Bowel cancer is the term given to any cancer that begins in your large bowel. Other terms for bowel cancer include colon cancer, rectal cancer and colorectal cancer.
Your large bowel is made up of your colon and rectum. The colon is divided into four parts; the ascending colon, transverse colon, descending colon and sigmoid colon.
Typically, bowel cancer develops from small benign (non-cancerous) growths of tissue (polyps) that form on the inside of the colon. Without removal, over time polyps can become cancerous. Bowel cancer can spread through the wall of your bowel, to the surrounding tissues and lymph nodes. It can also spread through your bloodstream, to your liver and your lungs.
Bowel cancer is one of the most common types of cancer in the UK with around 1 in 15 men and 1 in 18 women diagnosed with it in their lifetime. The sooner you are diagnosed, the higher your chance of recovery; the majority of people diagnosed at the earliest stage survive bowel cancer. It is important to take advantage of cancer screening if it is offered, and ensure you see your doctor if you experience any symptoms.
Types of Bowel Cancer
Bowel cancer is divided into different types depending on where it starts in the bowel, and the type of cell that it developed from. With this knowledge, your doctor will decide which treatment is right for you.
The most common type of colon cancer starts from adenocarcinomas that forms within gland cells in either the colon or rectum. The gland cells usually produce mucus (a slimy substance that helps make it easier for faeces to pass through the bowel). Other tumours can also cause bowel cancer, such as:
Lymphomas
Lymphomas are cancers of the lymphatic system that can form in lymph nodes or the colon and are treated differently to other bowel cancers.
Carcinoids
Carcinoids are slow growing tumours that develops in hormone-making cells within your digestive system.
Sarcomas
Sarcomas are cancers of the supporting cells in the body such as muscle or bone.
Gastrointestinal Stromal Tumours
Gastrointestinal stromal tumours develop in the gastrointestinal tract, typically in the stomach or small intestine. The tumours can start as benign and then become cancerous.
Squamous Cell Tumours
Squamous cells are skin cells that help make up the bowel lining. The second most common form of skin cancer, when caught early, squamous cell tumours are generally curable.
Melanoma
Melanoma, also known as malignant melanoma, is a form of skin cancer that develops from the melanocytes (pigment-producing cells). Melanoma typically occurs in the skin but can also begin in the back passage (rectum).
Your doctor may use staging as a guide to work out how advanced your cancer is. It is vital for your doctor to know the stage of the cancer so they can figure out the best treatment plan for you. The stages progress from 1 – 4, with 4 being the most advanced stage.
Stage 1
Stage 1 indicates the cancer has grown into the lining of the colon (called the mucosa), but has not spread to the organ walls or lymph nodes.
Stage 2
At stage 2, the cancer has spread to the outer walls of the colon or rectum but has not affected the lymph nodes or further parts of the body.
Stage 3
By stage 3, the cancer has spread to the lymph nodes but not to other parts of the body. Generally, 1 – 3 lymph nodes are involved at this stage.
Stage 4
Stage 4 indicates the cancer has spread to other distant organs, such as the liver or lungs and the lining of the stomach.
Symptoms of Bowel Cancer
In the early stages of the disease, many people with colon cancer experience no symptoms. When symptoms do occur, they are likely to vary depending on the size and location of the cancer in the large intestine. Signs and symptoms of colon cancer can include:
- A change in your regular bowel habits such as diarrhoea or constipation, or a change in the consistency of your stools
- Bleeding from the back passage or blood in your stool
- Constant abdominal discomfort, such as cramps
- A sensation of not being able to completely empty your bowels
- Feelings of weakness, fatigue and breathlessness caused by a low level of red blood cells
- Unexplained weight loss
- A lump in your abdomen or back passage that can be felt by your doctor
Just because you experience these symptoms, it does not necessarily mean you have bowel cancer; these symptoms can be linked to other health problems such as haemorrhoids. However, as you get older, symptoms should be taken more seriously, particularly if you have tried conservative treatments that have failed to address the problem.
In some cases, cancer can cause a bowel obstruction. The symptoms of an obstructed bowel include:
- Abdominal pains and cramping
- Feeling bloated
- Difficulty passing wind and constipation
- Vomiting
Seek medical attention immediately if you think you have a bowel obstruction.
Causes and Risk Factors of Bowel Cancer
Your risk of developing bowel cancer depends on many factors such as, age, genetics and lifestyle. Factors that may increase your risk of colon cancer include:
Age
Colon cancer can be diagnosed at any age, but is more commonly found in people older than 50.
