Bowel (or colorectal) cancer is the development of a malignant growth in the large bowel or back passage. It occurs when the cells that line the bowel change the way in which they divide.
Who is at risk from bowel cancer?
Some people are at greater risk than others.
- These include people who have an inflammatory bowel disease or those who have a tendency to develop polyps.
- Both men and women of any age can be affected by bowel cancer, but it tends to be a disease of late middle and old age. In the UK, 95 per cent of cases occur in those over 50 years of age.
- UK statistics show that it is slightly more common in men under the age of 75 years and thereafter more common in women.
- Around six per cent of all bowel cancer patients have a significant family history of the disease. Often, in these families, the disease appears under the age of 45 years and may affect two or more close relatives parent, child, brother sister). Some forms of hereditary bowel cancer are linked to other cancers: stomach, kidney, bladder, breast, ovaries or endometrium (uterus).
- Bowel cancer is primarily a disease of the western world. The incidence in‘developing’ countries is still generally low. Experts believe that diet is a major contributory factor.
• a high amount of dietary fat — particularly animal fats
• a low intake of dietary fibre – particularly from leafy green vegetables and cereals
• an excessive alcohol intake.
• A sedentary lifestyle and obesity increase the risk of bowel cancer.
Bowel cancer is one of the most curable forms of cancer if it is treated in its early stages. People whose tumours are treated while they are still localised, before they have spread through the wall of the bowel, to adjacent lymph nodes or to other organs, have around a 90% chance of cure. Inspect your motions in the toilet using a torch if necessary.
Symptoms of bowel cancer:
- Persistent change in bowel habits: more frequent motions or diarrhoea
- Blood in your stools
- Abdominal pain — cramps or tenderness
- Unexplained anaemia or weight loss
- Lump in your abdomen.
The symptoms listed are also found in other bowel disorders (e.g. irritable bowel syndrome, ulcerative colitis, Crohn’s disease, diverticular disease and piles). If your bowel habits change for more than two weeks – to see your GP
If you have symptoms
Keep a diary of any symptoms for up to two weeks. Note down the time of your bowel movements/pain. Go to your doctor.
Symptoms and tests
Many bowel disorders produce the kinds of symptoms listed in the box For example, bleeding from the bottom (rectal bleeding) is very common, because of piles or little cuts/tears in the bowel, but we tend not to talk about it. Bowel cancer is very rare in people under the age of 50 and the average age for the disease is 70.
If you have disrupted bowel habits and/or colicky abdominal pain and are under 50, with no history of bowel cancer in your family, it is far more likely that you are suffering from Irritable Bowel Syndrome (IBS) or possibly an Inflammatory Bowel Disease (such as Crohn’s Disease or Colitis). Please note that bleeding is not part of lBS. It may be because of something else (e.g. piles) happening at the same time as IBS, but bleeding and changed bowel habits should always be investigated.
If you are older, you may be suffering from Diverticular Disease or Diverticulitis. If you have a strong family history of bowel cancer or of developing polyps, or if you are over 50 and have symptoms, your doctor should rule out bowel cancer, first by giving you a digital rectal examination and then, if necessary, by referring you for a colonoscopy or a combination of sigmoidoscopy and barium enema (described below).
What tests are available?
- Test for hidden blood in the stools [faecal occult blood (FOB)] A sample of your motions is smeared onto a test card. This is sent to the laboratory for testing and the results returned to your doctor within 7 – 10 days. An FOB test is also available over the counter in Chemists’ shops.
- Digital rectal examination The doctor examines the back passage with a gloved finger to feel for any lumps or polyps.
- Sigmoidoscopy Visual inspection of the bowel. A sigmoidoscope is a narrow, lighted instrument which is gently inserted into the back passage. It allows the doctor to look for any changes in the inner lining of the sigmoid colon, the area where most bowel cancers occur. The scope has attachments which can remove a small sample of tissue for analysis where necessary (a tissue biopsy). The test lasts around ten minutes without sedation.
- Colonoscopy The same technique as a sigmoidoscopy but viewing the whole length of the bowel. Before the test, you will have to take laxatives to empty the bowel. At the hospital, you will be given a mild sedative; some people find the test uncomfortable. The test lasts 30-45 minutes.
