About the Condition
Bowel cancer occurs when the genetic material of cells in the bowels become damaged or changed, producing mutations that affect normal cell growth and division. The abnormal cells then replicate, causing cancer. If undetected, the cancer can spread beyond the bowel and move to other parts of the body. Also known as ‘colorectal cancer’, or ‘lower gastrointestinal cancer’, bowel cancer is not one single illness but includes large bowel cancer (colon cancer) and cancer of the back passage (rectal cancer or cancer of the rectum).
Bowel cancer is the third most common cancer among men in the UK and the second most common cancer in women in the UK. Every year, around 40,000 new cases are diagnosed and approximately 1 in 20 people will get bowel cancer during their lifetime*.
As with most cancers, the precise causes of bowel cancer are unknown, although there are a variety of risk factors for the condition. These include:
- Age, as almost 90% of bowel cancer patients in the UK are over 60
- Having a family history of bowel cancer
- Having a diet that is high in red and processed meat
- Drinking a large amount of alcohol
- Having a digestive disorder, such as severe Crohn’s disease or ulcerative colitis
- Having a genetic condition, such as:
o familial adenomatous polyposis (FAP) – a condition that triggers the growth of non-cancerous polyps inside the bowel
o hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome – an inherited gene fault (mutation) that increases your bowel cancer risk
The early symptoms for bowel cancer include:
- Bleeding from the back passage or blood in your stools
- Diarrhoea or looser stools that last longer than 6 weeks
- Noticing a lump in your back passage or abdomen
- A feeling of needing to strain in your back passage
- Weight loss
- A pain in your abdomen or back passage
- Feeling tired and breathless
Some people find it embarrassing to talk about these sorts of symptoms, but if any of the above apply to you, or if you have any concerns about similar symptoms, it is essential that you see your doctor at once, as your chances of recovery are much higher if your cancer is diagnosed early.
If you’re referred to CCL for diagnosis, your consultant or oncologist will advise you on which tests are relevant to your individual symptoms. Diagnosing bowel cancer involves a range of examinations and tests. These include:
- A rectal examination
- Blood tests to check for anaemia and abnormal kidney function
- Sigmoidoscopy, which is when a very thin, flexible tube attached to a camera is inserted into your rectum to examine your bowel
- Protoscopy, which is an examination of the rectum using a special plastic or metal scope
- Colonoscopy, which is similar to a sigmoidoscopy, except a longer tube is used to examine your entire bowel
- A Barium Enema, which is a special x-ray of the large intestine
- A histology, where a very fine needle is used to take sample cells from the bowel
At CCL, patients with bowel cancer are treated by a team of different specialists, called a Multi-Disciplinary Team, or MDT. This team works together to create a treatment plan to suit the individual needs of the patient.
In 80% of cases, surgery is the main treatment for bowel cancer. Treatment varies depending on whether the cancer is in the colon or the rectum.
Surgical treatment options for colon cancer include:
- an open colectomy – where the surgeon makes a large incision in your abdomen and removes a section of your colon
- a laparoscopic (‘keyhole’) colectomy – where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of colon
Surgical treatment options for rectal cancer include:
- Local resection, where the surgeon puts an endoscope (a flexible tube with a light) in through your back passage and removes the cancer from the wall of the rectum.
- Total mesenteric excision, where a large area of the rectum is removed, along with a border of rectal tissue around it that is free of cancer cells and fatty tissue from around the bowel (known as the mesentery). This type of operation is known as total mesenteric excision (TME).
- Low anterior resection, where the surgeon makes an incision in your abdomen and removes the upper section of your rectum, as well as some surrounding tissue to make sure any lymph glands containing cancer cells are also removed.
- Abdominoperineal resection, which is used to treat cases where the cancer is in the lowest section of your rectum. In this case, it will be necessary to remove the whole of your rectum and surrounding muscles to reduce the risk of the cancer re-growing in the same area.
Following surgery, a combination of other treatments are usually given to improve the patient’s outlook. These include:
- Radiotherapy, where high-energy rays are used to destroy the cancer cells
- Chemotherapy, which involves the use of chemical agents which are toxic to cancer cells, destroying them and preventing them from spreading to different areas. This can be given by injection or in tablet form.
- Biotherapy, which is the use of newer and more targeted therapies to assist the body in fighting the disease.
Cancer doesn’t just leave a physical impact on an individual, but that it can have a huge emotional effect as well. Cancer and its treatment can be overwhelming, causing a wide variety of emotions, and it is important to remember that there is no right or wrong response. Reactions vary hugely from person to person, and most people find that it becomes easier to cope when they’re given additional support, so that’s what we do.
At CCL we provide support both physically and emotionally before, during and after treatment. We offer a wide range of services for patients, as well as their loved ones, designed to make a very difficult time as easy as possible, and to give our patients the best treatment and support possible.
Surgery for bowel cancer may cause scarring, especially if you need to have a colostomy or ileostomy (a surgical opening bringing the end of your small intestine out onto the surface of the skin, making it easier to collect waste). Your consultant and our occupational therapist can help you cope with these symptoms, and will conduct follow-up appointments to help you manage.