Medical history
If you have already experienced colon cancer or had noncancerous colon polyps, you are at a greater risk of developing colon cancer in the future.
Inflammatory intestinal conditions
Chronic inflammatory diseases of the colon, such as Crohn’s disease, can increase your likelihood of colon cancer.
Genetics
You are more likely to develop bowel cancer if you have a family history of the disease. The risk increases if more than one family member has had it.
Diet
In some studies, it has been found that people that have a diet that is low in fibre and high in red and processed peat are at an increased risk of developing bowel cancer.
An inactive lifestyle
People who follow an inactive lifestyle may be more likely to develop colon cancer.
Diabetes
People with diabetes or an insulin resistance are at a greater risk of colon cancer.
Obesity
Obesity increases the risk of developing colon cancer and also limits the chances of making a full recovery.
Smoking and Alcohol
Following bad habits such as consuming large quantities of alcohol or smoking may have an increased risk of colon cancer.
Precancerous Growths
Abnormal cells collect in the lining of the colon, forming polyps (small, benign growths). Removing the polyps through surgery is a common preventive technique as if left untreated, polyps can become cancerous.
Prevention of Bowel Cancer
Certain risk factors for bowel cancer, such as family history or age, are unavoidable. However, lifestyle factors can be preventable, and may help decrease your overall risk of developing this disease.
Doctors suggest that people with a regular risk of colon cancer should consider screening from around the age 50. People at greater risk, such as those with a family history of colon cancer, should consider earlier screening.
You can take steps and make lifestyle changes to reduce your risk of colon cancer. These include:
- Eat a variety of fruits, vegetables and whole grains. Maintaining a healthy diet full of fruits, vegetables and grains play a role in cancer prevention.
- Cut out or limit your alcohol consumption. If you decide to drink alcohol, reduce the amount of alcohol you drink to no more than 2-3 units a day for women and 3-4 for men.
- Quit smoking. Talk to your doctor to get help with quitting.
- Regular exercise. Try to get at least half an hour of exercise at least 5 days a week to help reduce the risk of developing colon cancer.
- Maintain a healthy weight. Maintaining a healthy weight through diet and exercise is important. If you are advised to lose weight, ask your doctor for advice on healthy ways to achieve your goal.
Diagnosing Bowel Cancer
An early diagnosis of bowel cancer provides you with the best chance of curing it. During the diagnosis process, your doctor will begin by taking a full medical and family history. They may also carry out a physical examination where they check for the presence of lumps or polyps by pressing on your abdomen or performing a rectal examination. If your symptoms indicate that you could have bowel cancer, your doctor will likely suggest further tests, including:
Blood Testing
Your doctor may carry out a blood test to get a better indication of what is triggering your symptoms. No blood test can determine if you have bowel cancer, but liver function tests and complete blood count tests can eliminate other diseases and disorders. Your doctor may also check your blood for signs of a chemical sometimes produced by colon cancers (carcinoembryonic antigen, CEA). Monitored over time, the level of CEA in your system can help your doctor track whether the cancer is responding to treatment.
Colonoscopy
A colonoscopy involves the use of a long, flexible tube with a small, attached video camera. This technique allows your doctor to see inside your bowel and rectum to check for anything abnormal. If any irregularities are found, your doctor can pass surgical tools through the tube to take samples (biopsies), which will then be sent off to a laboratory for further testing. If you have polyps that may turn in to cancer, your doctor may also remove these during the procedure.
X-ray (Barium Enema)
Your doctor may order an X-ray using a contrast fluid that contains the metallic element barium (a substance that shows up on X-rays). Your doctor will insert this liquid via your rectum and into your bowels using an enema. The barium solution then coats the lining of the colon that helps improve the quality of the X-ray images.
If these tests show you have bowel cancer, you will need additional tests to indicate the size and location of the cancer. These tests will also check to see whether it has spread to other parts of your body. This is known as staging.
Treatment for Bowel Cancer
Effective treatment for bowel depends on numerous factors, including the location and stage of the cancer, along with any other health concerns. Treatment for bowel cancer generally involves a surgical procedure to remove the cancer. Other treatments, such as radiation therapy and chemotherapy may also be suggested.
Treatment for bowel cancer can be used to:
- Cure bowel cancer
- Shrink or slow down the development of bowel cancer
- Reduce the symptoms caused by bowel cancer (this is called palliative therapy)
Outlook
When bowel cancer is caught early, it is treatable and in many cases, curable. With early detection, the majority of people live at least another 5 years following diagnosis. If the cancer does not come back in that time, you are considered cancer free, particularly if were diagnosed in the first 3 stages of the disease.
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