In 2024, 36-year-old Gabby Zappia noticed blood in her stool while pregnant with her third child. Her obstetrician attributed it to pregnancy-related hemorrhoids, and she accepted that explanation. After her son was born, the bleeding continued. When she pushed for further evaluation, a colonoscopy revealed a large mass. In December 2024 she was diagnosed with stage IV colon cancer that had already spread to her liver.
Zappia began treatment immediately. She had a colectomy, then started chemotherapy and immunotherapy in January 2025 at City of Hope. In April 2025 she paused systemic therapy for a liver resection and placement of a hepatic arterial infusion (HAI) pump, then resumed chemotherapy. After 15 rounds she reached no evidence of disease and rang the survivor bell in September 2025. Months later, ctDNA testing and a PET scan detected cancer activity in her liver, and she underwent another liver surgery in January 2026. With ctDNA still detectable, she is now exploring clinical trials.
The diagnosis and treatment forced Zappia to scale back parenting and work while her husband handled much of the day-to-day care. She urges others to trust their instincts: if a symptom feels wrong, ask questions, demand testing, and seek a second opinion if you aren’t being heard. Her hope in sharing the story is that others will act sooner and catch cancer earlier.
Rising colorectal cancer in younger adults
Colorectal cancer has traditionally been viewed as a disease of older adults, but incidence among younger people has increased. A January 2026 JAMA study found colorectal cancer is now the leading cause of cancer-related death in U.S. adults under 50. Clinicians at City of Hope report seeing 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 roughly three out of four people under 50 are diagnosed with advanced disease, in part because routine screening historically began at older ages. Screening guidelines have shifted from starting at age 50 to age 45, but many younger patients still fall below that threshold and present with advanced or metastatic cancer.
Causes for the increase are not yet clear. Hereditary syndromes account for a small share of early-onset cases, but many young patients have no known risk factors. Researchers are investigating possible contributors — including antibiotic exposure, microbiome changes, diet, and environmental contaminants — but no single cause has been identified.
What to watch for and what to do
Because routine screening is limited for younger adults, experts emphasize paying attention to symptoms and asking for evaluation when something is off. Symptoms that should prompt diagnostic testing include:
– Rectal bleeding
– Changes in bowel habits (diarrhea, constipation, narrowing of stools)
– Unexplained abdominal pain
– Unintentional weight loss
Rectal bleeding in particular is a strong warning sign of early-onset colorectal cancer in adults under 50 and should not be automatically attributed to benign causes such as hemorrhoids without appropriate evaluation. When symptoms persist or don’t match expected patterns, ask for diagnostic testing, including colonoscopy, and consider a second opinion if your concerns aren’t taken seriously.
Research and future tests
Researchers at City of Hope are working on better treatments and earlier detection. Efforts include increasing immunotherapy response rates, developing targeted therapies, testing combinations of chemotherapy, immunotherapy, and radiosensitizers for rectal cancer, and exploring cellular and CAR-T therapies for refractory disease.
Ajay Goel, PhD, is developing blood-based tests to detect colorectal cancer in younger patients. Early results look promising for a test with high accuracy for young-onset disease; the goal is to validate it in larger studies and eventually make it available for routine use, potentially as part of annual lab work beginning at age 18 if effectiveness and safety are confirmed.
How to reduce risk
No strategy eliminates colorectal cancer risk entirely, but steps that may lower risk include:
– Getting screened with colonoscopy at age 45, or earlier if you have symptoms or risk factors; discuss stool- and blood-based testing options with your doctor if you’re younger.
– Maintaining a healthy weight, exercising regularly, and eating a diet rich in vegetables, fruits, and whole grains while limiting red and processed meats.
– Limiting alcohol intake and avoiding tobacco.
– Discussing supplements such as vitamins, calcium, and magnesium with your doctor, which some studies suggest may lower risk.
Zappia’s message is simple and urgent: know your body, advocate for evaluation when something feels wrong, and push for answers. Early attention to symptoms can change the course of a diagnosis and treatment.
