Tristan Evans and his daughter embrace in dance.
Tristan Evans and his daughter Janelle, 12, at their church Father/Daughter Dance, Feb. 2020. Tristan was the emcee and DJ.

Keeping the Faith


archive alertFrom the Duke Cancer Institute archives. Content may be out of date.

Tristan Evans and his daughter pause for a photo during a virtual 5K run/walk.
Tristan Evans and his daughter Janelle hit the streets of their Durham neighborhood for the Virtual 2020 CRUSH Colorectal Cancer 5K Run/Walk on March 21.

Last month, Tristan Evans, 50, took a few turns around the dance floor with his daughter Janelle, 12, at a sweet Valentine’s father-daughter dance hosted by their local church homeschool group. Celebrating life with someone dear to his heart. On Saturday, March 21, Evans walked around his neighborhood with Janelle for a cause dear to his heart — colorectal cancer awareness.

An eight-year colon cancer survivor, the husband and father-of-three was one of many “virtual” walkers and runners who participated in the seventh annual Duke CRUSH Colorectal Cancer 5K Walk/Run, held this way for social distancing due to COVID-19 concerns.

Evans, the first one in his family to be diagnosed with any cancer, was blindsided by a diagnosis of stage 3C colon cancer when he was only 42.

He’d thought he wouldn’t need a colonoscopy until he was at least 50. (The American Cancer Society now recommends screening all patients of average risk, beginning at age 45, while the National Comprehensive Cancer Network guideline starts at age 50.)

“If I had waited that long, I wouldn’t be here talking to you,” Evans shared.

Over the course of four years, he’d ignored the occasional symptoms of pain in his abdomen, figuring he ate something bad or didn’t hydrate enough. He’d walk it off. Push through the hurt.

It took shooting pain, noticeable blood in his stool, and chills for Evans to consider seeing a doctor. When he did seek care, at the Holton Wellness Clinic (a joint program of Lincoln Community Health Center and Duke Community Health), family medicine nurse practitioner Virgil Mosu, FNP-C, first sought to rule out an internal hemorrhoid or diverticulitis (an infection in the intestine).

Ultimately, Mosu said Evans was down to two options: a take-home colorectal cancer test kit or a colonoscopy to look for abnormalities in the colon. Evans went with the colonoscopy because he wanted answers as soon as possible and didn’t want to risk any mistakes with the home test. He was referred to gastroenterologist John T. Geneczko Jr, MD.

“I vividly remember, before I went under sedation, having a very jovial conversation with my GI doctor,” said Evans. “As I was coming out of sedation I looked at his face and I thought, “Something doesn’t seem to be right.” He was very straight-faced and I knew he was about to give me some bad news.”

As it turned out, Evans wasn’t “average risk.”

An Unexpected Diagnosis

Geneczko told Evans he had Familial Adenomatous Polyposis (FAP), a rare inherited syndrome that causes hundreds of polyps to form in the colon and rectum. According to the American Cancer Society, only 1 out of 100 people with colon cancer have FAP — those with the classic form are likely to develop cancer before age 50.  

As Evans understood it, “If my large intestine was turned inside out, it would look like it had a case of the measles.”

Even more seriously, Geneczko found two cancerous tumors — one the size of a golf ball — in Evans’ sigmoid colon, which had already started to penetrate into the muscle wall of his GI tract and invade his lymph system.

Most colon cancers start out as polyps (also called adenomas). During a colonoscopy, a long flexible scope with a lighted camera winds through the colon and looks for abnormalities such as polyps in the inside lining of the colon and removes them before they have the chance to become cancerous.

“Dr. Geneczko said I was probably going to lose a half to all of my large intestine,” recalled Evans. “So, you take somebody who has never had any major surgery and say that…well the hair on the back of my neck just kind of stood up and the first thing I thought about is, “Can you even live without your large intestine? How is that going to play out?””

Evans was ultimately referred to surgical oncologist John Migaly, MD, GI oncologist John Strickler, MD, and radiation oncologist Brian Czito, MD.

Evans credits his “head coach” Jesus Christ, “assistant coach” Michele Evans (his wife), and “some of the best physicians and support staff” at Duke, for defeating cancer. In his blog TeamTristan: For the Greater Glory of God!, he likened cancer to a force nearly as strong as Satan.

“Every darn day recently is a fight of some sort with a very powerful enemy only second in strength to Satan himself,” Evans wrote on June 24, 2012, after a six-month whirlwind of radiation therapy, oral chemotherapy, recovery, and surgery to remove his entire intestine and create a diverting loop ileostomy and J-pouch. “The skirmishes can range from trying to stay hydrated to managing pain; trying to stay coherent when in fact I’ve been doped up on every narcotic under the sun, to keeping a positive outlook on things when I can’t even pick up my baby for a hug because he weighs more than ten pounds; and keeping contact with my wife and kids even though the medications and pain either send me into pockets of despair and drowsiness or irritability and restlessness. It takes a lot to be in the place I am now, but I’m still in the fight – I think!”

Tristan Evans smiles with three children on a balcony overlooking the ocean.
Tristan Evans celebrates Fathers Day, June 2012, a few weeks after his first surgery. "I was fighting pain and a bit of depression," he recalled. "It was a sanity day at my favorite place on earth."


