Bowel cancer is a common term for cancer that begins in the large bowel, encompassing both the colon and rectum. Though small bowel cancer exists, it is far less common than cancer in the large bowel. Bowel cancer ranks among the most frequently diagnosed cancers in the UK.
Signs and Symptoms of Bowel Cancer
The three main symptoms of bowel cancer are:
- Blood in the stools (faeces)
- Changes in bowel habits – such as more frequent and looser stools
- Abdominal (tummy) pain
However, these symptoms are also associated with other, less serious conditions. For example:
- Blood in stools is often caused by haemorrhoids (piles).
- Changes in bowel habits or abdominal pain are often linked to dietary changes or temporary digestive issues.
The symptoms become more concerning in people over 60 and when they persist despite simple treatments. Most individuals diagnosed with bowel cancer experience one or more of the following combinations:
- Persistent changes in bowel habits with looser stools and blood in the stool.
- Bowel habit changes without blood but with abdominal pain.
- Blood in the stools without other haemorrhoid symptoms, such as itching or lumps.
- Abdominal pain, discomfort, or bloating triggered by eating, leading to reduced appetite and weight loss.
When to Seek Medical Advice
If you have symptoms of bowel cancer, it’s essential to visit your GP. They may:
- Perform a physical examination of your tummy and bottom to check for lumps.
- Arrange a blood test to check for iron deficiency anaemia, which can indicate internal bleeding.
- Recommend further tests at a hospital if symptoms persist or recur after treatment.
Who’s at Risk of Bowel Cancer?
The exact cause of bowel cancer is unknown, but several factors can increase your risk:
- Age: Most cases occur in individuals 60 or older.
- Diet: High intake of red or processed meats and low fibre.
- Weight: Overweight or obese individuals are at higher risk.
- Physical inactivity
- Alcohol and Smoking: High alcohol consumption and smoking may contribute.
- Family History: Having a close relative diagnosed with bowel cancer before age 50 increases your risk.
- Underlying Conditions: Chronic inflammatory bowel diseases, like ulcerative colitis or Crohn’s disease, can increase risk.
Bowel Cancer Screening
In Scotland, bowel screening is offered to men and women aged 50 to 74 every two years. The screening test looks for hidden blood in stool samples, which can be an early indicator of bowel cancer.
Treatment for Bowel Cancer
Treatment depends on the cancer’s location and how far it has spread. Main treatment options include:
- Surgery: Removal of the cancerous section of the bowel; often the most effective method for curing bowel cancer.
- Chemotherapy: Medications used to target and kill cancer cells.
- Radiotherapy: High-energy radiation to eliminate cancer cells.
- Biological Treatments: Newer medications designed to enhance chemotherapy effectiveness and prevent cancer spread.
The chances of a complete cure depend on the stage of cancer at diagnosis.
Signs and Symptoms of Bowel Cancer
The three main symptoms of bowel cancer are:
- Blood in the stools (faeces)
- Changes in bowel habits, such as more frequent or looser stools
- Abdominal (tummy) pain
Common Causes and Context
These symptoms are common and often caused by conditions other than bowel cancer:
- Blood in stools is frequently due to haemorrhoids (piles).
- Changes in bowel habits and abdominal pain may result from dietary factors or other benign issues.
In the UK, approximately 7 million people experience blood in the stools each year, and even more report temporary changes in bowel habits or abdominal discomfort. The majority of these cases are not due to bowel cancer.
Symptom Significance by Age
Bowel cancer symptoms are more prevalent and important to monitor in individuals over 60 years old. Persistent symptoms, especially when not relieved by simple treatments, should be taken seriously.
Common Symptom Combinations in Bowel Cancer Patients
People with bowel cancer often present with one or more of the following symptom patterns:
- Persistent change in bowel habits with looser stools and blood on or in stools.
- Persistent bowel habit changes without blood, but accompanied by abdominal pain.
- Blood in the stools without other haemorrhoid-related symptoms (e.g., no soreness, itching, or lumps).
- Abdominal pain, discomfort, or bloating triggered by eating, potentially leading to reduced appetite and weight loss.
It is important to note that the symptoms of bowel cancer can be subtle and may not make you feel particularly ill.
When to Seek Medical Advice
If you experience any of these symptoms:
- Visit your GP for a thorough evaluation.
- Your doctor may conduct a physical examination of your abdomen and bottom to check for lumps.
- A blood test may be arranged to detect iron deficiency anaemia, which can indicate hidden bowel bleeding.
In some instances, your GP may refer you for further tests at a hospital to rule out any serious underlying causes. It is essential to return to your doctor if symptoms persist or recur after treatment, regardless of age or symptom severity.
