Young-Onset Colorectal Cancer: A Changing Landscape—Alexa’s Patient Story

Alexa Morell was on her first vacation after having her son, taking a girl’s trip to Cape Cod when she started to notice symptoms of what would turn out to be colon cancer.

“Never in a million years did I think this would happen to me. I was 29, in the prime of my life, married for a few years, just had my son, everything was going as well as it possibly could and then I found blood in my stool... I didn’t want to stress but I was worried.”

After a week of progressive symptoms Alexa made a call to her doctors and made an appointment to get a colonoscopy that day. On September 11th, 2019, Alexa was diagnosed with Stage IV Colon Cancer, and found out that it had spread to her liver. “I didn’t go in there thinking I was going to get this life changing diagnosis.”

Having had her son a year prior at Emerson Hospital Alexa met with oncologist, John Dubois, MD, who sat with Alexa and her husband and took the time to go over her questions and how colorectal cancer treatment would unfold. “Everything started fast. I had to make the hard decision to not do fertility treatments because I was afraid to delay my care. Within two weeks of meeting all my doctors I had a port placed and started chemo."

A few months after starting treatment Alexa came to the Mass General Cancer Center for surgery. Motaz Qadan, MD, PhD resected 65% of her liver while she finished up chemo amidst the pandemic. A month later James Cusack, MD performed colon surgery in tandem with Dr. Qadan while he removed the remaining cancerous cells from her liver. After, Alexa, Dr. Qadan, and Dr. Cusack celebrated, leaving Alexa hopeful and excited for the future.

“With stage IV things can change at the drop of a hat” and Alexa’s first scan post-surgery showed nodules in her lungs, leading to another round of surgeries. Her spirit could not be shaken. “I consider myself very lucky to have had such limited disease for so long even with all the lung stuff. The fact that my colon and liver are clear is such a good indication.”

Trusting your cancer care team and the process

Alexa felt an immediate sense of trust during her first meeting with Dr. Qadan. “We talked about everywhere we hope that we'd be at in a few months' time, and I remember him drawing a liver and explaining exactly what he was going to do surgically.”

Dr. Qadan knows how important his role is in each patient’s care journey. "You want to try and give a young patient a lot of hope, but on the flip side you also know that it might not always be that case. There are things that are known and things that are unknown, and there are things that we can control and things that we can’t control.”

Regarding Alexa’s diagnosis he says, “Here’s a young person who could stand treatment well, who can recover from a big operation and come out the other end fighting. And a few days after surgery Alexa was running the halls.

Alexa’s care highlights one really important thing for me which is we get to take care of patients with this disease as a team. It's not one surgeon or one medical oncologist or one radiation oncologist, one thoracic surgeon...it's a group of us operating in a multidisciplinary setting. It involves close communication and collaboration; we have the same goal.

You make these strong connections with your patients, the nature of the relationship is very sacred. By proxy we get to learn through the physical, mental, and spiritual part of the healing process.”

Living in the moment and advocating for others

Alexa has not let her cancer diagnosis stop her from living her life. “I’m going to live now and enjoy my life, go on vacations and do fun things with my family and make memories because I know how fast things can change. We spend a lot of time making sure my son has a normal childhood.”

Multiple surgeries, treatments, chemotherapy, and survivors’ guilt all took a toll on Alexa’s mental health. Alexa learned how to manage her anxiety by starting therapy and leaning on her support system and family. Taking action also helped, leading Alexa and her husband Ryan to become advocates for lowering the screening age for colonoscopies to 30 years old in Massachusetts, working with state representatives to spread awareness and drive change. “The screening age is 45 and it’s just not good enough, it is too late for these young-onset patients, the symptoms can be silent,” says Alexa. “I don't really believe in the phrase everything happens for reason, but it does make me feel good that I'm able to do some good through the bad.”

This interview was conducted on May 11, 2022.