Evans would make it out of the hospital in time to enjoy Father’s Day and his daughter Janelle’s 5th birthday — “the icing on the cake.” After months of recovery and a second round of chemotherapy (oral and infused) to rid his body of any leftover cancer cells, Evans would have his second and final surgery to take down the ileostomy.

His November 30, 2012 blog entry had TeamTristan, “with time ticking away…pulling off one of the most incredible Hail Mary plays ever seen” against Team Colon Cancer. Evans, by that point, was cancer-free.

Tristan Evans and Angelo Moore talk in front of a "Duke Cancer Institute" background
Tristan Evans (right) shared his cancer story with Angelo Moore, PhD, RN, program manager, DCI Office of Health Equity, as part of a March 2 Facebook Live event — Shining a Light on Colorectal Cancer: A Conversation with Duke Experts.

Shining A Light

Evans’ cancer battle motivated multiple adult family members on both sides of his family to get screened and he wants others to do the same.

“In my effort to give back to my community and to advance treatment and research for colon cancer, I’m taking part in a number of awareness activities to inform as many folks as possible about the risk factors, treatment options and support for those with a diagnosis or family history of colon cancer, primarily, and other forms of cancer,” he said.

This included publicly sharing his cancer story with Angelo Moore, PhD, RN, program manager, Duke Cancer Institute Office of Health Equity, as part of a March 2 Facebook Live event — Shining a Light on Colorectal Cancer: A Conversation with Duke Experts — hosted by the Durham County Department of Public Health and Duke Cancer Institute.

Giving Back

The 14-year resident of Durham, North Carolina, also signed on to OHE’s revamped Community Health Ambassadors program, an initiative designed to help break down barriers to cancer health care access, particularly in minority communities.

Evans, 50, works full-time as a security manager at an independent data center in Durham. It pays the bills, and walking an average of 7,000 steps each shift, it also keeps the cancer survivor in shape.

But his part-time gig, his calling, is working for the Roman Catholic Diocese of Raleigh. There, as the coordinator of African Ancestry Ministry and Evangelization, he helps to meet the spiritual and pastoral needs of parishes and small faith communities in the diocese that serve African Americans, Native Africans or the Afro-Caribbean population of eastern North Carolina.

Like other CHAs, he’s hoping to use his knowledge and experience to help individuals in his community better understand risk factors and screening guidelines, their rights as a patient and how to navigate the complex health care system.

According to the American Cancer Society Cancer Facts & Figures for African Americans 2019-2021, blacks have the highest rates of colorectal cancer of any racial/ethnic group in the US. Colorectal cancer death rates are 47% higher in non-Hispanic black men and 34% higher in non-Hispanic black women compared to non-Hispanic white men and women.

“That’s largely because of the inability to get screening that could remove precancerous polyps when screening needs to be done,” explained Duke gastroenterologist Julius Wilder, MD, PhD. “In the United States, blacks are more likely to develop the type of polyp that can become colon cancer, and develop these polyps at younger ages. Because of this, some professional medical societies recommend blacks in the U.S. begin colon cancer screening with colonoscopy at age 45. Colonoscopy identifies the polyp and removes it now before it can manifest as colon cancer in the future.”

Evans is hoping to do his part to change this.

“My big advice is pay attention to your body,” said Evans. “Some of the little things you can walk off, like if you bump your knee or something. But if you are going to the bathroom and feel like you are going to shoot through the ceiling from the pain, that might be something that you want to talk to your doctor about. I just kind of ignored it. I think if we had caught it back then we might have been able to do some things differently, but I’m just very fortunate that I had that awesome healthcare team. I live so close to Duke that I was in the right place at the right time in that regard.”

Colorectal Cancer Quick Facts

Risk Factors

  • Age (>50) (risk doubles with each decade of life over age 50)
  • Obesity
  • Physical inactivity
  • Long-term smoking
  • High consumption of red or processed meat
  • Low calcium intake
  • Moderate to heavy alcohol consumption
  • Very low intake of fruits and vegetables and whole-grains

Increased Risk

  • Strong family history of colorectal cancer or certain types of polyps
  • Personal history of colorectal cancer or certain types of polyps
  • Personal history of inflammatory bowel disease
  • Hereditary colorectal cancer syndromes, such as FAP and Lynch Syndrome
  • Personal history of radiation to the abdomen or pelvic area to treat a prior cancer

Common Symptoms*

  • Abdominal pain
  • Weight loss when you are not trying to lose weight
  • Blood in the stool

*Many people have no symptoms, hence the importance of screening.

Colorectal Cancer Awareness

  • WATCH (in English): Program manager of DCI Office of Health Equity, Angelo Moore, PhD, RN, interviews gastroenterologist and hepatologist Julius Wilder, MD, and patient Tristan Evans.
  • WATCH (in Spanish): Chelsea Hawkins, MPH, MCHES, CDE, interviews gastroenterologist Juan Sanchez, MD.
  • WATCH (in Mandarin Chinese): Ping Zhang interviews gastroenterologist Tzu- Hao Lee, MD.
This page was reviewed on 03/24/2020