Rectal cancer diagnosis offers physician a new perspective on patient care

As a physician, Lara Lambert, M.D., is used to walking patients through medical scares when they come into a hospital emergency room. But neither her six years of professional experience nor the countless hours she spent in training could have prepared her for the news she received in May of 2019.

“The doctor walked in, and she looked like she had seen a ghost,” recalled Lambert.

Lambert was diagnosed with stage 3C rectal cancer — a finding determined through a colonoscopy she received as a precaution after noticing blood in her stool. The symptoms had started two and half years prior, but because they were sporadic, she assumed the culprit was either inflammation in her colon or irritable bowel syndrome — not cancer.

“I really didn’t expect it. I remember thinking that rectal cancer is something that happens to older men,” said Lambert, who was 37 when her symptoms began. “I was in the best shape of my life. I ate well. I didn’t have any risk factors. So, hearing that I had cancer — I just couldn’t believe this was happening.”

Because her cancer wasn’t caught until a late stage, the tumor was large, had broken through the walls of her intestine and involved her lymph nodes. Thankfully, it hadn’t yet spread to other areas of her body, but it was as advanced as it could be before reaching that point.

She immediately began treatment at MUSC Hollings Cancer Center, where she underwent six weeks of radiation, surgery to remove 23 inches of her rectum and intestines and six months of chemotherapy.

“Our vows ‘in sickness and in health’ really were gut-wrenching at that moment. They always said this was a curable cancer, but I know there is a real possibility it could come back.”
— Dr. Lara Lambert

Having worked with patients who had advanced cancers in the emergency room, Lambert couldn’t help but worry about her prognosis and what the diagnosis could mean for her future.

“My daughter was supposed to graduate from college two days later, and I was sitting there thinking that she was going to have to plan my funeral instead of planning her future after graduation,” said Lambert.

The diagnosis also came in the midst of planning her own wedding, which was set to take place in February of 2020. Fearing her future was no longer something her now husband, Carson, signed up for, she asked him if he wanted to break up. Instead, he supported her in moving the wedding up by seven months because of her fear of losing her hair during chemotherapy.

“Our vows ‘in sickness and in health’ really were gut-wrenching at that moment,” said Lambert. “They always said this was a curable cancer, but I know there is a real possibility it could come back.”

A physician’s point of view

Having completed medical school at the Medical University of South Carolina in 2007, Lambert was no stranger to MUSC Health, though she wasn’t used to experiencing the health system through the eyes of a patient.

“I did all of my training at MUSC, so it’s weird being on the other side of care here. I walked the halls of the Ashley River Tower as a medical student, and then I spent overnights there when I was a patient,” said Lambert. “It was a little surreal, but I knew that I was in really good hands.”

Though she didn’t feel prepared for a cancer diagnosis at such a young age, Lambert believes her background as a physician influenced the way she handled the news. She knew better than to focus on survival statistics, which typically come from studies that involve patient populations where the cancer is most prevalent.

“Being young and healthy, I knew I was not the typical cancer patient. I knew that I’d probably be able to tolerate radiation and chemotherapy better than most of the patients who are included in those studies,” said Lambert. “That was one of the things that made me thankful that I was a doctor, because if you hear that your chance of survival is 50/50 or 40% for five years, that’s absolutely terrifying. But you also have to take into consideration who they’re looking at and how sick those people are.”

 

Instead, she focused on doing everything she could to get the best prognosis for her specific situation, which meant taking on all the treatments available to her.

While she was required to learn about all cancers during her medical training to become board certified, colorectal cancer was never one that stood out to her. After her diagnosis, she did what any doctor would do when facing a new medical challenge — she immersed herself in the literature.

“I have binders of articles. I threw myself into learning as much as I could about rectal cancer,” said Lambert.

Through her research, Lambert learned that there’s a growing trend of colorectal cancers being diagnosed in younger, healthy people, though the reasons why this is happening aren’t yet clear.

People who were born after 1990 have a two-fold increased chance of getting colon cancer and a four-fold increased chance of getting rectal cancer compared to people born in 1950. Because of this trend, the American Cancer Society recently changed its recommendation for average-risk patients to begin screening at age 45 instead of 50.

Affecting one in 23 men and one in 25 women, the disease is common, but there’s a 90% chance of survival when the cancer is diagnosed before it has spread to other parts of the body. Lambert attributes her late-stage cancer to her mentality that her symptoms were not a big deal and that she was not at risk, causing her to push off scheduling a colonoscopy.

“This disease is 100% preventable if you get screened and know the signs and symptoms,” said Lambert. “I let my symptoms go on for so long because I thought this was predominantly diagnosed in older men. That’s why I’m an advocate, and that’s why I want to tell people to go get their colonoscopies, to know the signs and to get screened.”

A reminder to slow down

Lambert took her last chemo pill on April 1, 2020, and her scans have been clear ever since. For her, the journey has been an unwelcome reminder that life is not guaranteed — something she keeps in mind as she continues her work in the Emergency Department at the Ralph H. Johnson VA Medical Center.

“My cancer has reminded me to slow down and listen more. Sometimes people just need to talk about their fears and frustrations, and I feel like I have more patience to really sit with them and listen,” said Lambert. “It can be hard to do in a busy emergency room setting, but it means a lot to those people to know they’re being heard.”

Lambert, who never stopped caring for patients even amid a cancer diagnosis and the COVID-19 pandemic, also uses the experience to connect with her patients on a personal level.

“Blood in your stool is never normal. Get it checked, whether you’re 20 years old or 80 years old.”
— Dr. Lara Lambert

“There was a patient I took care of in the Emergency Department, and his oncologist was my oncologist. We were able to joke around about how Dr. Daniel Reuben talks with his hands. Whenever I walked into that patient’s room, I’d make hand motions like Dr. Reuben does, and he would just laugh,” said Lambert. “We had a great time sharing our Dr. Reuben stories.”

Lambert is thankful for her “amazing” care team at Hollings, with whom she has grown close throughout her cancer journey. Aside from Reuben, Lambert was treated by radiation oncologist Graham Warren, M.D., Ph.D., surgeon Virgilio George, M.D., and certified physician assistant Karen Anderson.

She’s also thankful for her husband, who has been her “rock” and caregiver, and the support she received from her coworkers at the VA, who gave her flexibility in her work schedule and bought her a Peloton that allowed her to maintain her exercise routine even during her treatment.

In light of March being Colorectal Cancer Awareness Month, she hopes to raise awareness among both doctors and patients that these cancers are on the rise among young and middle-aged adults. She encourages people to know the signs, which include blood in the stool, abdominal pain, bloating, constipation, diarrhea and weight loss.

“Blood in your stool is never normal,” said Lambert. “Get it checked, whether you’re 20 years old or 80 years old.”

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