BOWEL CANCER INFORMATION

One of the most insidious and therefore potentially fatal cancers is bowel cancer. It is second only to lung cancer in fatalities.
Approximately 11,300 cases are diagnosed each year in Australia resulting in approximately 4600 deaths. The chances for men in Australia getting bowel cancer are 1 in 18 and for women 1 in 26.

The potential for bowel cancer to be deadly is not because it’s a fast growing cancer but more because it spreads at a faster rate than other cancers. The fact is, it actually grows slower than most other cancers. The major problem with bowel cancer is its location. Inside the abdomen the large bowel is tucked out of the way which allows it to grow a cancer without displaying symptoms and as a result, has had plenty of time to grow and spread before diagnosis.

If, however bowel cancer is discovered and treated in its early stages the cure rate is approximately 90%. It follows from this that it’s important if you show any symptoms you go to your doctor immediately for a check up. If you are a person at risk such as being over 60yrs you are should be screened regularly and make an effort to take measures to reduce your risk such as changing to a healthy diet.

Let’s now look briefly at how the bowel works. Food leaves the stomach and passes into the small intestine where nutrients are absorbed into the body from the food that has been broken down.
What’s left is then passed into the large intestine (or bowel), which is a 1 ½ metre tube that includes the colon and rectum. As the waste moves along the bowel water is absorbed until finally it passes into the rectum and is then expelled via the anus as faeces.

Any part of the bowel which includes the colon and rectum can be affected by cancer. The terminology can be confusing sometimes. The large intestine and the bowel are the same thing. Included in the bowel are sections called the colon and the rectum. See diagram. Therefore, if someone has bowel cancer it could be further defined as colon cancer or rectal cancer depending on where the cancer strikes. To further muddy the waters bowel cancer can also be referred to as colorectal cancer which covers both colon and rectal cancer.

Causes of Bowel Cancer

A mutation of cells in the lining of the bowel is the cause of bowel cancer. These are known as gland cells and are therefore defined as adenocarcinoma. What causes this is not known but it’s suspected that one or more of the following are risk factors that may contribute to bowel cancer.

1. Age:  The older you get the more common bowel cancer is. It’s fairly rare under the age of forty but certainly not unknown. Basically the older you get over forty the greater the risk.
2. Family connections:   You have a greater risk of getting bowel cancer if you have a first degree relative who has had bowel cancer. A first degree relative is defined as a mother, father, brother, sister or child. If this is the case your risk increases by a factor of 3.

If you have more than one relative who has had bowel cancer you risk is even higher. There are a small percentage of people who are at a very high risk because these people have directly inherited, genetically, from a parent the faulty gene for bowel cancer. Statistics show that about 80% of bowel cancer sufferers do not have bowel cancer history in their family.

1. Diet:   People who eat a lot of red meat and fat and don’t have much fibre in their diets are probably more prone to bowel cancer. It’s been shown that societies with a high fibre diet of vegetables and grains, as in some parts of Africa and Asia, have a much lower incidence of bowel cancer compared to those in countries like the USA and Australia where a lot of red meat and fat is consumed and not enough fibre.
2. Polyps:   A polyp is a mushroom like growth, like a ball on a stick that is benign. They occur in some parts of the body’s internal cavities but particularly in the bowel. About 1 in 4 people have these growths in the bowel who are over the age of 50yrs. Polyps can become cancerous but only about 5% actually do. Working out which 5% is impossible and that’s why they are removed when a colonoscopy is performed. Most bowel cancers are caused by polyps so it follows that if you have polyps in your bowel you are at an increased risk of getting bowel cancer. There are rare hereditary conditions that may cause the recipient to develop polyps in the bowel and these people are at a greater risk of developing bowel cancer. There are two conditions that can cause this: Hereditary non-polyposis colorectal cancer (HNPCC) and Familial adenomatous polyposis (FAP)

People who suffer from ulcerative colitis and Crohn’s disease have an increased risk of getting bowel cancer.
 
Symptoms of Bowel Cancer

As stated before, bowel cancer develops slowly. The problem with that is it grows quite large before there are any symptoms. These symptoms can then manifest themselves by causing a disruption in normal bowel functions. The most common symptoms are as follows:

1. A persistent change in bowel habits such as constipation and/or diarrhoea lasting longer than two to six weeks.
2. Bleeding from the anus after a bowel motion often seen on toilet paper or in the toilet bowl.
3. Unexplained weight loss or lack of appetite.
4. Pain in the stomach or in the back passage. A bloating feeling in the stomach.
5. After a bowel motion you feel like you still have not emptied your bowel.
6. Mucous in the stools
7. Sometimes tiredness can be a symptom of bowel cancer. This can be caused by the bowel tumour bleeding and can cause a shortage of red blood cells. This is called anaemia and can also leave you feeling breathless.
8. It must be noted that in quite a few cases, rectal bleeding can often be attributed to haemorrhoids.
9. Any bleeding should be brought to the attention of your doctor. DO NOT IGNORE THESE SYMPTOMS.
10. If any of these symptoms persist for a few weeks or get worse CONSULT YOUR DOCTOR.

