TORONTO -- Ryan Halladay was 39 when he began noticing blood in his stool. Doctors he visited over the next few months weren't too concerned, dismissing the bleeding as likely being caused by hemorrhoids. A trip to the ER for pain caused by severe constipation was also brushed off. He was given a laxative and sent home.
Had he been a decade or more older, his symptoms likely would have sent up a red flag. But because he was a young adult, a much more serious possibility wasn't recognized.
It turned out the married father of two young girls had colorectal cancer -- a disease most commonly seen in people over age 50, but one that is increasingly occurring in adults in their 20s, 30s and 40s.
"I was 39 years old -- nothing is going to happen to you. You're healthy, you're invincible," said Halladay, who was shocked to learn he had colon cancer.
His diagnosis in late 2015 sent the Mississauga, Ont., family down a path they could never have imagined: he had radiation and chemotherapy to shrink the large tumour, then surgery to remove the remainder of the mass, followed by months of additional chemo.
But in early 2017, doctors discovered the cancer had spread to his liver, leading to a third of the organ being removed. Followup scans over the next several months showed no sign of cancer and the family heaved a collective sigh of relief.
The relief was short-lived: last November, Halladay started to experience back pain. Tests showed he had a new tumour on the outside of his colon. The surgeon told him and his wife, Christina, that it was unlikely more could be done.
"We assumed from that that if the surgeon couldn't do it, we were coming home so I could live it out until I died," he said. "That day was tough and that night was tough.
"And then we woke up the next day and said there's got to be something."
The couple got in touch with Colorectal Cancer Canada, which directed them to the Young Adult Colorectal Cancer Clinic at Sunnybrook Health Sciences Centre in Toronto.
Halladay had radical surgery -- called a pelvic exenteration -- to remove his bladder, prostate and rectum. He now wears two ostomy bags.
"I always say they gutted me like a deer," said the upbeat and positive Halladay, who has returned to work as a financial adviser while undergoing chemo.
Surgical oncologist Dr. Shady Ashamalla, head of colon cancer surgery at Sunnybrook, said Halladay's story is all too common; about 40 per cent of the 250 to 300 patients he operates on each year are under age 50.
While the rate of colon cancer in North Americans over 50 is declining, likely due to screening programs, incidence of the disease is rising "exponentially" among younger adults, he said.
A recent U.S. study found incidence has been going up by about one per cent per year for people in their 40s; 2.5 per cent annually for those in their 30s; and seven per cent a year among those in their 20s, he said.
"Your chances of getting colon cancer as a young adult now is many times greater than it was at the same age in 1990, for example," Ashamalla said. In fact, those born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to people born around 1950.
Doctors aren't sure why some people are developing the malignancy earlier in adulthood, but they point to such risk factors as diets high in red meat, sedentary lifestyles, excess alcohol intake, obesity and in some cases, family history.
Barry Stein, president of Colorectal Cancer Canada, said about 1,500 young adults in this country are diagnosed each year with colorectal cancer, and too often many are dealing with advanced disease because either they or their doctors didn't recognize symptoms for what they were.
Stein and Ashamalla both stress that certain signs -- rectal bleeding or blood in the stool; changes in bowel habits, including diarrhea or constipation, or a change in stool consistency; and persistent abdominal discomfort -- should be scrutinized without delay to rule out cancer.
"It behooves health-care practitioners, now with what we know, to really take any of these symptoms very seriously in all patients, regardless of age," said Ashamalla. "And it's important that patients bring these things to their family doctor or nurse practitioner to make sure they're being investigated and not to just write things off."
It's all about raising awareness, he said.
That's why the Halladays have thrown themselves into efforts to raise money for Colorectal Cancer Canada's Never Too Young program, which is putting on an event in Toronto this Sunday called Bowl'n For My Colon. As of Thursday, participants had raised nearly $170,000 in pledges.
For Christina Halladay, the goal is to make the fundraiser an annual event across Canada, with a longer-term objective of seeing Never Too Young clinics across this country, "because that is the only way that we are going to diminish the number of people who die of this disease."
She also wants to get the message out to young adults that they are not immune to colon cancer and to pay attention to any suspicious symptoms.
Halladay doesn't want others to go through the experiences her family has -- including having to tell daughters Madeline and Lauren, now 12 and 14, three times about their father's cancer diagnoses, seeing them "literally crumble" each time at the news.
With her husband soon to finish his last round of chemo, Halladay hopes that his post-treatment scans will come back cancer-free and continue that way, "so that we can start to put this behind us."
"And instead of living every day waiting for the shoe to drop, we start to just live our lives."
