Photos by JUSTIN COOK The Roanoke Times

Erika Kratzer survived stage-four colon cancer and is on the cover of the "colondar," a calendar featuring colon cancer survivors and their scars.

BLACKSBURG -- Symptoms include abdominal cramping, bloating, constipation, diarrhea and blood in the stool.

After treatment with surgery, there's typically a mark like the 12-inch river of scar tissue that flows up around Erika Kratzer's bellybutton to her sternum.

Any way you look at it, colon cancer isn't pretty.

But that didn't stop Kratzer, a Virginia Tech doctoral student, from starting a swimsuit calendar featuring herself and other young colon cancer survivors in 2005.

This year marks the release of the fifth "colondar" by The Colon Club, a Wilton, N.Y.-based organization that works to raise awareness of colon cancer.

More than 30,000 of the calendars are in circulation all over the world. Kratzer, 31, has graced the cover every year as it has morphed into an artistic project featuring both men and women under the age of 50 who have had surgery for colon cancer.

"It's supposed to be a little funny but at the same time serious," Kratzer said. "And I think if you want to catch people's attention, you've got to do something a little bit different."

Colon cancer is typically associated with older people, but Kratzer and Colon Club co-founder Molly McMaster both were diagnosed in their early 20s.

Kratzer thinks the calendar is one way to call the disease to the attention of young people and remove the general stigma associated with it.

"My hope is that, you know, it would become more of our everyday conversation to be OK talking about poop," Kratzer said.

Disease has become a subject of potty humor

Diagnosed with the disease while a master's student at the University of Georgia in 2000, Kratzer underwent three surgeries and multiple rounds of chemotherapy. But she isn't shy about talking about her ordeal and even joking about colon cancer.

Kratzer commonly refers to her ailment as "ass cancer" and jokes that she inherited it while her sisters inherited blonde hair and beautiful blue eyes.

Joking aside, Kratzer's experience was agonizing and frightening for her and her family. She attributed fatigue and digestive problems during her first year of graduate school to stress and poor eating habits. The symptoms worsened and she visited an on-campus doctor, who then referred her to an oncologist.

The oncologist scheduled a colonoscopy but never mentioned the word "cancer."

Heavily sedated, but awake during the procedure, Kratzer could hear the hushed, concerned voices of the doctors. Later that day, her gastroenterologist put his hand on her leg as he broke the news to her. Her tumor was so large the scope could not fit past it. She was scheduled for surgery the next day.

After the surgery, she was diagnosed with stage-four colon cancer that had spread to her liver. Five-year survival rates for people with her condition range from 5 percent to 10 percent.

But Kratzer's age worked to her advantage. Because she was young and otherwise healthy, doctors could be more aggressive in treating her.

She moved home to Pennsylvania and subsequent surgeries in Philadelphia later that year removed more than 60 percent of her liver.

She began chemotherapy treatment in January 2001. By the following fall, she was back in school. That December, she married her college boyfriend. She graduated in December 2002 and moved back to Pennsylvania with her husband.

Following treatment came emotional trials

She had a new job, a new degree and a clean bill of health. Her family, friends and husband were a great support system for her during her ordeal, she said, but they couldn't relate to the emotional problems and identity crisis she suffered now that she was a cancer survivor.

"I'd been through something really serious. I had survived it, but it's not as easy as you might think to just return to normal life and go on as if this had never happened," she said.

"And I really wanted to do that."

McMaster had similar struggles as a young colon cancer survivor. Diagnosed in 1999, her doctor told her she was the only person in the country with colon cancer at such a young age.

A hockey player, she traveled from her home in upstate New York to Colorado on in-line skates to raise awareness of the disease. Her efforts caught the attention of Amanda Sherwood Roberts of Little Rock, Ark. She e-mailed McMaster to tell her she had been diagnosed with colon cancer.

"All of a sudden, I wasn't like that lonely freak anymore," she said. "There was someone else like me."

Sherwood Roberts died on New Year's Day 2002 at the age of 27. Her cousin Hannah Vogler co-founded The Colon Club with McMaster and they toured the country in 2003 with a giant colon, complete with different colon-related ailments -- even hemorrhoids.

They met Kratzer in Philadelphia, one of their final stops.

Kratzer suggested the calendar. They loved the idea and the women recruited other young colon cancer survivors. A photo shoot at McMaster's parents' home resulted in the 2005 calendar.

Meeting other colon cancer survivors at annual gatherings and working to raise awareness for colon cancer helped Kratzer work through her emotional struggles.

Recent years have been spent living normal life

When she and her husband moved to Blacksburg in August 2006, Kratzer saw it as a symbolic shift from the "live every day like it's your last" cliche preached to and by cancer survivors.

"I thought, 'Well, what if I live?' What are all the things that I would have possibly put on hold and not have done."

Kratzer has also changed the way she thinks about her scar. After her surgeries she asked about plastic surgery. A doctor told her it was an option, but she would have to wait.

Now she couldn't imagine herself without the scar and is perfectly comfortable wearing a two-piece bathing suit at the beach. Or in a calendar.

"Scars, even though they're not pretty, they're not ideal, they're not the kind of things you want to see in magazines, these people have been through a lot," she said. "And just because they have a scar doesn't mean they're not beautiful."

On the Net: www.colondar.com