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Bowel cancer

Published by Bupa's health information team, February 2008.

This factsheet is for people who have bowel cancer, or who would like information about it.

Bowel cancer is a lump created by an abnormal and uncontrolled growth of cells in the lining of the bowel. There is a good chance that bowel cancer can be cured if diagnosed and treated early.

• Animation - How cancer develops
• About bowel cancer
• Symptoms of bowel cancer
• Causes of bowel cancer
• Diagnosis of bowel cancer
• Treatment of bowel cancer
• Prevention of bowel cancer
• Questions and answers
• Related topics
• Related Bupa products and services
• Further information
• Sources

How cancer develops

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About bowel cancer

Bowel cancer is the third most common cancer in the UK; around 35,000 people are diagnosed with it each year. It can occur at any age but is most common in people over the age of 60.

The large bowel, also called the colon, is the last section of your digestive system. Food passes through your small bowel (the longer, thinner part of your bowel) where nutrients are absorbed. Food waste then travels through your colon (large bowel) where it becomes more solid faeces. Your colon has three sections - the ascending, transverse and descending colon. The rectum, at the end of your colon, is where faeces collects before passing through your anus as a bowel movement.

The location of the large and small bowel

Bowel cancer, also known as colorectal cancer, is the name for any cancer of the colon (large bowel) and rectum (back passage). Very rarely cancers can occur in the small bowel.

Bowel cancer is caused by the abnormal and uncontrolled growth of cells in the lining of the bowel. Usually, large bowel cancers develop from small, non-cancerous (benign) growths of tissue called polyps that can extend from the lining of the bowel wall. Sometimes these can become cancerous (malignant). If the cancer is left untreated, it can grow through the wall of your bowel and spread to other parts of your body.

Early diagnosis and treatment is crucial. Knowing what symptoms to look out for, and seeing your GP about them, is the important first stage of this process.

Symptoms of bowel cancer

Bowel cancer is often painless in the early stages, but there are other indicators in the absence of any pain. You may have the following bowel cancer symptoms.

• Blood in your faeces - this may be mixed into your faeces or appear as flecks on the surface, be separate from your faeces or you may see it on the toilet paper. Get into the habit of looking into the toilet before flushing.
• Changes in your bowel habit for more than four to six weeks - for example going to the toilet more frequently than usual or having diarrhoea-like motions or being severely constipated. Make a conscious effort to know your bowel habits so you can recognise any changes.
• Unexplained loss of weight and/or loss of appetite.
• Tiredness or breathlessness for no apparent reason - this may be caused by the small amount of blood loss from your bowel, resulting in anaemia (when there are too few red blood cells or not enough oxygen-carrying haemoglobin in your blood).
• A lump or swelling in your abdomen (tummy).

Although not necessarily a result of bowel cancer, if you have these symptoms you should visit your GP.

Causes of bowel cancer

The cause of bowel cancer isn't fully understood. One of the main factors is increasing age - 85 percent of people diagnosed with bowel cancer are over the age of 60. Your risk of bowel cancer is higher if you have the inherited bowel condition familial adenomatous polyposis (FAP) - a genetic disease where large quantities of pre-cancerous polyps form on the lining of the bowel, or non-polyposis colon cancer (HNPCC), also called Lynch syndrome.

Your risk of bowel cancer also increases if you have:

• a family history of bowel cancer
• a long-term condition of the bowel such as Crohn's disease or ulcerative colitis
• a diet that is low in fibre, fruit and vegetables and high in red and processed meats
• an inactive lifestyle

Diagnosis of bowel cancer

Your GP will ask you about your symptoms and may examine you. He or she may refer you to see a doctor who specialises in colorectal disease. You may need to have one of the following tests.

• Colonoscopy - this allows your doctor to look inside your large bowel using a thin tube with a tiny light and camera at the end.
• Sigmoidoscopy - this is similar to a colonoscopy but only looks at the last section of your bowel.
• Barium enema - this test involves placing a fluid containing barium, which shows up clearly on an X-ray image, into your bowel via the back passage.
• Virtual colonoscopy - this uses a CT scanner, which uses X-rays to produce detailed images of your large bowel.

If your doctor diagnoses bowel cancer, you may need further tests to find out the position and size of the cancer.

