott Steele: Well, we are going to delve in a little bit more there. And for those of you who haven't heard AJ in the past, AJ, give us a little bit of your background. Where'd you train? And how'd it come to the point that you're here at the Cleveland Clinic?

Dr. Ajaratu (AJ) Keshinro: Thank you. I'm from Nigeria. I was born and raised in different countries. Ultimately, moved back to the States for medical school, and I did my general surgery residency at NYU in New York City. Got interested in colorectal from my experience there, from some mentors. And I went to University of Minnesota, where I did a colorectal surgery fellowship. And then, from there, I was recruited to Cleveland. Dr. Steele was one of the key figures in recruiting me over here. So I've been at Cleveland since then and practicing as a surgeon.

Dr. Scott Steele: We are super excited to have both of you here. And AJ, we're super excited to have you here, whoever hired you must be a genius. And so, Tim, can you tell us a little bit more about maybe your lifestyle, hobbies and activities that led up to this diagnosis?

Tim Beckner: So pretty much, I feel like I'm the same as every middle-aged guy there is. I originally was not being treated for any symptoms, I had no symptoms. I went down to Punta Cana for vacation, and when I came back, I had a fever, went to the urgent care. They sent me to the ER, and it was determined that I had salmonella and a mild case of diverticulitis. They ended up giving me some steroids and some antibiotics. And I think within two weeks, all pain, everything was cured, everything was fine. And I ended up going to Dr. AJ two weeks later just as a follow-up for the diverticulitis, and that's when she recommended that we get a colonoscopy just to be safe.

Dr. Scott Steele: Sometimes life has a funny way of turning something that's not great into something that can be life-altering. So AJ, let's start there. So we know that in this particular case, it might be a little bit circular in terms of how Tim got to there, and we'll just put that aside for one second. Tell us about some warning signs that you might be aware of to tell the listeners out there that may mimic some other benign conditions that maybe should spark interest to be able to tell your doctor.

Dr. Ajaratu (AJ) Keshinro: So that's one of the tough things about colorectal cancer, because majority of patients don't have symptoms, especially in the early stages. But if they do develop symptoms, things to look out for will be evidence of GI bleeding, so that means blood in the stool, it could be dark, it could be mixed in the stool. Abdominal pain, rectal pain, changing the bowel habits. So patients will sometimes say they went regular, and then suddenly now, they're going every few days, or their stool is thinner in caliber. So those are the things that you want to listen to, that I listen for as a provider. And then, weight loss is another big one, unintentional weight loss. Patients report they're doing the same activity, they're eating the same food, but somehow they're losing weight. So those are some of the key symptoms, which are not really specific if you think about it, but those are some of the symptoms that I listen for, I ask for, when I see patients, and that will sometimes trigger my alarm bells to do for the workup.

Dr. Scott Steele: So Tim, back to you, give us a little bit of feel. So now, all of a sudden, somebody tells you that, "Hey..." You're down on vacation. Now, you've, all of a sudden, got diverticulitis and a bit of an infectious diarrhea type process. You're feeling better, and they say you've got to get a colonoscopy. Walk me through that colonoscopy, walk me through what they found, and all of a sudden, maybe what you were thinking about when they told you what the results of it were.

Tim Beckner: Yeah. So I think it was approximately a month after Dr. AJ recommended the colonoscopy, and it was just to be safe. She said at that moment, and correct me if I'm wrong, but I believe she said, "I really don't have too much to worry about with you. We didn't see anything in the original CT scan. But since you're close enough to the age of getting it and you did have some abdominal pains, let's just be safe." I had no symptoms leading up to the colonoscopy, felt perfectly fine. The worst part of the colonoscopy, truthfully, was just the cleansing the day before. The procedure itself, there is no pain, you don't feel anything.

Tim Beckner: I remember going into it, not having a care in the world, just like a routine procedure. And when I woke up, I was still a little fuzzy, and I believe Dr. AJ said, "Well, we found something. There is a tumor that's in your large intestine, and it looks like it might be cancer. We're going to go and get a biopsy for it and we'll find out soon. But regardless if it is or not, you're going to have to have surgery." For me, that moment, time just kind of stopped. You think about going, "Okay, what are we doing later on in the year? What are we going to be doing?" And for me, it was like, "I'm not doing anything. We've got to take care of this now. What's going on?" So disbelief, I want to say, is this really happening? It's almost like it was a dream. That's how I felt when I found out the news, kind of in shock.

