On a recent outing at a bowling alley, Keith Alexander grinned widely as he nudged his way between his teenage son and youngest daughter as they sat on a long bench. Keith raised his arm to give his middle child a high five; she’d just picked up the spare.
Keith and his family, who had been through so much, enjoyed the simple moment.
Only a few months earlier, Keith, 55, a father of three children, was far from family bowling night.
When the symptoms of colorectal cancer are there
Keith and Dawn, his wife, arrived at the UCHealth Urgent Care Clinic – Harmony Campus in Fort Collins on Sept. 24, 2018, looking to get ahead of what he thought might be gallstones or a bug. He had not been feeling well for several days, and just having been promoted at work, he didn’t want to risk being out sick. He expected to get a prescription and be on his way.
As Dr. Michele Clingenpeel listened intently to Keith, a 55-year-old father of three, explain his symptoms, she sensed something more was going on.
“By what he was telling me, I couldn’t brush it off as just a gastrointestinal bug,” she said. She ordered a CT scan and blood work.
Her hunch was right. Although blood work can’t detect cancer, it revealed Keith had internal bleeding and infection. A CT scan showed a large mass on Keith’s colon and spots on his liver.
Clingenpeel delivered the unexpected and devastating news to the Alexanders: an almost certain metastatic colon cancer.
“I asked her three times, ‘You are kidding, right? You have to be kidding,’” Dawn remembered.
The colon and rectum
The symptoms of colorectal cancer — also known as bowel cancer, colon cancer or rectal cancer, depending on where it originates — can be similar to other less life-threatening issues, such as irritable bowel syndrome, hemorrhoids or infection. Many people who have the following symptoms don’t have cancer. Still, the American Cancer Society recommends you see your provider if you have any of these symptoms.
- Changes in bowel habits
- Rectal bleeding
- Dark stools, or blood in the stool
- Cramping or stomach pain
- Need to have bowel movement but not relieved by doing so
- Weakness and fatigue
- Unintended weight loss
The colon is a muscular tube about 5 feet long that forms the last part of the digestive tract. Together with the rectum, it makes up the large intestine.
The large intestine has an inner lining made up of millions of cells and changes in these cells can lead to abnormal growths called polyps. If they are not removed, polyps can become cancerous and invade nearby areas, such as the liver, which was the case for Keith.
With Keith and many others, symptoms of colon or rectal cancer did not appear until after the cancer established. Testing for colorectal cancer, starting at age 45, is the best preventive measure.
Colorectal cancer screenings can be done through various stool-based tests (repeated every one to three years) or a visual exam, such as a colonoscopy, which is recommended every 10 years. A positive stool-based test must be followed up by a colonoscopy, according to the ACS.
At age 55, Keith had yet to be screened.
Being diagnosed with colon cancer
After the Alexanders shared hugs and prayers with staff at the urgent care, Clingenpeel instructed them to go home and pack a hospital bag. Keith needed to be admitted to UCHealth Poudre Valley Hospital immediately.
A colonoscopy with a biopsy confirmed the cancer.
“It was clear that Keith needed surgery as he was bleeding (internally) and (his intestines) were obstructed by the massive tumor,” said Dr. Terri Marty, acute-care surgeon for UCHealth, who was working the day the Alexanders arrived at the hospital.
While doctors prepped Keith for surgery, Dawn prepared to tell their children, Toby, 13, Amandamae, 11, and Kailey, 6.
Nine years earlier, Dawn had lost her mother to advanced cancer. Her mom had not confided in her about the severity of the cancer, something Dawn felt cheated her out of an honest reaction to her mom’s cancer battle. As a result, Keith and Dawn decided they would be forthright with their own children.
“We didn’t have a lot of details at that point,” Dawn said. “But we all decided we’d stay as positive as we could and bond together.”
With advances in surgery, clinical trials, and aggressive treatment by interdisciplinary care teams, stage 4 colon cancer is no longer considered terminal as it had been a few decades ago, said Dr. Lynn Mathew, a medical oncologist with UCHealth Cancer Care and Hematology Clinic – Harmony Campus.
