Bowel cancer

What is bowel cancer?

Bowel cancer is the third most common cancer affecting Australians. It is estimated around 15,500 people are diagnosed with bowel cancer every year. It is most common in people over 50, but it can occur at any age. In its early stages, bowel cancer may have no symptoms, but if detected early, it can be successfully treated.

Bowel cancer can develop with no symptoms. It is important to participate in screening if you are eligible.

Surgery is the main treatment for bowel cancer. You may need a stoma, which can be temporary or permanent, you must discuss this with a doctor.

How bowel cancer develops

The colon and rectum together are known as the large bowel. Bowel cancer usually affects the large bowel. Cancer of the large bowel is also known as colorectal cancer and might be called colon cancer or rectal cancer, depending on where it starts in the bowel.

The bowel is part of the digestive system. The digestive system starts at the mouth and ends at the anus. It helps the body break down food and turn it into energy. It also gets rid of the parts of food the body does not use. The bowel is the long ‘tube’ that absorbs water and nutrients from food and processes waste products into faeces. The development of bowel cancer generally takes many years. It usually begins in the lining of the colon or rectum.

Types of bowel cancer

About 9 out of 10 bowel cancers are adenocarcinomas. This means they start in the gland cells in the lining of the bowel. Other rare types include:

  • squamous cell cancers (in the skin like cells of the bowel lining)
  • neuroendocrine tumours (NETs)
  • small bowel cancer
  • gastrointestinal stromal tumours
  • lymphomas

Bowel cancer risk factors

The causes of bowel cancer are not clearly understood. Regular screening is important because bowel cancer can develop without noticeable symptoms.

The risk of bowel cancer is greater if you:       

  • Are aged 50 and over (risk increases with age)
  • Have had an inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis), particularly if you have had it for more than 8 years 
  • Have previously had special types of polyps (called adenomas) in the bowel or a large number of polyps in the bowel.
  • Have a significant family history of bowel cancer or polyps   
  • Are overweight or obese   
  • Eat a lot of red meat, especially processed meats (such as salami, ham, bacon, sausages)       
  • Smoke tobacco     
  • Have a high alcohol intake

If you are worried about your risk of bowel cancer, speak to your GP (doctor).

Screening for bowel cancer

Screening is the process of looking for cancer, or abnormalities that could lead to cancer, in people who do not have any symptoms. It is particularly important for bowel cancer, which often has no symptoms in its early stages. The National Bowel Cancer Screening Program (NBCSP) sends free at-home bowel cancer screening test to all eligible Australians aged 50 to 74, every 2 years. A test kit can also be purchased from some pharmacies.

The screening test used is called the faecal occult blood test (iFOBT). This involves taking tiny samples from two separate bowel motions using a test kit. The samples are then posted to a laboratory for testing. If blood is detected, the doctor is likely to refer you for a colonoscopy. Most positive tests are not the result of cancer. However, if cancer is detected early, there is a higher chance of it being treated successfully.

Symptoms of bowel cancer

Bowel cancer can develop with no symptoms. So, it is important to participate in screening. Symptoms may include:        

  • Blood in your stool, on the toilet paper or in the toilet bowl       
  • A change in your bowel habits (such as diarrhoea or constipation)      
  • Feeling full or bloated in your belly or a strange sensation in the rectum, often during a bowel movement         
  • Anal or rectal pain        
  • A lump in the anus or rectum    
  • Unexplained tiredness, anaemia or weight loss        
  • Abdominal (stomach) pain, cramps, or bloating        
  • A blockage in the bowel

Having these symptoms does not mean that you have bowel cancer. People experiencing these symptoms should speak to their doctor.

Diagnosis of bowel cancer

Several tests can be used to diagnose bowel cancer including:          

  • Physical and rectal examination
  • Blood tests – including a carcinoembryonic antigen (CEA) test and immunochemical faecal occult blood test (iFOBT). · 
  • Colonoscopy and biopsy         
  • PET-CT scan         
  • CT scan        
  • MRI scan        
  • Molecular testing – may be used with a diagnosis of advanced bowel cancer to check the biopsy sample for gene mutations or other cell features. If this is the case, further genetic testing may be required        
  • CT colonography       
  • Flexible sigmoidoscopy

Treatment options could include:

  • Surgery is the main treatment for bowel cancer. The aim of surgery is to remove as much of the cancer as possible and nearby lymph nodes. Surgery may be performed as keyhole or open surgery. The most common type of surgery is a colectomy – where a part of the bowel, lymph nodes near the colon and some normal bowel around the cancer is removed. The surgeon removes the section of the bowel affected by cancer and then joins the two ends. If the end is made from the large bowel it is called a colostomy. If it is made from the small bowel it is called an ileostomy.
  • Stoma A stoma (an opening of the bowel onto the abdomen) is sometimes made during the surgery. Your bowel motions will come through the stoma into a bag. Some stomas are temporary – to allow the bowel to heal, while others are permanent. Around 1 in 10 people with rectal cancer need a permanent stoma. Before your surgery, you will be given a lot of education and support about having a stoma.
  • Chemotherapy and radiotherapy Chemotherapy or radiotherapy (also known as radiation therapy) is nearly always used in addition to surgery. Radiation therapy is often used before surgery and may be used with chemotherapy to reduce the size and number of cancer cells. Radiation therapy is not used for early colon cancer. Occasionally, if the cancer is more advanced, radiation therapy may be used after surgery to destroy any remaining cancer cells.

Your doctor will discuss your treatment in detail with you.

Where to get help

Source: betterhealth

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