In some cases the symptoms may be something entirely different and innocuous but if it does turn out to be bowel cancer, better it’s found as early as possible so that it can be treated and when a cure will be more likely.

Bleeding can sometimes occur high up in the colon and blood traces can’t be detected by simply looking. If this occurs the cancer can cause undetected bleeding that will deplete the body of iron which is an essential component of the blood. Lack of iron may inhibit the production of new blood cells to replace the ones being lost from bleeding and may result in anaemia. This can lead to feeling tired and looking pale. Sometimes these symptoms can be the first sign of bowel cancer.

In other cases the cancer will make itself known in more dramatic ways. A cancer can obstruct the bowel preventing faeces from passing through the bowel. The cancer may also perforate the bowel wall.  About 10% of bowel cancers are detected in this manner. These cases would be treated as medical emergencies and would need to be treated in a hospital, probably with high priority surgery.

It’s not uncommon for a bowel cancer to attach itself to other organs in the abdomen. It can also spread to nearby lymph nodes. In more advanced cases the cancer can be spread via lymph channels to other lymph nodes in the abdomen and via blood to other organs such as the liver, lungs and brain. When another organ such as the liver is infected from the bowel cancer they are called secondary cancers. A secondary cancer is where the original cancer has spread to another organ such as the liver or brain. If the bowel cancer cells have moved to the brain this is not classed as brain cancer but rather a secondary cancer of the bowel. Another term is the cancer has metastasised.

Diagnosing Bowel Cancer

If a doctor thinks that any of the symptoms he sees may be caused by bowel cancer they will complete a medical examination which will probably include feeling the abdomen for a lump and doing a rectal examination. This means the doctor inserts his finger in the rectum and checks for anything unusual. If you are a man he can also check your prostate while he’s there as a bonus. Many people, especially men won’t go to a doctor because they’re embarrassed about this procedure.

Let’s get this in perspective. The procedure does not hurt and the doctor has probably done it thousands of times in his medical career. You have to weigh your embarrassment against letting your symptoms continue i.e. your cancer continues to grow and cuts down your chances of survival, which in turn could lead to your premature death and a great loss to your loved ones. By the way, ignoring your symptoms doesn’t make the cancer go away. Make the right choice and if you have symptoms go to your doctor.

A lot of bowel cancers are not in the rectum but further up the bowel and a physical examination may not reveal anything. In this case you should be referred to a gastroenterologist for further tests.

The most common test is a colonoscopy. A thin, flexible tube called a colon scope is inserted into the anus and is pushed up the full length of the large bowel. The doctor is able to see the walls of the bowel as the scope progresses.  ( a day or two before the procedure you have to take a salt solution that will clean out your bowel so the doctor can see clearly) If any polyps are found they are removed. If anything else is found that looks suspicious a biopsy is taken and sent to a pathologist for examination.

The procedure is done with the patient sedated or anaesthetised. It may be a little uncomfortable but is not painful. It’s usually performed as day surgery and takes about half an hour. With preparation time and recovery time the whole procedure will be about 4 hours.

Blood tests, Z-rays and CT or MRI may be used to see if the cancer has spread from its primary site.

Treatments

If the cancer is small enough it’s possible for it to be removed during the colonoscopy. However, this is rare because the cancer has usually grown too big for that to be a viable option.
Most cancers are removed in surgery under a general anaesthetic. Normally, the cancer is removed along with a small piece of healthy tissue on either side of it, to ensure all the cancer has been removed. The ends of the bowel are then joined together.  Usually, only a small section is removed but this depends on the size of the cancer. Luckily, cutting out a small section of the bowel doesn’t affect its function.

In some cases where the cancer is low in the rectum, there may not be enough bowel left to make a join. The surgeon will then make an opening in the skin and join the bowel to it so that waste can leave the body through the new opening. The opening is called a stoma or colostomy and a bag is attached to the opening to collect the waste. In some cases this is a permanent solution and in others purely temporary while the bowel is healing. A permanent colostomy occurs in about 5% of bowel cancer patients and in 90% of cases none is needed at all.

If the cancer is found to have spread the doctor may well recommend chemotherapy and or radiation therapy as follow up treatment after surgery. This is to kill off any cancerous cells that may have been left behind after surgery. Sometimes chemotherapy and or radiation is used prior to the operation to try and shrink a particularly large tumour. The makes removing the tumour in surgery more manageable.

