Cancer is when abnormal cells start to divide and grow in an uncontrolled way. The cells can grow into surrounding tissues or organs, and may spread to other areas of the body. The food we eat ends up in the large bowel where water and some nutrients are absorbed leaving waste.
This passes through the bowel before leaving the body. The most common type of bowel cancer affects the large bowel, which includes the colon and the back passage. Large bowel cancer is also sometimes called colorectal cancer.
Cancer starts when something goes wrong in a cell and it starts growing uncontrollably to form a tumour. Your risk of developing bowel cancer may be higher if you have a strong family history of bowel cancer, or you have a genetic condition, or you gave a bowel condition such as colitis.
The good news is that more than half of all bowel cancers could be prevented through lifestyle changes. These include stopping smoking, being physically active - at least 30 minutes exercise five times a week, keeping to a healthy weight, eating smaller and fewer portions of red and processed meat, choosing wholegrain foods and at least five portions of fruit and veg a day, and cutting down on alcohol.
The less you drink the lower the risk. If you do drink, try and stick within the government guidelines, that is no more than 14 units a week. The UK has a bowel cancer screening programme for older men and women which aims to find cancer early. Those registered with a GP are sent a kit to test for bowel cancer every two years. You can find out more information about bowel cancer screening on the Cancer Research UK website.
Serrated adenomas contain tissues with a sawtooth look. There are two types: sessile serrated adenomas and traditional serrated adenomas. Most serrated adenomas are sessile and resemble small raised bumps. Sessile serrated polyps tend to carry a low risk of becoming cancerous as long as they do not contain major cellular changes. Traditional, or non-sessile, serrated adenomas are rarer and typically pedunculated. They carry a high risk of becoming cancerous. Hyperplastic polyps are typically benign, and they are not usually a cause for concern.
They will rarely become cancerous, as they have a low malignancy potential. Some people may also refer to these as pseudopolyps, as they are not true polyps but a reaction to inflammation in the colon. Inflammatory polyps are usually benign and generally do not carry the risk of developing into bowel cancer.
Who gets bowel cancer? Australia has one of the highest rates of bowel cancer in the world; 1 in 13 Australians will develop the disease in their lifetime. The risk of developing bowel cancer rises sharply and progressively from age 50 , but the number of Australians under age 50 diagnosed with bowel cancer has been increasing steadily.
What are the symptoms of bowel cancer? During the early stages of bowel cancer, people may have no symptoms , which is why screening is so important. These symptoms are often attributed to haemorrhoids or simply ignored. Cancers occurring in the left side of the colon generally cause constipation alternating with diarrhoea, abdominal pain and obstructive symptoms, such as nausea and vomiting.
Right-sided colon lesions produce vague, abdominal aching, unlike the colicky pain seen with obstructive left-sided lesions. Patients with cancer of the rectum may present with a change in bowel movements; rectal fullness, urgency, or bleeding; and tenesmus cramping rectal pain. Any of the below symptoms could be indicative of colon or rectal cancer and should be investigated by your GP if they persist for more than two weeks.
Blood in your poo or rectal bleeding A recent, persistent change in bowel habit e. What factors increase my bowel cancer risk? There are two kinds of risk factors for bowel cancer — those that can be changed modifiable and those that cannot non-modifiable. Bowel cancer risk is increased by smoking, eating an excessive amount of red meat especially when charred , eating processed meats smoked, cured, salted or preserved , drinking alcohol, and being overweight or obese.
These risks can all be addressed through diet and lifestyle changes and are referred to as modifiable. Age , family history , hereditary conditions and personal health history can also influence bowel cancer risk. Because they cannot be changed they are referred to as non-modifiable. People with certain diseases and illnesses seem to be more prone to developing bowel cancer.
Someone with several close relatives diagnosed with bowel cancer before age 50 has a much higher risk than someone with no close relatives with bowel cancer. In some family members, bowel cancer develops due to an inherited gene mutation.
How can I reduce my bowel cancer risk? Healthy diet and lifestyle choices , as well as screening and surveillance , can help to reduce your bowel cancer risk. Evidence reveals quitting smoking, abstaining from or limiting alcohol consumption, and eating foods containing dietary fibre are all beneficial. Maintaining a healthy weight and engaging in regular physical activity have also been shown to reduce the risk of colon cancer, but not rectal cancer.
