Diagnosed at 34, nurse beats rectal cancer

A change in bowel habits is something you should never ignore — no matter your age.

Katie Dutton, RN, was only 33 when she noticed blood in her stool.

“It was the summer of 2022. I was a travel nurse at the time,” Dutton recalls. “I didn’t have a primary care provider in place, so I went to a few different doctors. They figured I had hemorrhoids that were acting up due to constipation and recommended I eat more fiber.”

Adding fiber to her diet didn’t alleviate her symptoms.

The following winter, Dutton started working at MultiCare. No longer traveling around the state for work, she established care with MultiCare family physician Marissa Robinson, MD.

“Dr. Robinson immediately took my symptoms seriously,” she says. “She told me I needed a colonoscopy and tested me for Crohn’s and other autoimmune diseases.”

The tests for those conditions were negative. The colonoscopy, however, revealed a large polyp. Polyps are typically removed during colonoscopies, as they are at risk for becoming cancerous, but this one was too large to remove during the procedure. A biopsy was taken instead, and it came back negative for cancer.

Biopsies continue to show negative results

That’s when Dutton was referred to MultiCare colorectal surgeon Laila Rashidi, MD.

Dr. Rashidi ordered a CT scan and MRI. A CT scan will show if there’s cancer anywhere else in the body; the MRI looks at surrounding lymph nodes and tumor size.

“The CT scan didn’t show any distant metastatic disease — the tumor was local to the rectum,” Dr. Rashidi notes. “The MRI didn’t indicate that it had spread to surrounding tissues, but a lymph node in the area appeared to be involved.”

Although a second biopsy of the mass still didn’t show cancer cells, Dr. Rashidi and Dutton’s medical oncologist, Jennifer Slim, DO, continued to suspect cancer.

“Dr. Slim said it looked like cancer on the MRI, but the biopsies kept coming back negative,” Dutton says.

The standard protocol for rectal cancer is chemotherapy and radiation, then surgery. But because there was no evidence of cancer, she was scheduled for surgery to remove the mass and some of the surrounding tissue so it didn’t have the chance to develop into cancer.

A change of plan

Accredited by the National Accreditation Program for Rectal Cancer, MultiCare Cancer Institute takes a multidisciplinary approach to treatment. Medical, surgical and radiation oncology, pathology and radiology all come together to discuss treatment protocols and patient progress at weekly tumor board meetings.

“Tumor board met the morning of Katie’s surgery,” Dr. Rashidi recalls. “We spent 60 percent of our time on her case that morning. There was a concern the lymph node in question may be related to a cancer, which meant her surgery needed to be canceled.”

A concerning lymph node typically indicates cancer has spread from a nearby tumor, so another biopsy of the polyp was needed. If cancer was found, Dutton would first need chemotherapy. Surgery wouldn’t be performed until after chemo treatment.

“I was all prepped for surgery,” Dutton explains. “I took the pre-surgery antibiotics, I did the bowel prep, I took the disinfectant shower. I was just about to leave the house at 8am, when I got a call from Dr. Rashidi.”

Dr. Rashidi called Dutton right after the meeting to let her know the plan changed.

“I told her not to come to the hospital — we weren’t going to do surgery,” Dr. Rashidi says. “I felt so bad when I called her because she was all prepped for surgery. She was so understanding and said she trusted us.”

Dr. Slim says that Dutton’s case demonstrates how important it is to have a cohesive team.

“Having that multidisciplinary approach allowed the surgeon, oncologist, radiologist and radiation oncologist to get together and agree how to treat her safely and effectively,” she adds. “I couldn’t imagine if we could have treated her in such a timely manner if we didn’t have the tumor board.”

Persistence of care team leads to cancer diagnosis

Upon recommendation of the tumor board, Dutton had a third biopsy of the polyp.

“I’ll never forget — it was Black Friday when Dr. Rashidi called me to tell me the results,” Dutton recalls. “Cancer in the mass was finally found. I started chemo within a week.”

She went through eight rounds of chemo — every two weeks for four months. Her boyfriend Drew was by her side, accompanying her to every appointment.

Dutton with boyfriend Drew at a chemo treatment

“Katie’s partner was very supportive, understanding and inquisitive throughout her treatment,” Dr. Rashidi adds. “They both were truly teammates with us.”

In addition to Drew, Dutton received tremendous support from family and friends.

“My brother, who lives in Seattle, would go hiking with me every other weekend, on the weeks I didn’t have chemo,” Dutton says. “It felt good to get outside and do something active.”

New trial alters course of treatment

Chemotherapy and radiation before surgery is standard care for rectal cancer, but a study called the PROSPECT trial came out around the time of Dutton’s diagnosis that showed in many cases radiation can be avoided.

For Dutton, not having to do radiation of the pelvic area meant she could preserve her fertility.

“The change in plan for my treatment ended up being a good thing,” Dutton explains. “Radiation to the pelvis puts you in premature menopause, and I want to be able to have kids in the future.”

Dutton on a hike with her friend and brother between chemo treatments

“It was advantageous to be able to offer her and her family a new treatment that allows them to maintain their goal as a family,” Dr. Slim says.

After her chemo treatment, Dutton needed one final surgery — a minimally invasive robotic ultra-low anterior resection — to remove most of her rectum and surrounding lymph nodes.

“Katie’s tumor was low, but we were able to preserve her sphincter muscle,” Dr. Rashidi explains. “She started walking on her own the same day and was discharged from the hospital the next day.”

The lymph node in question was tested and found to be cancerous, which meant Dutton needed two more months of chemo.

Since then, Dutton’s had a scan every three months. Tiny nodules were found on her lungs, but she says they aren’t growing and will continue to be monitored. She also has regular genetic tumor tests to check for residual tumor DNA in her blood, which have all come back negative.

Cancer can affect anyone at any time

Dutton had no risk factors for colorectal cancer.

“I’m not a smoker or drinker; I rarely eat red meat,” she says. “I had genetic testing done, and no genetic markers were present.”

Dutton’s experience goes to show that cancer can affect anyone at any time.

“Colorectal cancers are showing up in younger and younger adults,” Dr. Rashidi says. “We don’t why it’s happening, especially to someone like Katie, who is a young, healthy person.”

It’s important to pay attention like Dutton did to any symptoms or bowel habits that are out of the ordinary.

“If you have symptoms like bleeding, don’t think it’s just something benign,” Dr. Rashidi advises. “If it’s ongoing, it doesn’t matter what age you are, you need to get checked to rule out that nothing serious is going on.”