Andrea Escalante, DO1, Amanda Eukovich, DO2, Gautam Anand, MD2, Karolina Marquez-Gil, MD, MSc2 1Broward Health Medical Center, Miami, FL; 2Broward Health Medical Center, Fort Lauderdale, FL Introduction: Semaglutide is commonly prescribed for obesity and type 2 diabetes to promote weight loss. While beneficial for many patients, the weight loss it causes can sometimes complicate the diagnostic process. We present the case of a 26-year-old woman whose diagnosis of colon cancer was delayed because her symptoms were misattributed to her menstrual cycle and semaglutide use.
Case Description/
Methods: A 26-year-old female with a history of iron deficiency anemia (IDA) presented for evaluation of worsening anemia. Her labs showed an iron percentage of 3% and hemoglobin (Hb) of 6.1 g/dL. She reported intermittent cramping lower abdominal pain for six months, melena, lightheadedness, tenesmus, nausea, and weight loss, which she attributed to semaglutide injections. She denied experiencing any other symptoms or having a family history. On a previous hospitalization for anemia, she underwent an endoscopy that only showed mild gastritis. She had no prior colonoscopy. Upon admission, the patient had microcytic hypochromic anemia and mild leukocytosis. She was tachycardic but normotensive. A CT abdomen and pelvis showed mucosal thickening in the transverse colon, suggestive of colitis. A fecal occult blood test was negative, and her fecal calprotectin was elevated. CRP and ESR were both normal. Tumor markers were negative and a gastrointestinal PCR was negative. The patient underwent a colonoscopy that revealed a 7-cm fungating transverse colon mass, consistent with malignancy. Pathology revealed adenocarcinoma. She underwent a staging work-up, which showed no evidence of metastasis. The patient ultimately elected to undergo a right-sided hemicolectomy in the outpatient setting. Discussion: While the benefits of semaglutide are well-documented, it is associated with side effects such as nausea, vomiting, gastrointestinal discomfort, and a potential link to pancreatitis. Some studies suggest that semaglutide may have a protective effect against colorectal carcinoma, given its weight loss and anti-inflammatory effects. However, cancer-related weight loss is one of the most common early signs of malignancy. Given that Semaglutide causes weight loss, distinguishing medication-induced weight loss from malignancy-related weight loss can be challenging. While colorectal cancer is less common in premenopausal women, its incidence in young patients has risen. IDA should not be quickly attributed to menstruation. In such cases, colonoscopy remains the gold standard for colorectal cancer screening.
Figure: Figure 1. Large fungating 7 cm mass noted to the transverse colon. Pathology revealed adenocarcinoma.
Figure: Figure 2. 3 cm mass in the cecum. Pathology reflected a villous adenoma.
Disclosures: Andrea Escalante indicated no relevant financial relationships. Amanda Eukovich indicated no relevant financial relationships. Gautam Anand indicated no relevant financial relationships. Karolina Marquez-Gil indicated no relevant financial relationships.
Andrea Escalante, DO1, Amanda Eukovich, DO2, Gautam Anand, MD2, Karolina Marquez-Gil, MD, MSc2. P2672 - Iron Deficiency Anemia and Weight Loss: A Case of Colon Cancer in a Young Woman on Semaglutide, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