Bowel Obstruction
In some cases, bowel cancer can lead to a bowel obstruction, preventing digestive waste from passing through the bowel. Symptoms of a bowel obstruction include:
- Severe abdominal pain (initially may come and go)
- Inability to pass stools
- Swelling or bloating of the abdomen
- Vomiting
A bowel obstruction is a medical emergency. Seek immediate medical attention by visiting your GP or going to the A&E department of your nearest hospital if you suspect a blockage.
For further information:
Causes of Bowel Cancer: Key Risk Factors and Preventive Insights
Bowel cancer arises when cells within the bowel divide and multiply too rapidly, creating a tumour. Many cases begin with small clumps of cells called polyps on the inner lining of the bowel. While not all polyps turn cancerous, they can sometimes develop into cancer over time.
Understanding What Increases Your Risk
Though the exact causes of bowel cancer are not fully understood, several factors are known to increase your likelihood of developing this condition.
1. Age
- Age is a significant risk factor: Nearly 9 out of 10 cases of bowel cancer occur in people over the age of 60.
2. Family History
- Having a close relative (parent, sibling) diagnosed with bowel cancer, particularly under age 50, raises your risk.
- If concerned about a family history of bowel cancer, speak to your GP. You may be referred to a genetics specialist for personalized advice and periodic screenings.
3. Diet
- High intake of red and processed meats is linked to an increased risk of bowel cancer. To reduce risk, limit red and processed meat intake to 70g per day, as recommended by the Department of Health.
- Fibre-rich diets can lower bowel cancer risk.
4. Smoking
- Cigarette smoking increases the risk of bowel cancer, along with other cancers and conditions like heart disease.
5. Alcohol
- Regular alcohol consumption, especially in large quantities, is associated with a higher risk of developing bowel cancer.
6. Obesity
- Being overweight or obese, particularly in men, raises the risk. Losing weight can help lower your chances.
7. Inactivity
- Physical inactivity is linked to a higher risk of bowel cancer. Staying active daily can reduce this risk and improve overall health.
8. Digestive Disorders
- Conditions like severe Crohn’s disease or ulcerative colitis increase your bowel cancer risk, particularly if these issues persist for many years. Regular check-ups involving colonoscopy examinations are recommended for people with these conditions.
9. Genetic Conditions
- Familial adenomatous polyposis (FAP): This rare inherited condition causes non-cancerous polyps in the bowel, with a high risk of one turning cancerous over time. Most people with FAP develop bowel cancer by age 50. Preventive removal of the large bowel may be recommended.
- Hereditary non-polyposis colorectal cancer (HNPCC) or Lynch syndrome: This inherited gene mutation significantly increases bowel cancer risk. Preventive surgery may be advised.
Families affected by FAP or HNPCC can find support through resources like The Polyposis Registry provided by St Mark’s Hospital, London.
Diagnosing Bowel Cancer: Tests, Procedures, and Staging
If you experience symptoms of bowel cancer, the first step is to visit your GP, who will ask about your symptoms and any family history of bowel cancer. Here’s what to expect during the diagnostic process.
Initial Examination
- Physical Examination: Your GP will likely perform a digital rectal examination (DRE) to check for lumps in your abdomen and back passage.
- Blood Tests: A simple blood test may be conducted to check for iron deficiency anaemia, a potential sign of hidden bowel bleeding.
- If your symptoms suggest bowel cancer or the diagnosis is unclear, you may be referred for further testing at a hospital.
Flexible Sigmoidoscopy
A flexible sigmoidoscopy is used to examine your rectum and lower bowel using a sigmoidoscope (a flexible tube with a camera). The procedure involves:
- Preparation: You may be asked to perform an enema at home to empty your bowels.
- Procedure: The camera relays images to a monitor, allowing for the detection of abnormal areas. Biopsies (tissue samples) may be taken.
- This test may feel uncomfortable but is brief, and most people go home immediately afterward.
Advanced Diagnostic Tests
Some cases require more extensive testing to confirm a diagnosis or assess the full extent of the cancer:
1. Colonoscopy
- Overview: This procedure uses a colonoscope (a longer version of a sigmoidoscope) to examine the entire large bowel.
- Preparation: You’ll need to follow a special diet and take a laxative to empty your bowel.
- Procedure: Sedation is provided, and the colonoscope is inserted to visualize the bowel. Biopsies may be taken if necessary.
- Colonoscopies typically take about an hour, and patients will need someone to accompany them home afterward due to drowsiness from sedation.
