Bowel cancer

Gastrointestinal system

Bowel cancer is a disease of the bowels. The bowels are part of the digestive system and are divided into the small bowel and the large bowel. Nearly all bowel cancers develop in the large bowel.

The large bowel is made up of the colon and the rectum. Approximately two out of every three bowel cancers develop in the colon and one out of every three develops in the rectum. If the bowel cancer develops in the colon it may also be called colon cancer, if it develops in the rectum it may also be called colorectal cancer.

Approximately 38,000 people develop bowel cancer in the UK each year. Bowel cancer is the third most common form of cancer in men and the second most common form of cancer in women. Although bowel cancer can occur at any age, it is more common in people who are late middle aged and over. 8 out of 10 people who get bowel cancer are over the age of 60.

Experts do not know precisely what causes most bowel cancers and in many cases there are no obvious causes. However, it is believed that family history, diet and lifestyle are the three things most likely to affect a person’s chance of developing bowel cancer.

There does appear to be a genetic link. In the UK, approximately 10 - 15% of all people diagnosed with bowel cancer have a family history of the disease. The risk is higher if bowel cancer has been diagnosed before the age of 45 in a close family member or if the person has two close relatives (eg mother, father, sister, uncle etc) who have had bowel cancer. However, it is important to note that even if a person has relatives who have had the disease, it does not necessarily mean that the bowel cancer genes would automatically be inherited.

People who have long term inflammatory bowel conditions such as ulcerative colitis or Crohn’s disease, or those who have tendency to develop polyps may also have an increased risk of developing bowel cancer.

Diet and lifestyle also appear to be responsible. People whose diets are low in fibre, fruit and vegetables and who do not exercise regularly appear to be at an increased risk of developing bowel cancer. So too are people whose diet is rich in animal meat, who smoke or who are heavy alcohol drinkers.

The symptoms of bowel cancer may include any of the following:

A persistent change of bowel habits such as:

• Feeling the need to go to the toilet more frequently
• Having looser, more diarrhoea-like stools
• Any bleeding from the bottom or blood in the stools
• Abdominal pain, especially if severe
• Unexplained weight loss
• Extreme tiredness without obvious cause

It is important to notethat most of these symptoms will not be cancer. However, if a person has one or more of these symptoms for more thanfour to six weeks she/he should go and see a doctor for further investigation.

The treatment for bowel cancer depends on the part of the bowel affected, how far the cancer has spread, the person’s medical history and general state of health.

The most common form of treatment for bowel cancer in its early stages is surgery. In most cases, the surgeon removes the portion of the colon or rectum containing the cancer together with the surrounding lymph nodes. Depending on the position of the cancer, the two ends of the colon can be joined together and normal bowel function is restored. However, in some cases, particularly if the cancer is close to the anus, this may not be possible. In such situations, the colon is brought to the surface on the abdomen with an opening known as a stoma. A small bag worn over the stoma will collect the waste products. This is known as a colostomy.

Following surgery, patients may be treated with chemotherapy to kill any remaining cancer cells or stop them from growing.  A number of different drugs may be used, for example 5-fluorouracil (5FU), capecitabine, gemcitabine, irinotecan, oxaliplatin and raltitrexed.

Other treatments known as monoclonal antibodies, for example cetuximab and panitumumab have the ability to recognise and specifically latch onto cancer cells in the large bowel preventing the cancer cells from growing and multiplying. Another monoclonal antibody called bevacizumab prevents cancer cells from developing blood vessels and so prevents the tumour growing by depriving the cancer cells of nutrients and oxygen.

Often several chemotherapy drugs or monoclonal antibodies are used together to give a better chance of getting rid of any remaining cancer cells and reducing the risk of cancer coming back.

Radiotherapy is more commonly used to destroy cancers of the rectum. It may be given prior to surgery to reduce the size of the cancer and make it easier to remove, or as a course of treatment following an operation.

If the bowel cancer is in an advanced stage and has spread to other parts of the body, then chemotherapy will usually be used to slow its growth and reduce any symptoms.

If you notice a change in your bowel habits it is important that you discuss your symptoms with your pharmacist. If your pharmacist decides that your symptoms may indicate something more serious than temporary diarrhoea or constipation you will be advised to visit your doctor.

If you do have bowel cancer, it is important that you let your pharmacist know what medicines you are receiving, particularly if buying medicines or supplements to treat minor illnesses. Sometimes, over the counter medicines and health food supplements may interact with your treatment and should be avoided.

If your treatment has required a colostomy, then your local pharmacy is likely to supply all the necessary equipment. Allow your pharmacist plenty of time to order the right size bags and accessories. If you are experiencing any problems with your colostomy, talk to your pharmacist because there are many types of colostomy appliance and compatible accessories that can be used to ease discomfort and improve personal satisfaction with the equipment.

