Q. I often have digestion issues and decreasing Hb levels. Can it be bowel cancer?

Answered by Dr. Arvind Guru and medically reviewed by iCliniq medical review team.


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Hello doctor,

I am a 30 year old male. My height is 5 feet and 7 inches, and I weigh about 87 kg. For the past 4 to 5 years, I am suffering from indigestion. This got more serious in the recent years. It used to occur three to four times every week, especially after lunch. I sought medical help and went to see a general physician, who ordered for blood tests. It revealed most of the levels to be normal, except for a mild elevation of ALT and AST levels. Then he ordered an ultrasound which showed I have a fatty liver, though I rarely drink alcohol. Also, H. pyroli came out as negative. He asked me to take a healthy diet and avoid alcohol. For indigestion, he prescribed Rabeprazole 20 mg every day, which seemed to help, since I did not get any indigestion anymore.More recently, I developed frequent loose motions. On some days, I pass stools thrice and have excessive gas. Over this period, I had four to five blood tests, which revealed that my hemoglobin was gradually decreasing. The first blood work done three years ago, showed my Hb to be 152 g/L, then 148, 143 and now in the last month it was 137 g/L. Also, my RBC count dropped from 4.89 to 4.5 million cells. My latest ferritin level was 194 ug/L. I asked my doctor here, and he ordered FOBT test. All three samples showed negative and no blood was found in the stool. Recently, he has ordered for a colonoscopy which I am waiting on, and I am really worried that I might have colon/rectal cancer. My question is, does negative FOBT and normal ferritin rule out any cancerous growth in the bowel and intestine? I have hypothyroidism and sleep apnea. I have no family history of bowel cancer.

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Dr. Arvind Guru
General Surgery, Surgical Gastroenterology, Surgical Oncology


Welcome to icliniq.com.

  • From your description, you are most likely having NAFLD (Non-alcoholic fatty liver disease). It is caused by an increased fat and carbohydrate intake leading to a fatty liver. Over a long time, like 20 years, it can lead to liver failure and cancer of the liver.
  • You also seem to have GERD (Gastroesophageal reflux disease) for which you have been prescribed Rabeprazole. GERD can cause esophageal cancer in the long run.
  • Hypothyroidism can cause anemia leading to lower hemoglobin levels. Over-correction of thyroid hormones can cause anemia, as well as loose stools.
  • In your case, the decreasing trend of hemoglobin is most likely because of the thyroid issues or nutritional deficiencies rather than colon or rectal cancer. Though a polyp in the colon can also be the cause.
  • Negative FOBT (Fecal occult blood test), and normal ferritin make a bleeding colon cancer unlikely. A cancer does not always bleed. Yet, do not worry about colon cancer. A colon cancer, in your case, is not a probability. Colonoscopy, can however, be done as a part of the evaluation of your frequent loose motions from one year.

So, discuss the above mentioned information with your treating physician. Follow up if you need more information regarding any thing else. Hope this helps.

For more information consult a surgical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/surgical-gastroenterologist


Hello doctor,

Thank you for your time and response. I have a few follow-up questions. I was diagnosed with hypothyroidism three years back, and my TSH level was 7.8. So, I was treated with 10 to 50 mg of Synthroid or Eltroxin. Now, my last reading of TSH was 1.9, after which the doctor reduced the dosage to 0.05 mg. So, is the reduction in hemoglobin levels likely to be due to this? Also, I was wondering that, since my issues are going on for more than a year, will not I be exhibiting more obvious symptoms like pain or bloody stool, if it is cancer? And lastly, may I assume that since my FOBT is normal, I am not losing blood through stool?


Dr. Arvind Guru
General Surgery, Surgical Gastroenterology, Surgical Oncology


Welcome back to icliniq.com.

  • With this new information, it makes it very likely, that your excess medication is the cause of both your loose stools, as well as your decreasing hemoglobin levels.
  • You are right on both accounts:
  1. If it was cancer, the symptoms would have increased by now. Very rarely, exceptions are possible.
  2. Normal FOBT is an indication that, you were not losing blood when the test was done. Had there been a cancer growing from a year or two, that would not be the case.
  • So, I think it is important for you to get your thyroid medications optimized. Then everything shall fall in place.
  • About the cancer risk, your young age and lack of any cancer-specific symptoms, make colon cancer unlikely.

For more information consult a surgical gastroenteologist online --> https://www.icliniq.com/ask-a-doctor-online/surgical-gastroenterologist

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