Dr. Scott Steele: So it ended up that you probably went and got some CAT scans and some blood work and met a bunch of people, and then ultimately found your way to AJ. So can you walk us through a little bit about what treatment, with whatever details you want to share with the listening audience, and how did that go and what was the recovery process like?

Tim Beckner: So like I said, with me, I had zero symptoms. Even up to the point of surgery, I never had any kind of symptoms where I was in any kind of pain. That's why I think my story's a little bit different. If we didn't do the colonoscopy originally, I don't think I ever would've known until it might've been too late.

Tim Beckner: But for the treatment, moving up there, life just kept going forward. There was no restrictions on what I had before surgery. I felt perfectly fine, had no pains, was still being active. And then, once we got to surgery, the recovery, especially when you first wake up, it was painful, I'm not going to lie. Doctor, what kind of surgery was it again? I'm sorry.

Dr. Ajaratu (AJ) Keshinro: It was laparoscopic surgery.

Tim Beckner: Yes, yes. So the abdomen didn't hurt too bad, but it felt like the air that was in there, that was what was the most painful, and that just lasted for about the first night. And then, once you got up and started moving around, things started feeling a little bit better. I don't think my recovery was very bad at all. Pain-wise, with the pain medication, nothing really slowed me down. But I just went through a major surgery and it takes time to heal, and that's the one thing that you have to know, don't overdo things. You have to take your time and let your body heal itself.

Tim Beckner: Well, I might've overdid it a little bit, because you feel perfectly fine, but you have to understand that after that major surgery, you have to let your body recover. So taking medication, watching what you eat, watching your bowel movements, making sure everything's okay, and that was the process, the recovery. And the last time I saw you, I think it was about a month later is the last time we met.

Dr. Scott Steele: So as somebody who's received care here at the Cleveland Clinic, can you touch a little bit on your journey along that process, what it was like?

Tim Beckner: From start to finish, the Cleveland Clinic, I believe everybody that was involved saved my life. From the first time I went to urgent care, I met with the physician assistant, I believe her name was Stephanie Bayer, and she was the one at the urgent care in Avon who pushed down on my stomach, said, "Hey, we're going to send you to the ER to make sure everything's okay." And she could have easily just gave me some antibiotics, knowing where I was at, and been like, "Okay. You'll be fine after you take some medicines." And truthfully, I was fine after I did that. Once I got to Lakewood Hospital, the doctors and nurses, they were fantastic, CT scan. Even after the next day, the doctor and one of the nurses called me just to make sure I was okay, which was very surprising, it was great.

Tim Beckner: Meeting with Dr. AJ, I can't say enough about her, I really can't, and I've told you this a hundred times. You saved my life just by recommending that colonoscopy. Even when we were meeting your office, you said, "If you don't feel comfortable with me, you can go with whoever you want to." It was, "Hey, let's just get this done wherever you feel comfortable." And then, all the way through the surgery, the recovery and even up to today, the Cleveland Clinic has been nothing but great for me. I credit them 100% with saving my life.

Dr. Scott Steele: Well, that's good to hear. And so, what would you say to a young person who may be on the fence about talking with their doctor or maybe they're nervous about a colonoscopy screening process, and again, as we've said, for many patients just like yourselves, they have no symptoms that something could be wrong?

Tim Beckner: I would just say, listen, don't be afraid of anything. Listen to your body. If your body's telling you that something's wrong, go get it checked out. When it comes to the colonoscopy, there's nothing to be afraid of on that. It was one of the easier procedures that I probably have ever done. There is no pain when it comes to it. It's a little nap, you wake up and you just feel like, "Okay, I've got to go home," you're a little drowsy and that's about it.

Tim Beckner: One thing I do want to say though, I did make a Facebook post after surgery, and a bunch of friends and family, I've had five people reach out to me and say that they scheduled their colonoscopy or they went and got it done just because of that post and they found out what happened to me. So I think just going ahead and getting it done, that's the best thing you can do. It's a very easy, and for me, it was preventative. We found it before anything bad could have seriously happened, before it got much worse, I should say.

Dr. Scott Steele: Well, that's fantastic, and truly do appreciate you spreading the word. So AJ, let's transition to you now. So is there a clear-cut reason why we're seeing an increase in early-onset colorectal cancer?