Chemotherapy involves poisonous drugs being introduced into the body. These drugs are quite toxic and slow down or kill of cancer cells. They also kill off healthy cells and there are some unpleasant side effects. Chemotherapy is commonly used to treat advanced cancer. It is less likely to be used on a patient with early stage bowel cancer but in some cases it might be.
The chemotherapy drugs can be administered either as an intravenous injection or drip or in some cases given as tablets or capsules. The side effects can be unpleasant and can include:

1. A reduced resistance to infection.
2. Tiredness.
3. Nausea.
4. Diarrhoea.
5. Mouth ulcers.
6. Hair loss.
7. Numbness or tingling in the hands, feet, neck and throat.

These symptoms go away gradually when the chemotherapy is finished. It is highly advisable that you don’t father a child or become pregnant whilst undergoing chemotherapy or for a year after the completion of the treatment as there is a high risk of the foetus being affected.

The outcome or prognosis depends somewhat on how far advanced the cancer is when it was treated.

There are four stages of bowel cancer and each one carries its own survival rate and is based on a five year period.

1. Localised within the bowel........................................88% of patients survive 5 years.
2. Penetrates the bowel wall........................................ 70% of patients survive 5 years.
3. Involves lymph nodes near the cancer site..............43% of patients survive 5 years.
4. Distant metastases (spread to other organs)...........7% of patients survive 5 years.

(Source: National Health and Medical Research Council)

A person who is diagnosed with bowel cancer will usually find this a traumatic event. After the initial shock they will find a number of things they have to consider and deal with. Primarily, they will have to deal with their diagnosis. They will need to talk openly with their doctor about their treatment. They need to be active in this discussion. When they get to this point they will need to make sure they pick the right surgeon. The wrong one can have disastrous results (See Susie and Allen’s story in my book)

Family will have to be taken into consideration and they will need to know as much as possible to support you through the months ahead with the treatment. It’s been found that patients who manage the best are those that communicate with their family and friends openly about how they feel and what their needs are. The same applies to their doctors and anyone else who is involved.

Join a cancer support group. There are quite a few forums on the internet that can help. This will allow the patient to talk to others who are in the same position as themselves.

In my book about bowel cancer survivors they all talk about how they managed and what strategies they used to survive. A positive attitude, education of their condition, following a plan of treatment and never giving up seems to be a common theme. 

Early Detection of Bowel Cancer

Being screened is one the best way of detecting cancer early. A colonoscopy every two or three years would be ideal. This is essential if someone is in the high risk category such as a close relative with bowel cancer.

The other type of screening is to test faeces for any microscopic traces of blood. This is called a FOB test.

What is an FOB test?

1. This is a Faecal Occult Blood test. You can buy kits or have one referred to you by your doctor, which allows you to test yourself and send it away for analysis.
2. The purpose of the test is to examine the sample, sent by the user to the laboratory, to detect any sign of blood in the stool. It is quick and easy to do and not messy.
3. The test may give an early indication of bleeding in the bowel that would need to be followed up with your doctor.
4. However, do not use this test in isolation. It is estimated this test can show up to 50% of cancers as negative. This falls to 30% if the test is done over three consecutive days.
5. If you present with any other symptoms that are suspicious, see your doctor as soon as possible.

Anyone over 50yrs should carry out one of these tests every year whether they have symptoms or not and regardless of having no other family member with bowel cancer.

If the test is positive and shows some sign of blood in the stool samples the person giving the sample should be referred for a colonoscopy to see if there are any polyps to be removed or if cancer is present.

Prevention of Bowel Cancer

• Eat a healthy diet.
• A diet high in meat, fat and salt intake increases your risk of bowel cancer.
• Eat plenty of fresh fruit, vegetables, drink plenty of water and fruit juice and cut down on meat, fat and salt.
• Exercise is beneficial. The good news is you don’t have to spend hours at the gym. Walking, cycling, swimming and gardening are some of the activities that will be helpful, not only for bowel cancer, but for overall good health.
• Being overweight can increase your risk of bowel cancer.
• Smoking and drinking alcohol increase your risk especially if you drink a lot.
• Give up smoking and you will reduce the risk of developing any number of cancers, heart disease and many other life threatening diseases.
• Reduce your alcohol intake. The European Code against Cancer recommends 2 units of alcohol per day for a man and one unit for a woman. A unit is measured as a half pint of beer, lager or cider.  Or one small glass of wine measuring 125ml, or a single 25ml drink of spirits.
• All of the above doesn’t necessarily mean a person won’t get bowel cancer but it does help reduce the risk.

Home | Articles | Blog | Bowel Cancer Information |Contact | FAQ | Sitemap |Terms of Use