Bowel Cancer
Your bowel consists of the small bowel (small intestine) and the large bowel, which includes the colon, back passage (rectum), and bowel opening (anus). Bowel cancer refers to cancer of the colon or rectum; we sometimes call it colorectal cancer. We may also refer to it as colon or rectal cancer.
In the UK, it is the 4th most common cancer and over half of all cases are preventable. Anyone can get this cancer, but it usually affects those over 50.
Symptoms
You may not notice any symptoms in the early stages of bowel cancer. Early warning signs include anaemia caused by iron deficiency and narrow poo (stools) that may look like ribbons. Anaemia can make you feel quite tired and weak. You may also get breathless more often than before.
Many people first notice symptoms in the second stage of this cancer. The main symptoms are:
- Frequent blood in your poo (bright red or dark) or bleeding from your bottom
- Bowel changes, such as pooing more often or incontinence
- Abdominal pain or discomfort
- Unexplained weight loss
- Runnier or looser poo
- Bloating after eating
You may only have one of these symptoms. Some people feel they need to poo, but nothing comes out (tenesmus), or they feel no relief after going. You might also feel or be sick. Occasionally, people hear stomach noises, such as a gurgling or rumbling noise, though this is often caused by wind or a food allergy.
Learn more about bowel cancer symptoms in our infographic.
Several conditions that are not cancer can cause the above symptoms, such as haemorrhoids (piles) or inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and diverticulitis. However, you must speak to a medical professional, like a Gastroenterologist, if you notice any changes that last longer than three weeks.
If you suddenly experience severe abdominal pain, distension and struggle to pass wind or poo, visit emergency care. These are signs of a bowel obstruction, which requires immediate medical attention. A tumour may cause a bowel obstruction as it grows and blocks the bowel.
Advanced symptoms
As your condition progresses, cancer may spread to other parts of your body, such as the liver, abdominal lymph nodes, bones, lungs, and brain or spinal cord. We call this metastasis.
Advanced symptoms include:
- Constipation
- Lost appetite
- Persistent coughing
- Swelling in the feet and hands
- High calcium levels and fractures
- Jaundice (yellowing skin or whites of the eyes)
If cancer reaches the brain, you may have memory loss, speech problems, and blurred or double vision.
Attending screening can help us find bowel cancer early, which makes the condition more treatable and prevents the above problems.
Screening
In the UK, the NHS offers bowel cancer screening to all people between 60 and 74, though this is gradually changing to start at 50 over the next four years. Those 75 and older can call the NHS and ask for a test kit if they would like to continue screening.
The process involves receiving a faecal immunochemical test (FIT) kit in the post every two years. You collect a sample of your poo using the test kit then send it to a lab. The lab will look for hidden blood in your poo, which can indicate a health problem such as polyps or bowel cancer. If the FIT finds blood in your poo, you will have further tests to find the cause.
If you do not fit the criteria for the NHS programme, you can pay for a private screening. At Digestive Health UK, we offer a private screening service and further tests, such as a colonoscopy, if we find blood.
Watch our videos below to learn more about screening for bowel cancer.
Diagnosis
During your first consultation, we will discuss how you are feeling, how long you have had your symptoms, and how much they are affecting you. Let us know if your symptoms worsen at any point in the day or after certain activities, such as lying down. We will also ask about your medical and family’s medical history as it helps us determine your cancer risk.
We may perform a digital rectal examination (DRE) – which involves checking your back passage for lumps – and order blood and stool tests. We may recommend additional tests if we find blood in your poo or other abnormalities.
These can include:
- Colonoscopy
- Computed Tomography (CT) colonography
Colonoscopy is an endoscopic procedure, meaning we use a thin, flexible tube called an endoscope during the procedure. The endoscope has a light and camera on the end that we use to look inside your back passage and bowel.
Bowel cancer is one of the reasons we perform a colonoscopy, so we can look for evidence of the cancer in the bowel. Read our blog on more reasons to have a colonoscopy.
A colonoscopy allows us to examine the entire large bowel. The major advantage of colonoscopy is that if we find polyps, we can remove them there and then to reduce the risk of bowel cancer in the future. We may also take a small tissue sample called a biopsy, which we send to our lab to look for cancerous cells. Read our blog to learn how to prepare for a colonoscopy.
CT colonography is an alternative for those not suitable for a colonoscopy. We sometimes call it a virtual colonoscopy. CT colonography involves inflating your bowel with gas and capturing three-dimensional images of your large bowel and rectum with a CT scanner.
If we find evidence of cancer, you may need a CT or Magnetic Resonance Imaging (MRI) scan to see whether it has spread and, if so, how far. We will then let you know which stage, grade, and type of cancer you have.
Stages
Staging tells us how advanced your cancer is, and grading refers to how aggressive it is.
There are two common staging methods: the number system and the TNM (tumour, node, metastasis) system. There are four number stages of this cancer.
Stage 1 is in the bowel or rectum lining or muscle wall.
Stage 2 means it has spread past the muscle wall and may have reached nearby organs.
By stage 3, cancer has affected the neighbouring lymph nodes.
At stage 4, it has spread to distant organs.
The numbered stages inform the TNM system, answering where and how far your tumour has grown (T), if it has reached the lymph nodes (N), and whether the cancer has spread (M).
Bowel cancer has three grades. These go from grade 1, which means it grows slowly with a low likelihood of spreading, to grade 3, where it is fast growing with a high chance of spreading.
Causes
Cancer occurs when healthy cells mutate and grow uncontrollably. We do not yet know what causes this in the bowel, though we often first find cancer in polyps. Polyps are small tissue growths on the bowel’s inner lining. They are quite common and usually benign. It can take years for a polyp to become cancerous.
Certain factors can increase your risk of developing cancer. We call these risk factors. You cannot change all risk factors, but there are many that you can control with bowel cancer.
Risk factors
- Smoking
- Physical inactivity
- Overweight or obese
- People over 50 years old
- A long-term low-fibre diet
- Drinking alcohol in excess
- Close family history of bowel cancer
- Eating a lot of red or processed meat
- Long-term ulcerative colitis and Crohn’s disease
Altering your lifestyle by quitting smoking, exercising more often, and eating a healthier diet may help you reduce your risk.
Treatment
Your treatment options depend on many factors, including your general health, age, and the size, stage, type, and grade of cancer. However, we often treat bowel cancer with surgery. We may combine this with radiotherapy or chemotherapy.
In the early stages, surgery may involve removing a small part of your bowel lining (local resection) or bowel (colectomy). Your specialist will talk through all treatment options with you in detail. You may want to bring a list of questions with you as it can be an emotional time dealing with your diagnosis and trying to remember everything.
The survival rate for bowel cancer depends on the stage of your cancer. The earlier the stage, the higher the chance of survival. It’s essential you seek medical advice if you suspect you may have or are at risk of bowel cancer so we can try and diagnose as soon as possible.
At Digestive Health UK, we can offer private diagnostic tests and treatment tailored to your needs. Book a consultation, and we can discuss your health concerns further.
Book an appointment
Bowel cancer is highly treatable when we catch it early. If you are experiencing concerning symptoms, get in touch to organise private diagnostic tests. Our specialists provide a calm and compassionate service to ensure you are as comfortable as possible through this process.