The start of colon cancer treatment
Less than 72 hours after Keith was admitted to the hospital, he had his first surgery. Dr. Marty removed a large section of the colon to make sure she got all the cancerous mass and, also, 40 lymph nodes.
“If the cancer is going to spread, it’s going to do that along the lymph nodes and blood vessels,” she said.
That’s exactly what had happened. Of those 40 lymph nodes, 30 had been invaded by the cancer. The involvement of more than one or two lymph nodes requires chemotherapy, Mathew said.
“If she hadn’t done that diligent work to get all those lymph nodes, I wouldn’t be around with my family,” Keith said.
Keith did well after the surgery and was released from the hospital a few days later. But in an unfortunate coincidence, he had a gallbladder attack after being home only a few days and returned to the hospital, where Dr. Christian Dennis removed his gallbladder laparoscopically.
“When I left the hospital, it was just such an amazing experience,” Keith said. “They took a bad situation from me and made it as positive as they could.”
Keith’s cancer care team
While Keith recovered from the surgeries, doctors who comprise a tumor board determined next steps.
“One of the things critical with cancer is individualized care plans for patients,” said Dr. Heather Lewis, a complex general oncology surgeon with UCHealth Surgical Clinic – Harmony Campus.
Lewis specializes in complex oncology surgeries of the gastrointestinal tract, and she is the only surgeon in northern Colorado performing major liver surgery (hepatobiliary).
“We recognize guidelines in place that help our process, but everyone’s cancer behaves a bit differently — it’s the biology of cancer — so that is part of what (the tumor board) looks at to create that individualized treatment plan.”
After surgery, Keith had several rounds of chemotherapy. Lewis was then ready to remove the lesions on Keith’s liver.
Executing the plan
It had been six months since Keith’s colon cancer diagnosis at the urgent care, and he was ready for his final surgery — a liver resection.
The lesions could be seen via ultrasound, but a pathologist wouldn’t be able to test them for cancer until they were removed. The hope was that Keith’s chemotherapy treatments had shrunk the lesions enough that Lewis could easily extract all the cancerous tissue.
Surgery was on Wednesday. Three days later, on Saturday, Keith went home with good news.
“I remember telling him early in the morning — he had such a big smile on his face when he got those results,” Lewis said.
The liver lesions tested negative for cancer: Chemotherapy had worked.
“When we see that, it’s a good indication in terms of long-term survival,” Lewis said.
5-year relative survival rates for colon cancer
(Figures are based on people diagnosed with cancers of the colon between 2008 and 2014.)
|SEER stage||5-year relative survival rate|
|All SEER stages combined||64%|
SOURCE: American Cancer Society.
Following surgery, Keith resumed chemotherapy to ensure that no more disease was evident.
In September 2019, Keith and his family united again with his cancer care team to determine if he remained cancer-free. Results showed no sign of disease. He will continue regular CT scans to make sure the cancer stays away.
“We all got a bit emotional,” Lewis said. “After he’s been through so much and then to see that response, it was a really big victory. It’s special to be part of that. It’s a memory that really sticks with me.”
Returning to say thanks
Keith recently returned to the urgent care where it all started to convey his appreciation to the staff.
“I’ve come a long way since we’ve last seen each other,” Keith told Clingenpeel and one of his registered nurses, Pam Schrock. “It’s been a rocky road, up and down with surgeries, but I can see the daylight. So I’m excited.”
It was a humbling experience for Clingenpeel.
“It really makes you step back and think, ‘I can make a little difference in people’s lives,’” she said. “All the trials and tribulations of this job are worth it when there is a positive thing like Keith’s story.”
Keith’s continued in his thankfulness for the staff.
“It’s not what they do, but how they do their job that really makes a difference,” he said. “They were always smiling, always upbeat — from my surgeons to nurses to individuals taking my blood.”
Keith’s doctors reciprocated that admiration back to Keith and his family.
“Keith was a superstar working through his treatment,” Mathew said. “He had to have motivation to go through all that — it is not a walk in the park. He and his wife get all the credit.”
Maybe it was a little of both, Keith admitted.
“Sometimes the man upstairs just surrounds you with the right people,” he said.