What Bill Walton's Story Can Teach Us About Colon Cancer

What was actually announced

Bill Walton won a national title at UCLA, won two NBA championships, and later became one of the most distinctive voices in sports broadcasting. He died on Monday, May 27, 2024, at age 71. The NBA said he died "after a prolonged fight with cancer," and his family said he died surrounded by his loved ones.

Worth noting plainly: the NBA's announcement and the news coverage that followed did not name the type of cancer. This page does not guess at it. What follows is an explanation of colorectal cancer, which is worth understanding on its own terms, because it is one of the few common cancers that screening can actually prevent.

A cancer that announces itself years in advance

Colorectal cancer usually begins as a polyp, a small growth on the inner lining of the colon or rectum. Most polyps never become anything. Some do, slowly, over years.

That slow timeline is the whole reason screening works here. A colonoscopy that finds a polyp can remove it during the same procedure. No polyp, no cancer. Very few cancers offer that.

Who carries more risk

The National Cancer Institute (NCI) lists these risk factors: advancing age, colorectal cancer in a first-degree relative, a personal history of colorectal polyps or cancer, inherited conditions such as familial adenomatous polyposis and Lynch syndrome, long-standing ulcerative colitis or Crohn's disease, heavy alcohol use, cigarette smoking, obesity, and being African American.

Family history is the one most people can act on immediately. If a parent, sibling, or child had colorectal cancer, say so at your next visit. It usually moves your screening start date earlier.

Screening now starts at 45

The Centers for Disease Control and Prevention states that most people should begin colorectal cancer screening at age 45. That is younger than the age many people remember, and the change matters.

CDC lists several acceptable tests, and doing any of them beats doing none:

• Colonoscopy every 10 years for people at average risk
• FIT, a stool test for hidden blood, once a year
• FIT-DNA, a stool test for blood and abnormal DNA, every 3 years
• CT colonography, a scan of the colon, every 5 years
• Flexible sigmoidoscopy every 5 years, or every 10 years with a yearly FIT

One caution about blood tests. NCI states that CEA, a tumor marker, "is not a valuable screening test for colorectal cancer because of the large number of false-positive and false-negative reports." CEA has a role after diagnosis, not before.

Symptoms mean a diagnostic test, not a screening test

Screening is for people without symptoms. If you have symptoms, you need a diagnostic colonoscopy, and a stool test is not a substitute. Ask for one if you have:

• Blood in the stool, blood on the paper, or black tarry stools
• A change in bowel habits lasting more than three weeks, such as looser stools, narrower stools, or going more often
• Cramping or belly pain that keeps returning
• A feeling that the bowel has not fully emptied
• Weight loss you did not intend
• Iron-deficiency anemia found on a blood test, at any age

Go to an emergency department for severe belly pain with vomiting and an inability to pass gas or stool. That can mean the bowel is blocked. NCI notes that bowel obstruction and bowel perforation both signal a worse outlook, which is a reason not to wait them out.

How doctors decide the stage

Stage describes how deep the tumor has grown and how far it has traveled. NCI's system runs from stage 0 through stage IV.

Stage 0 is confined to the innermost lining. Stage I has reached the submucosa or the muscle layer. Stage II has grown through the muscle wall into surrounding tissue, or into the lining of the abdomen, or into a nearby organ. Stage III means cancer has reached lymph nodes, and the substages depend on how many. Stage IV means it has spread to a distant site, most often the liver or lungs.

One quality marker is worth knowing. NCI recommends that at least 12 lymph nodes be examined by the pathologist before anyone concludes the nodes are clear. Fewer than that, and the "clear" result is less reliable.

What treatment involves

Surgery is the backbone for disease that has not spread. Stage 0 can often be handled endoscopically. Stage I is usually surgery alone, without chemotherapy afterward.

Stage II is surgery, with chemotherapy considered when high-risk features are present: a T4 tumor, obstruction, perforation, or too few lymph nodes sampled. Stage III is surgery followed by adjuvant chemotherapy, meaning chemotherapy given to lower the chance of return. NCI names two standard regimens, FOLFOX and CAPOX. Both pair oxaliplatin with a fluoropyrimidine drug.

NCI is candid that recurrence after surgery remains a major problem and is often the ultimate cause of death. It also notes that microsatellite instability, a specific defect in a tumor's DNA repair machinery, is linked to better survival independent of stage in younger patients. That is one reason tumors are tested for it.

Why the stage numbers matter so much

SEER, the federal cancer surveillance program, tracks outcomes by how far the cancer had spread when it was found. Among people diagnosed between 2016 and 2022, five-year relative survival is 91.3% for localized disease, 75.2% for regional disease, and 16.9% for distant disease. Overall it sits near 65%.

Now look at when cases are caught over the same span: 34% localized, 37% regional, 23% distant. For 2026 the American Cancer Society projects about 158,850 new cases and 55,230 deaths.

Most cases are diagnosed between ages 65 and 74. But roughly 2.1% of new cases occur in people aged 20 to 34, and 5.3% in people aged 35 to 44. Being young does not rule this out, which is exactly why symptoms in a 38-year-old deserve a real workup.

These are group figures drawn from a whole population. They describe patterns, not people.

Sources

• https://www.cancer.gov/types/colorectal/hp/colon-treatment-pdq
• https://seer.cancer.gov/statfacts/html/colorect.html
• https://www.cdc.gov/colorectal-cancer/screening/index.html
• https://www.nba.com/news/bill-walton-passes-away-age-71
• https://www.npr.org/2024/05/27/g-s1-1178/bill-walton-dies-ucla-portland-trailblazers-boston-celtics-broadcaster-grateful-dead