2. CT Colonography (Virtual Colonoscopy)
- This procedure involves using a CT scanner to create 3D images of the large bowel. Gas inflates the bowel through a thin tube, and multiple scans are taken.
- This is a less invasive alternative to a colonoscopy, but further testing may be needed to biopsy abnormal areas.
Further Testing
If bowel cancer is confirmed, additional tests determine if the cancer has spread and help in planning the most effective treatment:
- CT Scan: Focuses on the abdomen and chest to check for spread to the liver or lungs.
- MRI Scan: Provides detailed images, particularly for cancers in the rectum.
Staging and Grading of Bowel Cancer
Once tests are complete, the stage and grade of cancer are determined:
- Staging describes how far the cancer has progressed:
- Stage 1: Cancer is contained within the bowel or rectum lining.
- Stage 2: Cancer has spread beyond the bowel’s muscle layer.
- Stage 3: Cancer has reached nearby lymph nodes.
- Stage 4: Cancer has spread to other parts of the body (e.g., liver).
- Grading indicates the cancer’s growth rate and likelihood of spreading:
- Grade 1: Slow-growing, low spread risk.
- Grade 2: Moderate growth and spread risk.
- Grade 3: Fast-growing, high spread risk.
Understanding your stage and grade helps your healthcare team develop the best treatment strategy. Don’t hesitate to ask your doctor for clarification on your specific diagnosis.
Comprehensive Guide to Treating Bowel Cancer
Treatment for bowel cancer depends on factors such as the location, stage of the cancer, and your overall health. The main treatment methods are surgery, chemotherapy, radiotherapy, and biological therapies.
Surgical Treatments
1. Colectomy (Colon Surgery)
- Local Excision: For early-stage colon cancer, a small section of the colon lining may be removed.
- Colectomy: Required if cancer has spread to surrounding muscles.
- Open Colectomy: Involves a single large incision.
- Laparoscopic (Keyhole) Colectomy: Performed through smaller incisions using specialized instruments. It offers quicker recovery and less post-operative pain.
2. Rectal Cancer Surgery
- Local Resection: Suitable for small, early-stage rectal cancer. The cancer is removed using an endoscope through the rectum.
- Total Mesenteric Excision (TME): Removes a larger area of rectum and surrounding mesentery tissue to reduce recurrence risk.
- Low Anterior Resection: Removes cancer in the upper rectum, reattaching the colon to the lower rectum.
- Abdominoperineal Resection: Removes the lower rectum, requiring a permanent stoma.
3. Stoma Surgery
In some cases, a temporary or permanent stoma is needed. This involves diverting stool through an opening in the abdomen (stoma), with either an ileostomy or colostomy.
Recovery Support: A stoma care nurse provides guidance on managing and adapting to a stoma.
Side Effects of Surgery
Common risks include bleeding, infection, blood clots, and nerve damage affecting urination or sexual function. Patients with rectal cancer may experience more frequent bowel movements post-surgery.
Radiotherapy for Bowel Cancer
- Pre-Surgery Radiotherapy: Shrinks rectal cancers for easier removal.
- Palliative Radiotherapy: Manages symptoms and slows cancer spread.
- Types:
- External Radiotherapy: High-energy beams target the rectum.
- Internal Radiotherapy (Brachytherapy): Radioactive tubes placed near the cancer.
Common Side Effects: Include nausea, fatigue, skin irritation, and urinary issues. Long-term effects may involve frequent urination, blood in urine/stools, and infertility.
Chemotherapy for Bowel Cancer
- Neoadjuvant Chemotherapy: Administered before surgery to shrink tumors.
- Adjuvant Chemotherapy: Given after surgery to reduce recurrence risk.
- Palliative Chemotherapy: Slows cancer spread and manages symptoms.
Common Side Effects: Include fatigue, nausea, vomiting, mouth sores, hair loss, and heightened infection risk. Men and women undergoing treatment should use contraception, as chemotherapy can temporarily damage sperm or eggs.
Biological Treatments (Monoclonal Antibodies)
Medications like cetuximab, bevacizumab, and panitumumab target specific proteins (EGFR) on cancer cells. Used alongside chemotherapy for advanced/metastatic cancer. These treatments are available under specific NHS criteria or privately.
Living with Bowel Cancer: Support, Recovery, and Practical Tips
Talking to Others
Dealing with bowel cancer can be emotionally challenging. Here’s how to seek support:
- Professional Support: Reach out to your GP, nurse, or specialist counsellors.
- Support Groups: Joining local or online communities can connect you with others who understand what you’re going through.
