Gastrointestinal cancer surgeon Anton J. Bilchik, MD, will never forget the day he met Annie Clausen. He was needed for a consult—the way he is needed almost every day at Providence Saint John’s Health Center. But this case was unusual, a nurse told him. The colorectal cancer patient was a young woman who was pregnant.

“The combination of hearing that a young person, being diagnosed with colorectal cancer, who was four months pregnant, was a day I’ll never forget because then it occurred to me that we have two lives to save,” says Dr. Bilchik, who is chief of general surgery, director of the gastrointestinal and hepatobiliary program, and director of the gastrointestinal research program at Saint John’s Cancer Institute. Dr. Bilchik is also co-director of the Digestive Health Institute at Saint John’s.

The three years that followed that day in 2019 have been a story of determination, courage and success as Saint John’s caregivers rallied around a remarkable woman and her family. Today, Clausen, 37, is the mother of two healthy young children and is grateful for the treatment that has allowed her to move forward with her life.

“For me, survival was about staying positive and having confidence in my doctors and my team. It takes a village,” the Calabasas resident says. “There really aren’t any other words than just ‘thank you.’ Dr. Bilchik played such a huge role in getting me to where I am today and making me feel comfortable.”

The case captures many of the factors that Dr. Bilchik has worked to develop at the renowned gastrointestinal and hepatobiliary program at the institute: leading-edge surgical techniques, compassionate multidisciplinary care, novel treatments, and an exploration of the perplexing rise of colon cancer rates in people ages 45 and younger.

Ongoing research at the institute is attempting to address colorectal cancer prevention and early detection in young people. According to the American Cancer Society, from 2012 to 2016 colorectal cancer rates rose 2% per year in Americans younger than age 50 while falling in people older than age 50. More research is needed to understand this disturbing trend and the risk factors involved in the development of the disease.

Few young people expect to be diagnosed with late-stage colon cancer. Annie Clauson didn’t expect it either. Both of her parents were cancer survivors, and she had one grandparent who had developed colorectal cancer.

But she says, “It would never have crossed my mind that at 34 years old, I would have stage IV colorectal cancer. Never in a million years.”

Save the baby

Annie and Rick Clausen had a toddler, Quinn, and had just learned they were expecting their second baby when Annie’s obstetrician, Emily Sikking, MD, a board-certified OB-GYN at Saint John’s, discovered a mass on her ovary in November 2019. Clausen had not been feeling well—she was nauseated, had stomach aches and was anemic—but she attributed those annoyances to early pregnancy. Dr. Sikking suspected ovarian cancer.

Clausen quickly had surgery to remove the mass. The pathology report, however, showed the tumor did not originate in the ovary. A colonoscopy nine days later revealed a large tumor in the colon. Dr. Bilchik was summoned and performed surgery on Clausen to remove the tumor and a large section of her colon. But before that surgery took place, heartbreaking questions had to be confronted.

A multidisciplinary team of physicians convened at Saint John’s to discuss whether Clausen could be treated while still protecting the pregnancy.

“Annie’s story is a great example of the institutes at Saint John’s working collaboratively to save lives, rather than in silos,” says Tiffany B. Grunwald, MD, director of the Women’s Health and Wellness Institute at Saint John’s.

That teamwork is essential for complex cases, Dr. Bilchik says.

“It’s one of the most challenging situations for a physician to be in, and even tougher for Annie to be in,” he recalls. “But Annie didn’t hesitate. She wanted to have a healthy baby, and she didn’t want cancer to get in the way of having that healthy baby. The challenge for Annie and for us was how do we accomplish both and do it successfully.”

Clausen was adamant about keeping her baby. If it had not been for routine testing during pregnancy, it’s possible the cancer would have remained undetected for many more months, Clausen says. The baby saved her. Now, she reasoned, she would save her baby.

“It was important to me to fight for her and make sure I did everything I could to keep the baby,” she says. “With the help of some amazing doctors, I realized I could keep my little baby and still go through treatment at the same time.”

Clausen’s courage continued to be tested, however. She underwent nine rounds of chemotherapy during her pregnancy. At 35 weeks gestation, she gave birth to
Cody Grace.

“We gave her the middle name Grace because we just felt like she was here by the grace of God,” Clausen says. “She’s our little miracle baby. She’s spunky and fierce and full of life.”

Clausen praised Dr. Sikking for navigating the challenging birth without having to perform a C-section. A C-section would have complicated Clausen’s recovery and delayed her return to chemotherapy. Cody spent five days in the neonatal intensive care unit, with only Clausen able to visit the baby due to COVID-19 restrictions. But the baby has since thrived.

“She was such a little fighter from the moment she was born,” Clausen says. “It’s a miracle that she’s here.”
Clausen continued with chemotherapy, but in the summer of 2020, scans showed the cancer had spread to her pelvic area. She had radiation therapy and was prescribed a targeted therapy drug. However, another scan showed the cancer in her liver. In June 2020, Dr Bilchik performed surgery to remove 30% of her liver and her gallbladder.

Eyeing the big picture

Clausen has continued with chemotherapy—about every two weeks—since then. “It’s manageable,” she says. “With the help of family and friends and a village, we’re getting through it all. I just had to block out all the negativity, all the what-ifs and all the questions. I didn’t go down the rabbit hole and go to that dark place. I stayed positive, and I stayed confident in what we were doing and in our game plan. I took it one day at a time.”

Clausen’s determination and ability to look at the big picture have both impressed and humbled her caregivers, Dr. Bilchik says. “Annie made it so easy for us. She’s just such a delightful person and had such insight into her life and to what she wanted to do and just made us feel comfortable, as treating physicians, to get her better and move forward.”

Both Dr. Bilchik and Clausen ponder the randomness of the illness and the fact that a seemingly healthy young adult could develop stage IV colorectal cancer. Clausen underwent genetic testing. In some families, specific genetic mutations are present that dramatically increase the risk of certain types of cancer.

However, Clausen’s tests did not reveal specific genetic risk factors. Both doctor and patient will not rest until answers emerge.

“No one thinks of looking for colon cancer in someone in their early 30s,” Dr. Bilchik says. Researchers at the Digestive Health Institute are examining not only the incidence of colorectal cancer in younger people but the higher rates of incidence and colorectal cancer death in people of color. Philanthropic funding, including a recent gift from music legend Berry Gordy, has ignited important research projects directed toward these underserved populations.

Clausen encourages her family and friends to be attuned to unusual symptoms, to know their family’s cancer history and to undergo colonoscopy when recommended.
“Colonoscopy is not that bad, I promise. Given what I’m going through now, I would have given anything to just have had a colonoscopy when I was young enough to catch this early,” she says. “We don’t know why I developed cancer. But I’m determined before I die to have an answer to that—to have an answer to why this disease is happening in younger people.”

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Dr. Rudolph A. Bedford and Dr. Anton J. Bilchik