BOWEL CANCER
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
Better Diet
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.
Bowel Awareness
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.
Keeping Fit
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.
Information Courtesy of:
COLON CANCER CONCERN
9 Rickett Street
London
SW6 1RU
Tel Admin 020 7381 9711
Infoline 020 7381
Fax 020 7381 5752
Email: help@coloncancer.org.uk
For Further information visit the website
www.coloncancer.org.uk