- Barium Enema This is an x-ray which allows the doctor to see if there any blockages in the bowel. Your bowel must be clear (after laxatives). The nurse will insert a small tube into your back passage through which a mixture of air and barium will be passed into your bowel. The doctor ~ watch the movement of barium on the x-ray screen. Test lasts 30 minutes.
The Three Bs to combat Bowel Cancer
Eat a high fibre, low fat diet containing:
- At least 5 helpings of fruit and vegetables a day (this does not include potatoes). Each portion should be equivalent to the size of an apple or average helping of carrots. Or substituted with a glass of fruit Juice. Deep orange-yellow and very dark green fruit and vegetables, such as carrots, peaches, oranges, bananas, spinach, spring greens and broccoli contain vitamins and minerals found to lower the risk of developing cancer. Fruit and vegetables high in Vitamin C such as citrus fruit, strawberries, broccoli,spring greens and green peppers are also beneficial.
- At least 18 grams of fibre a day. By ensuring your diet includes fruit and vegetables in their skins, wholemeal bread or rolls, brown rice and pasta and high fibre cereals, you can substantially increase the amount of fibre in your diet. You may find it helpful to check the fibre content on packaged goods. Make sure you drink plenty of fluids, ideally at least 2 litres/1O cups per day.
- Limited fat. Fat should make up to 30% of your total calorie intake. Cut down on visible fat such as fried foods, trim excess fat on meats and poultry and reduce less visible fats such as chocolate and cakes. This will also help reduce cholesterol levels which may be a contributory factor.
Become more self aware: Get to know your own bowel habits. This will allow you to identify what is normal for you and to recognise and respond to any changes.
- The bowel is the body’s natural ‘waste’ system and should be emptied frequently and easily.
- Check your motions each time, they should normally be dark brown in colour.
- Avoid constipation, you should be able to pass motions easily without straining. Motions should be kept soft to move things quickly through the bowel.
Avoid being overweight. Men and women who are overweight or obese are at a higher risk of developing cancer. You can maintain a desirable body weight by balancing calorieintake with physical activity. Your GP or Practice Nurse will be able to discuss with you your ideal weight and look at the best way forward if you need to lose weight. Aim to fit in at least twenty minutes of moderate exercise three to five times a week.
Who should be tested for bowel cancer? CY: 611 0/98
You should be tested if:
- Your family has a significant history of bowel cancer
- You have the symptoms of bowel cancer.
Bowel cancer in the family
Doctors say that a family history for bowel cancer is significant if it includes:
1. A close relative diagnosed before the age of 45 years, or
2. Two or more close relatives [parent, child, brother, sister] with bowel cancer, especially when diagnosed under the age of 45.
These two groups have an approximately four-fold increased risk of bowel cancer over the general population. Relatives of cases diagnosed between the ages of 45 and 60 have a modest increase in risk of bowel cancer while the risk to relatives of cases diagnosed after the age of 60 is essentially the same as the population risk.
improving Outcomes in Colorectal Cancer (NHS Executive, November 1997) If there is a significant history of bowel cancer in your family, you should talk to your GP, who may refer you to a Genetic Counsellor. The Genetic Counsellor would talk through the medical history of members of the family. Before talking to your GP or the Genetic Counsellor, it is useful to draw out your family tree, to three generations if possible, noting down illnesses and causes of death in the family. Include cases of bowel cancer and other bowel disorders, as well as cases of the other cancers related to bowel cancer. These are cancers of the stomach, kidney, bladder, ovaries or endometrium (uterus). Try to give an idea of the age of each family member when their symptoms first appeared and when they died. Do not worry if you do not have all the details, but try to be as complete as possible.
Screening for bowel cancer
Bowel cancer is the UK’s second most serious cause of cancer death, with 30,000 people each year in the UK diagnosed as having the disease. If patients are treated early, while the disease is localised, the cure rate is around 90 per cent. Various scientific studies have shown that bowel cancer screening programmes save lives, and Colon Cancer Concern is actively involved in the planning of the pilot studies for a national screening programme for bowel cancer that are due to start in 1999.
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