These tests may include:

• an ultrasound scan of your abdomen - to see if the cancer has spread (for more information, see Related topics)
• a CT (computerised tomography) scan - to show the position of the tumour (for more information, see Related topics)
• an MRI (magnetic resonance imaging) scan - to show two- and three-dimensional pictures of your bowel (for more information, see Related topics)
• a chest X-ray - to check the health of your heart and lungs (for more information, see Related topics)
• blood tests - to assess your general health

Screening for bowel cancer

Screening is important for detecting bowel cancer in its early stages. Bowel cancer is one of the most curable cancers if it's found early.

A faecal occult blood (FOB) test detects small amounts of blood in the faeces. Alternatively, tests such as a sigmoidoscopy or virtual colonoscopy can detect bowel cancer.

You may choose to have regular screening if you:

• have a close relative who has had bowel cancer
• have familial adenomatous polyposis or other diseases of the bowel lining such as ulcerative colitis or Crohn's disease (for more information, see Related topics)
• are over 60 years old

The UK Department of Health is currently introducing a bowel cancer screening programme. Bowel cancer screening kits will be sent to people aged between 60 and 69, although if you are older you can also request a kit. Ask your GP whether the screening programme has started in your area.

Treatment of bowel cancer

Surgery

Surgery is the most common bowel cancer treatment.

The piece of the large bowel that contains the cancer is surgically removed and the two open ends are joined together. Lymph nodes near the bowel are often removed because they are the first place the cancer usually spreads to.

Sometimes, depending on the location and size of the cancer that is removed, the ends of the bowel can't be rejoined. If this is the case, the opening nearest the beginning of your bowel will be brought out on to your skin surface of your abdomen. This is called a colostomy and the opening of the bowel is known as a stoma. A bag is worn over the stoma and collects your bowel movements outside the body. Most people who have surgery don't need a colostomy, but if you do, it's usually temporary. People with colostomies are able to live normal lives, including participating in sporting activities.

If you have cancer affecting your rectum, you may need surgery to remove the part of your rectum that contains the cancer as well as the fatty tissue and lymph nodes around your rectum. You are more likely to need a colostomy if you have cancer of the rectum than if you have cancer of the colon.

Non-surgical treatments

Colonoscopy

If you have small polyps in your bowel, these can be removed during a colonoscopy. You may then need regular check-ups, including further colonoscopies.

Chemotherapy and radiotherapy

Sometimes it's not possible to remove all the cancer by surgery, in which case you may need to have additional treatment with chemotherapy and/or radiotherapy. These treatments are given to destroy any remaining cancer cells and to prevent it spreading further. Chemotherapy and radiotherapy are sometimes used to shrink the tumour before surgery.

Prevention of bowel cancer

There is evidence that taking the following steps can help to reduce your risk of getting bowel cancer.

• Exercise for at least 30 minutes, five times a week.
• Eat five or more portions of fruit and vegetables every day.
• Cut down on the amount of processed and red meat you eat.
• Maintain a healthy weight.
• Eat foods high in fibre such as wholegrain bread, cereals, pasta.
• If you smoke, try to quit.

Related topics

• Abdominal ultrasound
• Barium enema
• Bowel cancer surgery
• Chemotherapy
• Colonoscopy
• Crohn's disease
• Hemicolectomy
• MRI scan
• Radiotherapy
• Stoma care
• Ulcerative colitis
• Virtual colonoscopy

Further information

• Beating Bowel Cancer
  020 8892 1331 / 020 8892 5256
  www.beatingbowelcancer.org
• Bowel Cancer UK
  08708 50 60 50
  www.bowelcanceruk.org.uk

Sources

• Management of colorectal cancer. SIGN. www.sign.ac.uk, accessed 18 July 2007
• National statistics. www.statistics.gov.uk, September 2006
• Cassidy J, Bissett D, Spence R. Oxford Handbook of Oncology. Oxford: Oxford University Press. 2002.
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2002
• What is bowel cancer? Beating Bowel Cancer. www.beatingbowelcancer.org, accessed 18 July 2007
• Bowel (colon and rectum). Cancerbackup. www.cancerbackup.org.uk, accessed 18 July 2007
• Bowel Cancer UK. www.bowelcanceruk.org.uk,accessed 18 July 2007
• Spot the symptoms early to reduce your risk. Cancer Research UK. http://info.cancerresearchuk.org, accessed 18 July 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. It has also been reviewed by the charity Beating Bowel Cancer. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: February 2008