Duke Raleigh Hospital

By Linda Farkas, MD, Duke Colon and Rectal Surgery of Raleigh

Colorectal cancer can run in families.

Anyone diagnosed with familial adenomatous polyposis (FAP), a rare, inherited condition in which tens to hundreds to thousands of benign polyps form in the colon, has a 100 percent chance of developing cancer by the time he or she turns 40.

Seventeen-year-old Austin Brown didn’t have cancer yet, but because he tested positive for FAP, it was certain he would develop it. He lost his mom to colon cancer, and his great grandfather died from the disease at 48. His grandfather is also a colorectal cancer survivor. His great aunt died of colorectal cancer at 36, and four of her five sons have the disease.

His maternal aunt, Holly Huggler, also had the disease and is currently a survivor of early rectal cancer.  When Austin was 16, he underwent genetic testing and was found to carry the gene mutation. A follow-up colonoscopy showed that he already had many polyps throughout his colon. He then made the decision to have his colon removed before his polyps could turn to cancer. He felt it was important to proceed soon, as he had a second cousin die of the disease at the age of 10.

Dr. Ben Hopkins and I performed single-incision laparoscopic surgery, which removed Austin’s entire colon and left his rectum intact. He understands that eventually his rectum will need to be removed. But in the meantime, he opted for removal of just his colon so that there would not be potential issues to prevent him from joining the military – which is his dream. Since he is an active teenage (and since body image is very important for teens), we opted for laparoscopic surgery. Austin chose to have single incision laparoscopic surgery, so the small (3 cm) incision around his belly button is barely visible today.

We operated on Austin’s aunt, too. Holly had early rectal cancer; therefore we had to remove her whole rectum and colon. She also had a desmoid tumor common with FAP that prevented us from reconnecting her small intestine to the anus. So,  she has an ileostomy, which is when the small intestine connects to the surface of the skin. She has not allowed this to stop her from enjoying life; she knows her surgery was life-saving.

FAP accounts for only about 1 percent of colon cancers, and genetic testing can frequently determine if FAP is present.

Most of the time, though, your family medical history need not foretell the future. Just because colon cancer runs in a family, doesn’t mean every individual is going to inherit it. Eating well, getting exercise, maintaining a healthy weight, not smoking and getting adequate sleep can lower your risk.

Screening is important, but it can’t be relied on exclusively. If you have a first-degree relative with colorectal cancer, you should start getting screened earlier. Earlier may mean 40, but if the first-degree relative was young, high-risk screening may need to start as early as your twenties. If there is a family pattern of multiple cancers including colon, ovarian, uterine, gastric and sebaceous cyst cancers, ask your doctor about getting your first colonoscopy in your twenties.

Most people diagnosed with colon cancer never exhibit any signs. These signs include blood in the stool, abdominal pain, anemia and change in the shape or size of stool. But since many people can have colon cancer and feel their healthiest, screening is recommended even without signs, and the age you start is dependent on your family history and race.

Today, Holly and Austin are both doing well. Holly is raising Austin, who will be 18 on his next birthday and plans to fulfill his dream of enlisting.

A healthy lifestyle, regular check-ups and early screening all play a part in preventing and detecting color cancer. Be vigilant, and take charge of your health. Family history is only part of the story. You play a part in the outcome of your own story.

Linda M. Farkas, MD FACS FASCRS is associate professor of surgery in the division of surgical oncology at Duke. She is part of Duke Raleigh Hospital’s colorectal health program, which also includes M. Benjamin Hopkins, MD. Learn more about colorectal screening.