Dr. Ajaratu (AJ) Keshinro: Unfortunately, no. There is a lot of research going on in that space to try to figure out what's going on. It most likely is not increasing genetic risk factor, because the percentage of people with inheritable colorectal cancer is about the same, so we don't believe it's from that factor. Most likely, it's environmental. So it could be anything from the diet to metabolic syndrome to exposures as we're growing up. There's a lot of research into the change in the microbiome of the gut, which is the natural composition of the bacteria that we have in our GI system. So there's been some data showing that there's a change, dysregulation in that can sometimes be related to early-onset colorectal cancer. But there's a lot of research going on in that space. We don't have a smoking gun, per se, about what's causing this, but there's still a lot to be answered in that.

Dr. Scott Steele: So whether you're under or over 45 years old, from a physician's perspective, what would you say to those who, even if they are asymptomatic, a little hesitant to get colorectal cancer screening?

Dr. Ajaratu (AJ) Keshinro: Yeah. So I would say, just to backtrack a little bit, what is the purpose of a screening colonoscopy? The goal is to, for patients who are at risk of developing cancer, is to find things at a stage of polyp, which are precancerous growths. So at that stage, during the colonoscopy, we can typically take it out, treat it and be done with. When that happens, that's a huge win, because one, you prevent the patient from having to undergo something more invasive, and two, you prevent them from getting cancer. So that's why we like to do colonoscopies. Polyps typically don't have symptoms. Patients can have it growing for years and not have any symptoms at all. Similarly, early rectal cancers as well can be growing for years without symptoms.

Dr. Ajaratu (AJ) Keshinro: So patients might not have any symptoms, but have this process going on in their body, so that's why the colonoscopy is crucial. So anyone over the age of 45, I would highly encourage, when you're due for your screening, please get it done, because you might feel fine, you might be healthy. Like Tim just mentioned, he's young, healthy, just a regular guy, has kids, just living his life, and unfortunately, this was going on. So I would say just this can happen to anyone and to get just a colonoscopy done for that reason.

Dr. Scott Steele: So AJ, can you talk a little bit about the risk factors of colorectal cancer, and can people reduce their risk?

Dr. Ajaratu (AJ) Keshinro: So yes, to answer your question, you can reduce your risk. There's a couple of factors that we know could increase your risk of colorectal cancer. Smoking is one of them, not eating enough fiber, eating a lot of processed red meat, obesity contributes, and then family history also contributes. Some of that, family history, is not something you can modify, but the other ones I mentioned are. So active lifestyle, maintaining a healthy weight, eating lots of fiber, less processed meat, could be very helpful, avoid smoking. Those are the things that one can do to minimize their risk, in addition to getting screened. That way, if they have predispositions forming a cancer, they can hopefully find things at the stage of a polyp.

Dr. Scott Steele: I think it's important to point out that, very similar to Tim, you could be in absence of many or if not all of those risk factors and still have it unfortunately happen to you, even in the setting of a negative family history. So AJ, for a young person who may be nervous about a colonoscopy screening, or is a little bit uncomfortable about talking about their bowel movements at all or blood in their bowel movements or change in their stools, what advice can you give them?

Dr. Ajaratu (AJ) Keshinro: Yeah. My advice is it's completely normal to be nervous, a lot of people come into my office very nervous, so just know that you're not alone. And the other thing I would say is if you feel awkward talking to your doctor about your bowel movement and blood in the stool and some of the symptoms, our job is to treat you and not judge and do our job and investigate the reason for why you're having those symptoms. And even if it turns out to be nothing, that reassurance and the peace of mind that you get from being evaluated goes a long way and you gain a lot of knowledge from that visit that can be empowering. So I would say don't be nervous. Talk to your doctor, that's what we're here for. That's why we have a job, that's why we're trained, so we can help you with this.

Dr. Ajaratu (AJ) Keshinro: In terms of the colonoscopy, it's relatively quick and safe, and as Tim mentioned, you go to sleep, you wake up, it's over. There's different ways we can do it sometimes. But most of the time, people do do it with sedation, so you sleep, you wake up. The toughest part is the prep. And I would really encourage a lot of people to really get it done when they're due for it.

Dr. Scott Steele: Some great advice. And now, it's time for our quick-hitters, a chance to get to know each of our guests a little bit better. I'll ask you four questions. Tim, you can answer first on each one of them, then AJ, you're second. So first of all, what was your first car?

Tim Beckner: A 1988 Grand Marquis.

