Katie Rich, a New York-based educator, was perplexed by an unusual soreness in her abdomen that seemed to linger. After recently delivering her third child via cesarean section, the 33-year-old noticed a discomfort in her ribs that hadn’t appeared during her previous pregnancies.

“It wasn’t painful enough to take immediate action,” Rich, who is now a 47-year-old educational administrator, recounted in an interview with the Daily Mail.

Back in 2018, during a routine visit to her OBGYN, she mentioned this persistent pain. Initially, it was attributed to a potential gallbladder issue, a reasonable assumption given her family history—both her brother and mother had undergone gallbladder removal. With this in mind, she scheduled a follow-up appointment with her primary care doctor.

However, just five minutes after conducting an abdominal sonogram, doctors informed Rich that her gallbladder was perfectly healthy. Instead, there was an unexpected finding—a ‘shadow’ on her liver.

Five minutes after performing a sonogram of Rich’s abdomen, doctors called her with news that her gallbladder was fine, but there was a ‘shadow’ showing up on her liver.  

Rich claims the doctor said, ‘You know what? You’re 33 years old. Don’t worry about it.’ Still, he ordered an MRI scan to be safe, which came back inconclusive. A biopsy a few days later, however, revealed a devastating diagnosis: Stage 4 colorectal cancer. 

Despite having no symptoms other than the pain around her ribs, Rich’s cancer was severe enough to have spread from one tumor in her colon to several that covered about 70 percent of her liver. 

At the time, her youngest son was only eight weeks old, she was looking at a survival rate of just 13 percent.

Katie Rich (pictured at right with her husband and four children) was diagnosed with Stage 4 colon cancer in 2012 after suffering just one symptom: abdominal pain

Within days, doctors at Memorial Sloan Kettering Cancer Center in New York City fitted her with a chemotherapy port to start aggressive treatments. 

‘They just kind of hit the ground running because it was bad,’ Rich said. 

Rich is one of a growing number of Americans under the age of 50 to be diagnosed with colon cancer (CRC), squashing the long-held idea that it is an old person’s disease.

Despite the disease decreasing by about 2.5 percent per year in people over 65, a recent report from the American Cancer Society (ACS) found incidence among adults under 50 – which is considered early-onset – has gone up by about three percent yearly.

In fact, 45 percent of CRC diagnoses are in people under 65 years old, according to ACS.

The ACS report also found three in four CRC patients under 50 are diagnosed at either regional (Stage 3) or distant (Stage 4) stage.

Within that group, 27 percent are in Stage 4 at the time of diagnosis, including Rich.

According to ACS data, the five-year survival rate for localized colorectal cancer is 91 percent, which drops to 74 percent for regional cases. But in distant disease, the survival rate drops to 13 percent.

Another study also found CRC to be the leading cause of cancer death in Americans under 50.

And many patients, like Rich, have few or no symptoms, allowing the disease to lurk undetected for months or years and be diagnosed in later, harder to treat stages. 

Common signs like dabs of blood on toilet paper, abdominal pain and trouble passing bowel movements also often get ignored in young patients or attributed to more common, benign conditions such as irritable bowel syndrome (IBS). 

‘I think my pregnancy probably masked a lot of my symptoms, maybe like constipation,’ Rich told the Daily Mail. ‘I always had small bowel issues, but nothing major. I was diagnosed with IBS in my early 20s, but it wasn’t anything debilitating.’ 

Increasing numbers of colon cancer patients also have no obvious risk factors for the disease such as diets high in processed meat, a lack of physical activity and obesity. Rich was a Division I athlete before having kids and always maintained a healthy diet. 

‘It comes as a shock for sure. It doesn’t seem like something that can affect you, being young and healthy,’ she said.

Rich had only had one colonoscopy at age 20, 13 years before her colon cancer diagnosis, to diagnose her IBS. 

Colon cancer also does not run in her family, though her brother had pre-cancerous polyps removed soon after Rich’s diagnosis.

Rich started her first of eight rounds of chemotherapy a week after being diagnosed with colon cancer, which was done with 48-hour infusions. 

The treatment shrunk the tumors on her liver enough to help her qualify for surgery in February 2013, which removed 70 percent of her liver and 30 percent of her colon. While the colon does not regenerate, the liver grows back to its normal size within a few weeks. 

Along with chemotherapy and surgery, Rich also saw a nutritionist and adopted some alternative therapy practices such as Reiki.  

Rich completed her chemotherapy treatments in June 2013 and soon after was declared cancer free. In July 2014, she found out she was pregnant with her fourth child, despite the risk of chemotherapy damaging her eggs and increasing her chance of facing fertility challenges. 

While the family was overjoyed, the news was also ‘very, very scary,’ Rich told the Daily Mail, because Stage 4 colon cancer has a 30 to 50 percent recurrence rate within five years. 

‘I had three healthy kids at home,’ she remembered thinking. ‘Do I risk my life for this?’

Rich and her husband decided to keep the pregnancy, and their fourth child, a daughter named Hope, was born in April 2015. While Rich has not suffered any recurrences and her baby was born healthy, she knows the risk was real. Keeping the pregnancy, she said, ‘was a very, very tough decision to make.’

After completing chemotherapy, Rich found out she was pregnant with her fourth child, a daughter named Hope, who is pictured above with Rich and her husband

Rich is now cancer free and is encouraging other young patients to look out for the warning signs and listen to their bodies 

‘During cancer, I felt like there really weren’t hard decisions because we had one goal. No matter what the doctor said, we said to do it. We wanted to survive. Here, we had a decision to make, and it was hard,’ she added. 

Rich had her hepatic artery infusion (HAI) pump, which delivered maintenance chemotherapy directly into her liver, removed in 2024 after it was first inserted for chemotherapy in 2012. She has scans every 18 months to check for recurrence and undergoes a colonoscopy every two years. 

Health authorities in the US recommend adults over 45 have a colonoscopy every ten years, but due to their family history, Rich’s children will have them starting at age 23, ten years before her own diagnosis. 

Along with visiting a doctor for any unusual symptoms, Rich urges other young people diagnosed with cancer to focus on their mindset. 

‘Throughout the whole ordeal, I was very, very positive, and I just had a mentality of: There’s really only one option here, I’m going to beat this,’ she said. ‘The alternative really didn’t cross my mind often. 

‘I really, really believe that your mindset plays such an important part in how your body reacts. Having that positive mindset and idea that there’s always hope is really important.’