Bowel cancer screening

Bowel cancer is a cancer that develops in the large intestine, colon, or appendix. Also known as colorectal cancer, it is the fourth most common cancer in the UK. About 40,000 people are diagnosed with it each year. In this country, it affects about one in twenty people over their lifetime.

The key symptom of bowel cancer to look out for is blood in the stools. Abdominal pain, bloating and discomfort, weight loss and nausea, a change in bowel habit, usually towards diarrhoea and lasting for more than three weeks, and persistent fatigue, are all symptoms of bowel cancer.

Our GI consultants understand that it is easier to treat bowel cancer in its early stages, and are able to diagnose the problem before symptoms, such as bleeding or abdominal pain, begin to occur. Bowel cancer can have similar symptoms as less serious medical conditions, and bowel cancer can be in a more severe stage when these symptoms show, so it is important to be screened.

The screening process involves a stool sample test carried out by your GP. Depending on these results, you can then visit Circle for a colonoscopy investigation. During a colonoscopy procedure, a thin, flexible tube with a camera is used to view the inside and lining of your bowel. The results of the colonoscopy and any further treatment you require should then be discussed with you.

A colonoscopy is a routine test that can be performed on an outpatient basis, usually under sedation. Patients should be ready to go home hour after the procedure, although if sedation has been used then driving, operating machinery or drinking alcohol should be avoided for 24 hours

The causes are slightly ill-defined. People can inherit genes which pre-dispose them to bowel cancer. There are rare conditions where a person can inherit a gene which makes it almost certain that they will develop bowel cancer, but all the screening tests and surveillance tests that are done in the UK and elsewhere will be more likely carried out if the person has a family history of bowel cancer. There are factors like smoking, being overweight, eating a diet high in red meat, that are among some of the possible risks.

Family history is very important. However, there are a number of cases which are sporadic, where there is no evidence of any family history of the disease. The number of people that develop bowel cancer also increases with age. Bowel cancers develop from a particular type of polyp called an adenoma. Not all adenomas develop into cancers but all cancers start off as a polyp. There is also a subgroup of people with an Inflammatory Bowel Disease (Crohn’s disease or ulcerative colitis) that have an increased risk of cancer in the colon.

If the patient has any bleeding from the back passage they should immediately go and see their GP. If they have a change in bowel habit which is more than short-lived then they should also go and see their GP. If they are not sure about their family history and want to talk it through with someone, they should go and see their GP because they may be eligible for screening.

The important thing is not to diagnose the cancer as such. What is really important is to find people that have polyps that can be removed and prevent the cancer from spreading. About one in four people will have some type of polyp in their bowel, but not all of those will be cause for concern. If a person does have a polyp that is an adenoma, then it should be removed. This will prevent the cancer and then the patient would undergo regular screening thereafter.

The type of treatment prescribed depends on how extensive the cancer is. If the patient were newly-diagnosed with bowel cancer they would have a CT scan to see if there was any spreading of the cancer. If it was in the back passage they would likely have an MRI scan as well. The majority of people have surgery to remove the part of the bowel that is involved in the cancer unless it is in the back passage when they might have radiotherapy or chemotherapy and then surgery.

The benefits will be entirely secondary to the stage of the cancer. It is not always possible to say how extensive it is until the bowel cancer is removed and the lymph nodes that are attached to it. Any therapy after that, such as chemotherapy, would be due to the cancer having a poorer prognosis.

If the cancer is detected relatively early, treatment can cure bowel cancer and prevent it from coming back. Symptoms can be controlled and the spread of the cancer can be slowed using a combination of treatments.

In cancer treatment, there are always risks but they are weighed up against the risk of doing nothing. If a person has a cancer and it is not removed, then they will almost certainly eventually succumb from the cancer. The risks and benefits really are based on an individual’s case.

Unfortunately, a complete cure is not always possible and there is sometimes a risk that the cancer could recur in the future. A cure is highly unlikely in more advanced cases in which the cancer cannot be removed completely by surgery.

Side effects also need to be considered. They usually get better over time, but some people may have side effects that persist for longer than six months or develop months or years after they have undergone treatment. Side effects may include tiredness, hernia, nerve damage, changes in the bowel, a noticeable difference in sexual performance, and alterations in bladder function.

Bowel cancer is staged. The earliest stage is Dukes' A and surgery for somebody with Dukes' A is a cure. It will go up to D or E where any surgery is not curative but a combination of surgery and chemotherapy can prolong life for quite a considerable length of time.

Everybody is at risk of bowel cancer. If there is a family history, then they should certainly explore this with their GP to see whether or not they need to see a geneticist for further advice or to have a colonoscopy to try and pick up any early polyps. In addition to this, they can look out for any symptoms, and must never ignore rectal bleeding.

One in twenty people will develop bowel cancer. For people with rectal bleeding, anything from one in thirty to one in fifty will have a bowel cancer, which means that a doctor may see either 29, 39 or 49 people who do not have a bowel cancer to pick up the one person who does, so it should not be ignored and the person will not be wasting anybody's time by getting themselves checked and sorted out.

If there are other people in the patient’s family with bowel cancer then they certainly need to go and see their GP, and find out whether or not they need a colonoscopy. They may not, but they may do, and will be able to find out from the doctor at what age they will need a colonoscopy. For the first five years, they will undergo CT scans and colonoscopies. Recurrent bowel cancer is not that common and the patient will need to have a healthy lifestyle just as everybody else does.

There are a number of measures people with bowel cancer can do in their lives that may produce a noticeable change to their quality of living. These may include changing their work-life balance, adopting a more positive outlook to help their own day-to-day morale, improving their diet, doing more exercise, and using complementary therapies. Patients should also consider doing their own research and seeking advice and support from organisations such as Bowel Cancer UK if they need to.

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Circle Health Group, 1st Floor, 30 Cannon Street, London, EC4M 6XH