Additionally, people who are more physically active before a bowel cancer diagnosis are less likely to die from the disease than those who are less active. These symptoms should be taken more seriously as you get older and when they persist despite simple treatments.
Read about the symptoms of bowel cancer. See a GP If you have any of the symptoms of bowel cancer for 3 weeks or more. Make sure you see a GP if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age. You'll probably be referred to hospital.
Read about diagnosing bowel cancer. The exact cause of bowel cancer is not known, but there are a number of things that can increase your risk, including:. Some people also have an increased risk of bowel cancer because they've had another condition, such as extensive ulcerative colitis or Crohn's disease in the colon for more than 10 years. Although there are some risks you cannot change, such as your age or family history, there are several ways you can lower your chances of developing the condition.
A number of different staging systems are used by doctors. A simplified version of one of the common systems used is outlined below.
If colon cancer is at a very early stage, it may be possible to remove just a small piece of the lining of the colon wall. This is known as local excision. If the cancer spreads into muscles surrounding the colon, it will usually be necessary to remove an entire section of your colon. This is known as a colectomy. During surgery, nearby lymph nodes are also removed.
It is usual to join the ends of the bowel together after bowel cancer surgery, but very occasionally this is not possible and a stoma is needed. Both open and laparoscopic colectomies are thought to be equally effective at removing cancer and have similar risks of complications. However, laparoscopic colectomies have the advantage of a faster recovery time and less postoperative pain. It is becoming the routine way of doing most of these operations.
Laparoscopic colectomies should be available in all hospitals that carry out bowel cancer surgery, although not all surgeons perform this type of surgery.
Discuss your options with your surgeon to see if this method can be used. There are a number of different types of operation that can be carried out to treat rectal cancer, depending on how far the cancer has spread.
If you have a very small, early-stage rectal cancer, your surgeon may be able to remove it in an operation called a local resection transanal resection.
The surgeon puts an endoscope in through your back passage and removes the cancer from the wall of the rectum. In many cases, however, a local resection is not possible. Instead, a larger area of the rectum will need to be removed. This area will include a border of rectal tissue free of cancer cells, as well as fatty tissue from around the bowel the mesentery.
This type of operation is known as total mesenteric excision TME. Removing the mesentery can help ensure all the cancerous cells are removed, which can lower the risk of the cancer recurring at a later stage. Depending on where in your rectum the cancer is located, one of two main TME operations may be carried out. These are outlined below. Low anterior resection is a procedure used to treat cases where the cancer is in the upper section of your rectum.
The surgeon will make an incision in your abdomen and remove the upper section of your rectum, as well as some surrounding tissue to make sure any lymph glands containing cancer cells are also removed. They will then attach your colon to the lowest part of your rectum or upper part of the anal canal. Sometimes they turn the end of the colon into an internal pouch to replace the rectum.
Abdominoperineal resection 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 regrowing in the same area. This involves removing and closing the anus and removing its sphincter muscles, so there is no option except to have a permanent stoma after the operation.
Bowel cancer surgeons always do their best to avoid giving people permanent stomas wherever possible. Where a section of the bowel is removed and the remaining bowel joined, the surgeon may sometimes decide to divert your stool away from the join to allow it to heal. The stool is temporarily diverted by bringing a loop of bowel out through the abdominal wall and attaching it to the skin — this is called a stoma.
A bag is worn over the stoma to collect the stool. When the stoma is made from the small bowel ileum it is called an ileostomy , and when it is made from the large bowel colon it is called a colostomy. A specialist nurse, known as a stoma care nurse, can advise you on the best site for a stoma prior to surgery.
The nurse will take into account factors such as your body shape and lifestyle, although this may not be possible where surgery is performed in an emergency. In the first few days after surgery, the stoma care nurse will advise on the care necessary to look after the stoma and the type of bag suitable. Once the join in the bowel has safely healed, which can take several weeks, the stoma can be closed during further surgery. In some people, for various reasons, rejoining the bowel may not be possible or may lead to problems controlling bowel function, and the stoma may become permanent.
