Helen Worthington, a 40-year-old primary school teacher from Adelaide, went to hospital expecting to be told she was fine. Instead, she learned she had stage four bowel cancer that had already spread to her liver.

The first sign was an uncomfortable twinge in her abdomen in the early hours of 27 August last year, followed by a sharp pain higher in her stomach. She thought she was coming down with gastro, or stomach flu.

Unable to book a GP appointment, she went to a nearby emergency department later that morning. Doctors initially thought there could be a very simple explanation for her pain.

Fear of Wasting Doctors' Time

Worthington feared she was overreacting and apologised to physicians for using valuable hospital resources. She said she did not want to make a fuss or waste anyone's time.

Things then escalated very quickly, from thinking she had gastritis to being told she had stage four bowel cancer. There was no gradual sense that something was wrong, and the diagnosis was a complete shock.

In the days that followed, she struggled to take in the news. Cancer Research UK explains that stage four bowel cancer means the disease has spread to other parts of the body and is also called metastatic or advanced.

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Why Mild Pain Can Mislead

Cleveland Clinic states that the level of pain a person feels does not always match how serious the cause is. Common, short-lived conditions can cause intense abdominal pain, while some life-threatening conditions may feel mild.

Abdominal pain that is unexplained, severe or does not go away should always be seen by a doctor. Even mild cases can be serious, and the pain can come from organs other than the stomach.

Few Symptoms Before Diagnosis

Worthington spent a long time trying to work out how she had missed it. Apart from mild tiredness, she said she had experienced no obvious symptoms before the sudden abdominal pain that led her to seek medical attention.

Many colorectal cancers develop from precancerous growths called adenomas, which can take about 10 years to become cancerous. However, not all bowel cancers follow this pathway, and the time taken can vary. These can include abdominal pain, a bloated stomach, blood in the stool and feeling tired or weak.

Most people with colon cancer are older than 50, but the number of cases in people younger than 50 is increasing. Medical researchers are not sure what is driving the change.

Treatment and Survival Outlook

Less than 24 hours after the cancer was found, Worthington underwent emergency surgery to remove the affected section of her bowel. Chemotherapy followed, and her cancer has a BRAF V600E mutation, which makes it more aggressive.

She has since completed her 27th round of chemotherapy. Her plan is to continue for as long as it works and her body can tolerate it, with regular scans monitoring the cancer. There is no set end date.

The American Cancer Society, using US National Cancer Institute SEER data, reports a five-year relative survival rate of 13 per cent for colon cancer that has spread to distant parts of the body. This is a population estimate, not an individual prognosis. These figures are estimates, however, and each person's experience may differ.

The hardest moment came when she had to tell her 12-year-old daughter about the diagnosis. Worthington could not promise her everything would be okay because she did not know that herself.

Exercise as Part of Care

Her sister-in-law, an oncology physiotherapist, encouraged her to add exercise to her care. Worthington was sceptical, but she has become fitter and stronger, and exercise gives her something to do for herself when so much of cancer is outside her control.

The Clinical Oncology Society of Australia says exercise belongs in standard cancer care, with at least 150 minutes of moderate aerobic exercise weekly. Cancer Council NSW says it can reduce treatment side effects and may improve survival for some cancers.

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