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

Question

Hello doctor,

I am a 30-year-old male. My height is 5 feet and 7 inches, and I weigh about 191 pounds. For the past four to five years, I have been suffering from indigestion. This got more serious in 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 blood tests. It revealed most of the levels to be normal, except for a mild elevation of ALT (alanine transaminase) and AST (aspartate aminotransferase) levels. Then he ordered an ultrasound, which showed I have a fatty liver, though I rarely drink alcohol. Also, H. pylori 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 three times 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 hemoglobin 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 the FOBT (fecal occult blood test) test. All three samples showed negative, and no blood was found in the stool. Recently, he has ordered a colonoscopy, which I am waiting for, and I am really worried that I might have colon/rectal cancer. My question is, does a 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.

Answer 1

Hello,

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. Overcorrection of thyroid hormones can cause anemia, as well as loose stools. In your case, the decreasing trend of hemoglobin is most likely because of thyroid issues or nutritional deficiencies rather than colon or rectal cancer. However, 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 for one year.

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

Answer 2

Hello,

Welcome back to icliniq.com.

With this new information, it is very likely that your excess medication is the cause of both your loose stools and your decreasing hemoglobin levels. You are right on both accounts. If it were cancer, the symptoms would have increased by now; very rarely, exceptions are possible, and a normal FOBT is an indication that you were not losing blood when the test was done. Had there been a cancer growing for 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.