Should you assume you CAN’T have stage 4 colon cancer because you “feel fine”? Wouldn’t advanced disease always have symptoms?

You may already be familiar with the symptoms:

• Abdominal pain

• Flat, ribbon-like or pencil-like stools

• Blood in the stools. This can present as red, maroon or a goopy-looking black that doesn’t appear to be the same substance as the stools.

• Feeling of incomplete voiding after having a bowel movement

• The voiding of hard small “balls” of stools – especially straining to do so – alternating with bouts of diarrhea.

• Reduced appetite

• Unexplained weight loss or fatigue

You may also be aware that by the time colon cancer begins causing symptoms, it has spread beyond the colon.

However, is it at all possible to have stage 4 disease yet not experience any of the symptoms?

“Colorectal cancer is so dangerous not only because it’s common, but also because it’s usually a totally silent disease,” says Joseph Weiss, MD, board certified gastroenterologist and clinical professor of medicine at the Medical School, University of California, San Diego.

“It’s rare that it offers any warning signs or symptoms until it has become more advanced,” continues Dr. Weiss.

“Even late in the disease at stage 4, when it has spread beyond the colon, signs of symptoms may still not be present.”

What’s particularly frightening is that the symptoms of colon cancer can have multiple benign causes, which can lead to a delayed diagnosis.

This is why, when one is pursuing a cause for new-onset concerning symptoms, colon cancer should be at the top of the list as a possibility. If that’s ruled out, you can then somewhat relax while non-malignant differentials are investigated.

“The presence or absence of features such as internal bleeding, anemia, constipation, obstruction, and loss of appetite and weight can be due to a variety of causes,” says Dr. Weiss.

“When these signs and symptoms result from colorectal cancer they are influenced by the tumor location and the nature of the cancer.

“These symptoms can be very subtle and develop so slowly over extended periods of time that they are recognized only in retrospect.”

For example, reduced appetite (from colon cancer) that leads to weight loss, or an unexplained weight loss by itself, might be welcome changes for a person who’s had long-term struggles with too much of an appetite or attempts to lose excess weight.

Stool Shape

“A cancer in the proximal (farther from the anus) colon is much less likely to cause constipation or obstruction,” explains Dr. Weiss.

“The material leaving the ileum of the small intestine is called chyme, a semifluid mass of partially digested food and secretions.

“As it’s not solid, material in the proximal colon can easily get around a large cancer.

“In contrast, a similar sized cancer in the distal colon (closer to the anus) is more likely to obstruct the passage of solid feces, creating constipation, obstruction and distention.

“If the cancer is in the rectum or anus the constricting blockage may narrow the stool caliber to that of a pencil, or flatten it into a very different shape than normal.”

Blood in the Stool

Dr. Weiss explains, “Blood from a polyp or cancer in the distal (closest to the anus) colon may be visible if the quantity is enough.

“If the quantity is limited, or arises higher up in the colon, the loss of blood from colon polyps and cancer is mixed into the stool and starts as invisible to the naked eye.

“Although it cannot be seen without testing, it can easily be identified by screening annually from age 45 with a fecal immunochemical test (FIT).

“As the tumor continues to grow larger the loss of blood increases, yet it may still not be enough to be visible.

“As iron deficiency develops from the continued loss of blood, anemia may develop leading to pallor, fatigue, weakness.

“When a routine blood test reveals iron deficiency anemia, colorectal cancer becomes one of the diagnoses under consideration.”

Screening Procedures

“While obstruction, constipation, pain, loss of appetite and weight, blood loss, anemia, excess mucus and narrowing of the stool caliber may raise a warning about possible colorectal cancer, it may be too little warning that comes too late,” continues Dr. Weiss.

“Since signs and symptoms are infrequent at the earlier stages of colorectal cancer, when it’s so much easier to manage and cure, screening programs are strongly advised.

“For the person at average risk screening should begin at age 45, either with colonoscopy or the fecal immunochemical test.

“The FIT test is the easiest, safest, most rapid, inexpensive and sensitive test that can be performed at home annually.

“Colonoscopy is substantially more expensive, invasive, requires sedation, has significant risks, one to several days of bowel cleansing, and time off from work or other activities.

“It does have advantages in that it can be done every 10 years, and can identify and remove polyps.

“The choice of screening tests is expanding with stool and blood tests identifying genetic markers of polyps and cancers.”

NOTE: If a FIT turns up negative, but you’re still experiencing unexplained symptoms, you should speak to your gastroenterologist about a colonoscopy, even if you’re under 45. Younger people can get colon cancer.

Dr. Weiss is the author of Got Guts! A Guide to Prevent and Beat Colon Cancer. He has also presented numerous presentations on various health topics.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


Top image: pressfoto