Dr. Scott Steele: AJ?

Dr. Ajaratu (AJ) Keshinro: Mine was a 2022 Tucson Hyundai. So you can hear the word 2022, meaning I didn't get it until a few years ago.

Dr. Scott Steele: Fantastic. And what is your favorite food?

Tim Beckner: Cheeseburgers.

Dr. Ajaratu (AJ) Keshinro: My favorite dish is one of the Nigerian cuisine, it's called pounded yam and egusi, it's very nice. If you ever have a chance, try it.

Dr. Scott Steele: I encourage all of you to Google that and look that up. And so, Tim, back to you, what is a place maybe over the next decade or so on your bucket list to travel to?

Tim Beckner: Somewhere in Europe. Me and my wife talked about doing a trip over to Europe sometime. Paris, something like that. But hopefully one day.

Dr. Scott Steele: AJ?

Dr. Ajaratu (AJ) Keshinro: Yeah, I'm a huge traveler so I have a lot of places on my list. But for next year, I'm hoping to go to Japan and visit the Great Wall of China.

Dr. Scott Steele: It's amazing, amazing, amazing. And then, finally, if you could get one superpower added to your repertoire, what would that superpower be, Tim?

Tim Beckner: Flying. If I could fly anywhere, I can go anywhere, I can get there pretty quick.

Dr. Scott Steele: Fantastic. AJ?

Dr. Ajaratu (AJ) Keshinro: Mine, similar, probably teleportation. Just then, I don't have to worry about the wind in my face and the tears. I just go from one spot to the other, my suitcase is right there with me and I can just live life.

Dr. Scott Steele: Very, very good. So Dr. Keshinro, are there any advancements on the horizon when it comes to colorectal cancer treatment? And can you give us a final take-home message that you'd like to share with our listeners regarding this young-onset or early-onset colorectal cancer?

Dr. Ajaratu (AJ) Keshinro: I think a lot of the advancement is in the medical treatment, to say, with the medical oncologist. So immunotherapy is a huge one, in which they are using your own immune system to fight the cancer. We haven't gotten to a point where surgery is not necessary yet. But ultimately, that would be the goal, if we can treat some of this cancer without even needing surgery. So it's made a huge difference in the rectal cancer space, where some patients ultimately can avoid undergoing surgery. But currently, for colon cancer, we still only use it in patients with recurrent disease or metastatic disease. But there's a lot of work going on there, and hopefully, the goal is one day to be able to avoid surgery. But there's also advances in surgeries itself and the technique. Like Tim mentioned surgery is done laparoscopically with little incisions. But we also do surgery robotically with little incisions, and some of the techniques we use during the surgery is also advancing.

Dr. Ajaratu (AJ) Keshinro: And then, final take-home message I would say is don't be afraid to talk to your doctor about your symptoms. If you're worried, that's what we're there for. Even if it turns out to be nothing, I think just the reassurance could be very helpful. And again, don't forget that some of this cancer can grow without symptoms, so if you are due for your screening, please get it done. If you really, really are opposed to getting a colonoscopy, there's other ways you can get screened as well, so talk to your doctor about it, because I would rather you get some screening done than no screening at all. Colonoscopy is the gold standard, but there are other ways you can be screened as well.

Dr. Scott Steele: And Tim, any final takeaways for our listeners regarding your journey or your experience as a patient here at the Cleveland Clinic?

Tim Beckner: If you are ever questioning the Cleveland Clinic, I give them 100%, an A+. From start to finish, every doctor, every nurse, administrative, anybody that I met that was helping me out throughout the process was nothing but fantastic. Everyone did their job, and because they all did their job, I'm able to be on this podcast saying that I'm cancer-free.

Dr. Scott Steele: Well, I think that last statement is the most important take-home message that we could possibly give, and thank you for trusting us in your health and your care. So to learn more about Cleveland Clinic's accredited colorectal cancer program, or to schedule an appointment for treatment, please call 866.223.8100. That's 866.223.8100. You can also visit clevelandclinic.org/digestive for more information. That's clevelandclinic.org/digestive. And I will also say that we are here at the Cleveland Clinic, one of the few places in the world that has a young-onset cancer center of excellence specifically geared towards patients that are younger with colorectal cancer. And so, Tim, AJ, thank you so much for joining us here on Butts & Guts.

Tim Beckner: Thank you.

Dr. Ajaratu (AJ) Keshinro: Thank you for having us.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.