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Bowel Cancer Awareness – spotting the signs could help save your life

24 April 2017

Bowel or colorectal cancer is one of the biggest cancer killers in Britain. Overall it’s the third commonest form of cancer in adults. One in 20 people over the age of 50 in the UK will get bowel cancer over their lifetime.[i]  Each year approximately 40,000 people are diagnosed with the disease however, if detected early the vast majority of bowel cancer cases can be successfully treated. [ii]

This type of cancer affects the large bowel (colon) and the rectum which is the lowest part of the bowel joining the back passage. Most bowel cancers originate in polyps (adenomas) that develop in the inner lining of the bowel wall.  Over many years the cells lining the polyps alter and in about 25% of polyps cancer develops. Because it can take five to ten years for the polyp to transform into a cancer if the polyps are known about and removed, bowel cancer can be prevented.

Who is most at risk?

As bowel cancer is so common many of the cancers can develop out of the blue and are described as ‘sporadic’ i.e. by chance. Most of these will develop over the age of 55 to 60. In order to try to identify cancers early there is a bowel cancer screening programme in the UK starting after age 55; the starting age varies in England, Scotland and Wales but all run a screening programme using a combination of tests including tests on stool samples and camera tests to inspect the bowel. These programmes are successful in picking cancers up earlier.

A small proportion of bowel cancers are known to occur earlier in life and are then found to be associated with family cancer syndromes. Some genetic conditions including Lynch Syndrome and Hereditary Non-Polyposis Colon Cancer (HNPCC) are associated with a greater risk of developing bowel cancers. In these cases the cancer presents in the third or fourth decade, are more likely to be on the right hand side of the bowel and may be multiple.  A rare genetic condition Familial Adenomatous Polyposis (FAP) results in many hundreds of polyps in the bowel and bowel cancers occur very early in life often as early as between 20 to 30 years of age. There is small increased risk of bowel cancer in patients with longstanding inflammatory bowel conditions such as Ulcerative Colitis and Crohn’s disease of the colon.

Common Symptoms

It’s really important to be aware of what is normal for you, if you know your body then you can act quickly if something out of the ordinary happens.

The most common signs of bowel cancer include:

  • Unexplained bleeding from the back passage or blood in your stool (small amounts of blood when wiping after a bowel movement is common particularly if you have passed a hard stool – however if you have more than a smear do not put it down to piles)
  • A feeling of incomplete emptying of the bowel and the need to return to the toilet to empty
  • A  change in bowel habit (going more often and/or looser stools) for more than four to six week
  • Persistent abdominal pain
  •  Unexplained weight loss or tiredness
  • A lump in your tummy

 Diagnosis

If you are concerned that you might have bowel cancer, you should seek the advice of your GP or a colorectal specialist as early as possible. The GP will take a history; s/he may examine your tummy and do an examination of the back passage (sometimes they feel this is best undertaken by a specialist to whom they refer); blood tests might indicate that you have a low blood count (anaemia). The GP might refer you to see a colorectal specialist for further investigations. The two most common investigations to diagnose bowel cancer are a colonoscopy or flexible sigmoidoscopy (a camera examination of the large bowel) and a CT colonogram (a virtual colonoscopy where pictures of the bowel are recreated to simulate the camera test). If bowel cancer is identified you should have a body CT scan to look for any signs of spread and sometimes an MRI scan of the pelvis.

Treatment

This depends on the type, size and stage (how far it has spread) of bowel cancer. If you are found to have a polyp of the bowel, this can be removed at the time of the colonoscopy. Other treatments include surgery to remove the affected bowel, or chemotherapy and/or radiotherapy. Early detection makes a real difference to the success of treatment, so it advisable to seek medical advice sooner rather than later to ensure that, if present, bowel cancer is treated at the earliest possible stage.

Prevention

Over the last decade much has been learnt regarding how bowel cancers develop and progress. Whilst the majority are often down to bad luck it is clear that living a healthy lifestyle improves your outlook if you are unlucky enough to develop such a cancer. Eating a healthy balanced diet low in saturated fat, red meat and refined sugar, reducing alcohol and increasing exercise all improve your outlook when it comes to bowel cancer. If you have diabetes try to keep your sugars controlled, and if you are overweight, slowly try to lose weight with sensible eating and increased activity level; crash dieting is not likely to help.

Professor Sarah O’Dwyer is a Colorectal Surgeon specialising in bowel cancer at HCA Healthcare UK’s The Wilmslow Hospital, The Christie Clinic and The Christie NHS Foundation Trust. She is nationally and internationally acclaimed in the fields of colorectal disease and peritoneal malignancy. She has long promoted screening for the early detection of pre-cancerous polyps and bowel cancer, in parallel with evaluation of cancer risk and family cancer syndromes. 

To make an appointment or for more information please call 01625 545 036.

Professor Sarah O'Dwyer

References

[i] https://www.bowelcanceruk.org.uk/about-bowel-cancer/bowel-cancer/

[ii] https://www.bowelcanceruk.org.uk/about-bowel-cancer/bowel-cancer/

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