- Beating Bowel Cancer offers a nurse advisory line and a patient-to-patient network called Bowel Cancer Voices.
- Other resources include Bowel Cancer UK and Cancer Support Groups.
Emotional Impact
Being diagnosed and living with bowel cancer often brings up various emotions, including:
- Shock, anxiety, relief, sadness, and depression. Everyone responds differently.
- Talk to Someone: Whether it’s a loved one, healthcare professional, or fellow survivor, sharing your feelings can help.
Recovery After Surgery
Most hospitals use an enhanced recovery programme that aims to help you recover faster. This approach often includes:
- Pre-Operation: Detailed information about the surgery, potential pre-surgery dietary changes, and other preparations.
- Post-Operation: Careful management of IV fluids, pain control, and early mobility.
- Home Recovery: Most patients can go home within a week, but full recovery varies.
Preventing Complications: Compression stockings and blood-thinning medications may be used to reduce the risk of blood clots.
Diet After Bowel Surgery
- Changes in Stools: If part of your colon was removed, you might experience looser stools and more frequent trips to the toilet.
- Tracking Your Diet: Keeping a food diary can help identify foods that may cause issues, such as high-fibre fruits and fizzy drinks.
- Dietitian Support: Reach out to your care team for assistance with maintaining a balanced diet.
Living with a Stoma
- Adapting to Life with a Stoma: If you have a stoma, there are resources available to help you adjust, from stoma care and diet advice to support groups.
- Patient Support: The Ileostomy and Internal Pouch Support Group offers a visiting service to connect you with others who have had similar surgeries.
Relationships, Sex, and Bowel Cancer
- Open Communication: Talk with your partner about how you’re feeling. A stoma may affect how you feel about intimacy, but many people continue to have a fulfilling sex life.
- Professional Help: Your doctor or nurse can offer advice and support.
Financial Concerns
- Financial Support: If bowel cancer has impacted your work, there is support available for you and any carers.
- Resources: Visit Macmillan Cancer Support, GOV.UK, and Money Helper for financial assistance and benefit information.
Palliative Care and End-of-Life Support
If treatment options become limited, you can still receive:
- Palliative Care: Pain relief and symptom management from your GP.
- Family Support: Resources are available for loved ones and carers.
- Macmillan Cancer Support and Marie Curie offer guidance and support for end-of-life care.
Preventing bowel cancer
To help prevent bowel cancer, there are several lifestyle adjustments you can make, even though certain risk factors like family history and age are beyond your control. Here are some key steps to lower your chances of developing bowel cancer:
1. Diet Adjustments
- Reduce processed and red meat: Eating less cured and processed meat, such as bacon, sausages, and ham, as well as limiting red meat intake, can help lower your risk. Consider increasing your consumption of fish as an alternative.
- Increase fibre intake: A diet high in fibre from cereals, beans, fruits, and vegetables can contribute to better bowel health and reduce cancer risk.
- Limit red and processed meat: The Department of Health recommends cutting down to 70g per day if you currently consume more than 90g.
2. Regular Exercise
- Engage in moderate-intensity activities: Aim for at least 150 minutes of moderate aerobic exercise, such as cycling or brisk walking, every week. Regular physical activity not only reduces cancer risk but also contributes to overall health.
3. Maintain a Healthy Weight
- Weight management: Being overweight or obese increases bowel cancer risk. Maintaining a healthy weight through a balanced diet and regular exercise is crucial.
- Check your BMI: Use a BMI chart or calculator to determine if you are in a healthy weight range.
4. Quit Smoking
- Stop smoking: Smoking is linked to various cancers, including bowel cancer. Quitting smoking can significantly lower your risk.
- Get support: Services like Quit Your Way Scotland offer advice and support. Contact them at 0800 84 84 84. Your GP or pharmacist can also provide assistance and resources to help you quit.
5. Limit Alcohol Consumption
- Reduce alcohol intake: Drinking alcohol increases the risk of bowel cancer. Men and women are advised not to exceed 14 units of alcohol per week. Spread your drinking over at least 3 days if consuming up to 14 units.
- Learn about alcohol units: Educating yourself on units and reducing intake can have a positive impact on your cancer risk.
6. Participate in Bowel Cancer Screening
- Early detection: Screening cannot prevent bowel cancer but can help catch it early when treatment is more effective. It is offered to men and women aged 50 to 74 in Scotland.
- Continue screening after 75: You can request a screening test every 2 years if you’re 75 or older.
By making these lifestyle changes and participating in screening programs, you can lower your risk of developing bowel cancer and improve overall health outcomes.
Diverticular Disease and Diverticulitis