Before having surgery, the care team will advise you about whether it may be necessary to form an ileostomy or colostomy, and the likelihood of this being temporary or permanent. There are patient support groups available that provide support for patients who have just had or are about to have a stoma.
You can get more details from your stoma care nurse, or visit the groups online for further information. Learn more about coping with a stoma after bowel cancer.
Bowel cancer operations carry many of the same risks as other major operations, including bleeding, infection, developing blood clots, or heart or breathing problems. The operations all carry a number of risks specific to the procedure. One risk is that the joined-up section of bowel may not heal properly and leak inside your abdomen.
This is usually only a risk in the first few days after the operation. Another risk is for people having rectal cancer surgery. The nerves that control urination and sexual function are very close to the rectum, and sometimes surgery to remove rectal cancer can damage these nerves.
After rectal cancer surgery, most people need to go to the toilet to open their bowels more often than before, although this usually settles down within a few months of the operation. There are two main ways radiotherapy can be used to treat bowel cancer. It can be given before surgery to shrink rectal cancers and increase the chances of complete removal, or be used to control symptoms and slow the spread of cancer in advanced cases palliative radiotherapy.
External radiotherapy is usually given daily, five days a week, with a break at the weekend. Depending on the size of your tumour, you may need one to five weeks of treatment. Each session of radiotherapy is short and will only last for 10 to 15 minutes.
Internal radiotherapy can usually be performed in one session before surgery is carried out a few weeks later. Palliative radiotherapy is usually given in short daily sessions, with a course ranging from 2 to 3 days, up to 10 days. These side effects should pass once the course of radiotherapy has finished. Tell your care team if the side effects of treatment become particularly troublesome. Additional treatments are often available to help you cope with the side effects better.
If you want to have children, it may be possible to store a sample of your sperm or eggs before treatment begins so they can be used in fertility treatments in the future. There are three ways chemotherapy can be used to treat bowel cancer:.
Chemotherapy for bowel cancer usually involves taking a combination of medications that kill cancer cells. They can be given as a tablet oral chemotherapy , through a drip in your arm intravenous chemotherapy , or as a combination of both.
Treatment is given in courses cycles that are two to three weeks long each, depending on the stage or grade of your cancer. Most people having oral chemotherapy take tablets over the course of two weeks before having a break from treatment for another week. A course of chemotherapy can last up to six months, depending on how well you respond to the treatment. In some cases, it can be given in smaller doses over longer periods of time maintenance chemotherapy.
These side effects should gradually pass once your treatment has finished. It usually takes a few months for your hair to grow back if you experience hair loss. Inform your care team or GP as soon as possible if you experience possible signs of an infection, including high temperature fever or a sudden feeling of being generally unwell.
Medications used in chemotherapy can cause temporary damage to men's sperm and women's eggs. This means that for women who become pregnant or for men who father a child, there is a risk to the unborn baby's health.
It is therefore recommended you use a reliable method of contraception while having chemotherapy treatment and for a period after your treatment has finished. Find out more about chemotherapy.
Biological treatments, including cetuximab, bevacizumab and panitumumab, are a newer type of medication also known as monoclonal antibodies. Monoclonal antibodies are antibodies that have been genetically engineered in a laboratory.
They target special proteins found on the surface of cancer cells, known as epidermal growth factor receptors EGFR. As EGFRs help the cancer grow, targeting these proteins can help shrink tumours, and improve the effect and outcome of chemotherapy. Biological treatments are therefore usually used in combination with chemotherapy when the cancer has spread beyond the bowel metastatic bowel cancer.
These treatments are not available to everyone with bowel cancer. Cetuximab, bevacizumab and panitumumab are available on the NHS through a government scheme called the Cancer Drugs Fund. All these medications are also available privately, but are very expensive.
Your GP or nurse may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP surgery will have information on these. Some people find it helpful to talk to others with bowel cancer at a local support group or through an internet chat room.
Beating Bowel Cancer offers support services to people with bowel cancer. They run a nurse advisory line on or available 9am to 5.
You can also email a nurse at nurse beatingbowelcancer. The organisation also runs a national patient-to-patient network called Bowel Cancer Voices for people affected by bowel cancer and their relatives. Find more support from Bowel Cancer UK and cancer support groups. Having cancer can cause a range of emotions.
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