If you have any of the symptoms described above, or if there is a history of bowel cancer in your family, it is important that you are checked by your doctor. Although bowel cancer is one of the biggest causes of cancer deaths, if it is caught early and treated successfully it is completely curable. Early diagnosis is essential, so do not be embarrassed to talk to your doctor if you are worried. It is always important to remember that most symptoms do not turn out to be cancer.

Standard investigations for bowel cancer will usually include a rectal examination and blood test at the doctor’s surgery. If necessary this will be followed by a referral to a hospital consultant or specialist clinic for a colonoscopy, an investigation that involves looking directly at the lining of the large bowel. A sedative is given and then a thin, flexible tube with a tiny camera attached (a colonoscope) is passed into the back passage and guided around the bowel. If polyps are found, most can be removed painlessly, using a wire loop passed down the colonoscope tube. These tissue samples are then checked for any abnormal cells that might be cancerous.

Bowel Cancer Screening Programmes are currently operating throughout the UK. The Bowel Cancer Screening Programmes aim to detect bowel cancer at an early stage, before symptoms develop and when treatment is more likely to be effective. Bowel cancer screening can also detect polyps. Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16 per cent.

The Bowel Cancer Screening Programmes offer screening every two years to all men and women aged 60 to 69 in England and Northern Ireland, or aged 50 to 74 in Scotland and Wales. The programmes operate a national call and recall system to send out test kits that can detect the present of blood in faeces (faecal occult blood (FOB) test kits), analyse samples and despatch results. Screening centres provide colonoscopy services and specialist screening nurse clinics for people receiving an abnormal result. Screening centres are also responsible for referring those requiring treatment to their local hospital multidisciplinary team.

Faecal occult blood (FOB) test kits are sent automatically to all men and women in the age ranges specified above. Additional information can be obtained from the country in which you live:

England

http://www.cancerscreening.nhs.uk/bowel/index.html

Helpline: 0800 707 60

Northern Ireland

http://www.cancerni.net/networkservices/regionalprojects/bowelcancerscreening

Helpline: 0800 783 3339

Wales

http://www.wales.nhs.uk/sites3/home.cfm?orgid=747

Helpline: 0800 294 3370

Scotland

http://www.bowelscreening.scot.nhs.uk/index.php/about-the-screening-programme

Helpline: 0800 0121 833

Protecting against bowel cancer

There are a number of improvements in lifestyle that can be made to reduce the risk of developing bowel cancer. Try to adopt a healthy diet. This means eating lots of fruit, vegetables, wholegrain foods such as wholemeal bread and brown rice. The rich, natural fibre content of these foods will increase gastrointestinal activity and help frequent bowel motions. The fibre also reduces constipation and reduces straining when going to the toilet. It is not known exactly why high fibre diets reduce the risk of cancer but it is probably related to clearing toxic substances from the gut quickly.

Try also eating less red meat, less processed meat and less fats and eating more oily fish. People who eat a lot of red meat, particularly if it has been cooked at a high temperature, have a higher risk of developing bowel cancer.

Take up regular exercise. Try to aim for at least 30 minutes of vigorous exercise each day. Regular exercise, improves bowel function, reduces the risk of bowel cancer and lowers the risk of other diseases such as heart attacks, stroke and diabetes.

If you drink, moderate your alcohol consumption and do not drink more than 12.5 units per week.

If you smoke, give up. Stopping smoking lowers your risk of bowel cancer and is the most effective way of preventing cardiovascular problems such as heart attacks and strokes and preventing respiratory problems such as chronic obstructive pulmonary disease and lung cancer.

When you receive the test kit to screen for bowel cancer, use it. Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16 per cent. The test is simple to do. All that is required is to spread a small sample of your motion onto the test, on 3 separate occasions, and send the test back for analysis.

Once bowel cancer has been confirmed, your doctor will talk to you about how far it has developed as this determines the type of treatment you will receive. Your doctor will discuss with you the options available, the procedures involved, the type and length of treatment and the side effects that you may experience. Involve your partner or close friend in any discussions with your doctor to provide support and to ask any questions that you may not have considered.

Even when bowel cancer is not life-threatening, the consequences of the disease and its treatment can be life-changing. You may experience potentially overwhelming emotional and physical changes. The important thing to understand is that you are not alone. There are healthcare professionals who are there to help. Talk with family and friends, join self-help groups and talk with others who are affected by bowel cancer. Get as much information as you think is necessary to help you understand bowel cancer and to answer any doubts or fears that you may have.

Cancer Research UK is the world’s leading charity dedicated to beating cancer through research. Follow the link below to get the facts about bowel cancer, its diagnosis and treatment, as well as practical advice for those living with bowel cancer.

http://www.cancerhelp.org.uk/type/bowel-cancer/?script=true