Gastrointestinal Concerns: Anxiety, Fatigue, and Cancer Risks

Gastrointestinal issues consultation?

Hello Doctor, I am a 41-year-old male, 172 cm tall and weighing 80 kg.
I have been suffering from anxiety disorder, obsessive-compulsive disorder, and hypochondriasis for over ten years.
I have long-term issues with fatigue and poor sleep quality.
My diet is not particularly healthy, but it's not terrible either.
In recent years, I've switched to drinks with reduced sugar.
I do not smoke, drink alcohol, or consume betel nut.
I have experienced fatigue and poor sleep for many years, and it seems to have become more pronounced in the last two years.
I am unsure if this is related to aging or post-COVID syndrome.
I have read online that chronic fatigue can have many causes, and it is advisable to see a family physician to rule out serious illnesses and cancers.
Some articles also mention that fatigue and stress are more closely related to lung cancer, colorectal cancer, and gastric cancer.
Last week, I visited a family physician, who said it is difficult to pinpoint the cause of my issues.
Two months ago, I spent 700 NTD on blood and urine tests to check basic health parameters, and I brought the report to the doctor.
He said there seems to be nothing major wrong and advised me to relax and exercise more.
I would like to ask you, Doctor, about my situation.
I had a colonoscopy and gastroscopy two years ago, and the results were normal.
I plan to have routine colonoscopy and gastroscopy again early next year.
However, I am currently experiencing hypochondriasis, which has led to sudden panic about my dietary habits over the past 40 years, the stress from my long-term hypochondriasis, my consumption of sugary drinks, my fatigue, and my weight gain from 74 kg to 80 kg over the past two years (obesity is a cancer risk factor).
I have also been less active in the past two years (I used to play basketball on weekends).
Additionally, I have read that the mortality rate for hypochondriasis is higher.
Given all these factors, I am worried that since my last colonoscopy and gastroscopy two years ago, I might have developed gastric or colorectal cancer.
Do you think I currently have gastric or colorectal cancer? What should I do?
Note: I have been seeing a psychiatrist and primarily take SNRI medications, but I have been inconsistent with them because sometimes I feel they are ineffective.

JAMES, 40~49 year old female. Ask Date: 2024/05/08

Dr. Chen Shidian reply Gastroenterology and Hepatology

First of all, it's understandable to have concerns.
However, based on the information you provided, your colonoscopy and gastroscopy results are normal, which is good news and indicates no cancer risk in the short term (1-3 years).
It is advisable to collaborate with a mental health professional to help relax your mind, engage in regular exercise, and try to minimize worries.
If you still feel uneasy, consider discussing further with your physician.

Reply Date: 2024/05/08

More Info

Your concerns about gastrointestinal health, anxiety, fatigue, and cancer risks are valid and reflect a common intersection of mental and physical health issues. Given your history of anxiety disorders and your recent experiences, it's important to address these concerns comprehensively.

First, let's discuss the relationship between anxiety, fatigue, and gastrointestinal symptoms. Chronic anxiety can significantly impact your gastrointestinal system. The gut-brain connection is well-documented; stress and anxiety can lead to symptoms such as stomach discomfort, bloating, and changes in bowel habits. In your case, the recurring discomfort in your abdomen that seems to correlate with your anxiety levels suggests a psychosomatic component. This means that your mental state may be influencing your physical sensations.
Regarding your fatigue, it's essential to consider both psychological and physiological factors. Chronic fatigue can stem from various sources, including sleep disturbances, stress, and lifestyle choices. Your reported poor sleep quality and increased fatigue over the past two years may indeed be exacerbated by anxiety. Additionally, lifestyle factors such as reduced physical activity and dietary choices can contribute to feelings of fatigue. While you have made some positive changes, like reducing sugar intake, maintaining a balanced diet and regular exercise is crucial for overall health and can help mitigate fatigue.

Now, concerning your fears about cancer, it's important to note that your previous screenings (colonoscopy and endoscopy) showed no abnormalities. This is a positive indicator, as significant changes or cancers typically develop over time and would likely have been detected during those examinations. The fact that you are scheduled for routine screenings next year is also a proactive approach to monitoring your health.
While there are studies suggesting links between chronic stress and certain cancers, it is crucial to understand that correlation does not imply causation. Your anxiety about cancer, particularly in the context of your long-standing health concerns, may be amplifying your fears. It's common for individuals with health anxiety to fixate on potential illnesses, leading to increased stress and further physical symptoms.
In terms of your weight gain, while obesity is a recognized risk factor for various cancers, it is just one of many factors. Maintaining a healthy weight through diet and exercise is beneficial not only for cancer risk reduction but also for managing anxiety and fatigue. Engaging in regular physical activity can improve your mood and energy levels, which may help alleviate some of your anxiety symptoms.

Lastly, regarding your medication, it's essential to communicate openly with your healthcare provider about your experiences with SSRIs and SNRIs. If you feel that your current medication isn't effective, discussing alternative treatments or adjustments with your doctor could be beneficial. Mental health treatment often requires a tailored approach, and what works for one person may not work for another.

In summary, while your concerns about cancer are understandable, the evidence from your previous screenings and your current health status suggests that you are not at immediate risk. Focus on managing your anxiety through therapy, maintaining a healthy lifestyle, and continuing with your scheduled health screenings. If your anxiety persists or worsens, consider seeking additional support from a mental health professional who can help you develop coping strategies and address your fears more effectively.

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