In 2024, 36-year-old Gabby Zappia was pregnant with her third child when she noticed blood in her stool. Her OB told her it was likely pregnancy-related hemorrhoids — an explanation that felt plausible, so she accepted it. After her son was born, the bleeding and other symptoms persisted, and she pushed for further evaluation.
A colonoscopy revealed a large mass in her colon. In December 2024, she was diagnosed with stage IV colon cancer that had spread to her liver. Zappia immediately underwent a colon resection, then began chemotherapy and immunotherapy in January 2025 at City of Hope. In April 2025 she paused chemotherapy for a liver resection and placement of a hepatic arterial infusion (HAI) pump, then resumed chemotherapy afterward.
After 15 rounds of chemotherapy she was declared no evidence of disease (NED) and rang the survivor bell in September 2025. A few months later, ctDNA testing detected cancer, and a PET scan confirmed activity in her liver. She had another liver surgery in January 2026. Because ctDNA remains detectable, she is now exploring clinical trials.
Zappia says the experience forced major changes in her life: she stopped working to focus on appointments and recovery, leaned on her husband to manage day-to-day tasks, and had to step back from many parenting roles. She urges other patients to trust their instincts, ask questions, request testing (including colonoscopy), and seek second opinions if they aren’t being heard. “We need more awareness. We need to listen to young patients,” she said.
Rising colorectal cancer in younger adults
Colorectal cancer, once considered a disease of older adults, is increasing in people under 50 and has become the leading cause of cancer-related death in U.S. adults under 50, according to a January 2026 JAMA study. Clinicians at City of Hope report treating dozens of patients in their 20s, 30s, and 40s each week. Pashtoon Kasi, MD, MS, Medical Director of GI Medical Oncology at City of Hope Orange County, notes that about three out of four patients under 50 are diagnosed with advanced disease because routine screening is not recommended for most people under 45.
While hereditary syndromes explain a small percentage of early-onset colorectal cancer, many younger patients have no known risk factors. Researchers are investigating potential contributors such as antibiotic use, the microbiome, diet, and environmental exposures like microplastics, but no single cause has been identified.
Symptoms to take seriously
Because many younger patients aren’t eligible for routine screening, paying attention to symptoms is critical. Warning signs that warrant prompt evaluation include:
– Rectal bleeding
– Changes in bowel habits
– Unexplained abdominal pain
– Unintentional weight loss
Experts emphasize that symptoms often dismissed as hemorrhoids — especially during or after pregnancy — should prompt further investigation, including consideration of colonoscopy.
Research and future tools
City of Hope researchers are working to improve treatments and diagnostics. Efforts include enhancing immunotherapy effectiveness, developing targeted therapies, combining chemotherapy with immunotherapy and radiosensitizers for rectal cancer, and exploring cellular and CAR-T therapies for refractory cases.
Ajay Goel, PhD, is developing a blood-based test to detect early-onset colorectal cancer. Early results are promising — he reports a test with roughly 90% accuracy in detecting young-onset colon cancers — but it is not yet available clinically. He envisions incorporating such a blood test into routine annual labs for younger patients once validated in larger populations.
Risk reduction
While no method guarantees prevention, the American Cancer Society recommends steps to help lower colorectal cancer risk:
– Get screened with colonoscopy at age 45 or older; if younger, discuss stool- or blood-based tests with your doctor.
– Maintain a healthy weight, eat a diet high in vegetables, fruits, and whole grains and low in red and processed meats, and exercise regularly.
– Limit alcohol and avoid smoking.
– Talk with your doctor about supplements such as vitamins, calcium, and magnesium that might help reduce risk.
Zappia’s message is simple: know your body and push for answers. If something feels off, ask for testing and a second opinion. Sharing her story, she hopes, may help others catch cancer earlier.
