Bowel Cancer FAQs

(Sometimes mis-spelt Bowell, Bowl)

How common is bowel Cancer?

In the UK, cancer in the large bowel or rectum is responsible for the second highest number of cancer deaths (after lung cancer). It is the third most common cancer diagnosis (after lung and breast cancer).

However, bowel cancer can be cured if diagnosed and treated early. It is rare in people under 40 years of age.

What is bowel Cancer?

The building blocks of the body are tiny cells, which normally repair and reproduce in a controlled process. With cancer, this process goes wrong and cells can divide and grow in an uncontrolled way, causing a lump – a tumour – on or within the part of the body affected. If this tumour contains cells that are able to invade neighbouring tissues or organs, it is known as malignant. If the tumour does not do this, it is termed benign.

The large bowel

Also called the colon, this is the lower part of the intestines. It is involved in absorbing water and nutrients from the digested food that passes through it.

The colon can be divided into three sections – the ascending, transverse and descending colon – see the diagram over the page. The rectum, at the end of the colon, is where faeces collect before they are expelled through the anus as a bowel movement.

The lining of the large colon and the rectum is constantly regenerating, with new cells replacing those that die. If this process of cell reproduction goes wrong, abnormal cells that grow much faster than normal can form. This is the start of a cancerous growth, or cancer tumour.

Who can be affected by bowel cancer?

About one in 18 people in the UK will develop cancer in their bowel or rectum (colorectal cancer) at some point in their lives. Cancer of the small bowel, the longer, thinner part of the intestines is much rarer.
The cancer can spread through the wall of the bowel and into other tissues within the abdomen. When a cancer spreads to another organ, it is known as a metastasis or secondary. The liver is a common site for colorectal cancer secondaries. Less commonly, bowel cancer can spread to other, more distant organs such as the lung or brain.
In general, the more bowel cancer has spread from the original site, the less likely it is that the condition will be cured. This is why early diagnosis and treatment are crucial.

What are the Causes of bowel cancer?

The exact reason why some people get cancer and others do not isn’t fully understood. But there are certain factors that make cancer more likely:

• Eating a diet which is low in fibre.
• Long-term conditions of the bowel such as ulcerative colitis (known as inflammatory bowel disease).
• A history of bowel cancer in close relatives.
• Familial adenomatous polyposis – an inherited condition where large quantities of benign growths called polyps form on the lining of the bowel.
• People who have a sedentary lifestyle are more likely to get bowel cancer than people who take regular physical exercise.

what are the Symptoms of bowel cancer?

Bowel cancers tend to bleed easily, so blood in the stools or from the back passage is a cause for concern. However, most bleeding of this sort is from piles.

Other possible symptoms include:

• Anaemia – sometimes the cancer can leak small amounts of blood that are invisible to the naked eye. This loss can cause anaemia – a shortage of iron in the blood – which can, in turn, cause tiredness and breathlessness.
• A change in bowel habit resulting in either more constipation or diarrhoea than normal.
• Abdominal pain.
• Unintended weight loss.

A person who has any of these symptoms, particularly if they are over the age of 45, should seek medical advice. However, just because you have some of these symptoms does not necessarily mean you have bowel cancer. A number of other conditions can have similar symptoms.

What the doctor will do?

The doctor will ask about how and when you noticed the symptoms and perform a physical examination, which may include feeling the abdomen and examining the rectum with a gloved finger. Further tests may be organised either by a GP or specialist. These include the following:
Colonoscopy and sigmoidoscopy.

These are investigations using a long, thin telescope (a colonoscope or sigmoidoscope) that is passed via the back passage, so a doctor can directly view the bowel. The same instrument can also be used to remove polyps and take a sample (biopsy) from areas that look suspicious. These samples are sent to a laboratory for analysis.

What about Blood tests?

Tests for anaemia and to assess liver function may be performed.

What is a Barium enema?

A hospital test that involves placing a fluid containing barium (a substance which shows up on x-rays) into the bowel via the rectum. X-ray pictures of the abdomen can then show what is going on inside the bowel.

Other tests

These may include ultrasound, MRI and CT scans. These help detect cancerous growths and other abnormalities. Scans can also determine the spread of any suspected tumour.

What is the Treatment?

If symptoms are caused by polyps, the polyps can be removed during a colonoscopy. Regular checkups, including further colonoscopies, may then be all that is needed.

If the symptoms are found to be caused by cancer, about 60% of people will need surgery to remove the diseased segment of the bowel. In many cases the bowel will continue to work as before, with stools passing through the bowel, rectum and anus. However, in some cases, depending on the location and size of the cancer that is removed, the bowel cannot be repaired and a colostomy will be required.

A colostomy involves diverting the route of the bowel through a hole in the abdomen, with a bag to collect the faeces. Specialist advice and support is available from stoma-care nurses.

Courses of chemotherapy and/or radiotherapy may be needed in addition to surgery. These treatments are given to destroy any remnants of the cancer and to prevent it spreading further. Treatment may also be given to shrink the tumour prior to surgery.

what are the Signs and symptoms of bowel cancer?

With around 35,000 cases of colorectal cancer every year, bowel (or colorectal) cancer is the third most common type of cancer in the UK and the second biggest cancer killer.1 Yet, many deaths from bowel cancer could be avoided by early detection. Click here to purchase test

How do I know if I'm at higher risk of bowel cancer?

If your risk of bowel cancer is high, then you may need screening for the disease, and you should certainly be vigilant about potential symptoms of cancer. Factors that increase your risk include:

• A family history of bowel cancer
• A personal medical history of cancer of the breast, ovary or uterus
• Increasing age - most people develop bowel cancer over the age of 60
• A history of ulcerative colitis or Crohn's disease

Certain lifestyle habits including your diet, weight and exercise levels may also affect your risk of bowel cancer..

What are the "risk" symptoms of bowel cancer?

There are certain symptoms that could mean you are at higher risk of bowel cancer. Keep an eye out for these, and talk to your doctor if you are concerned:

What if I experience Bleeding?

• If you experience bleeding from the bottom without any symptoms that are associated with piles (such as the pain, lumps, feeling of straining with hard stools and itching) you will probably need hospital tests Click here to purchase test
• If you are aged more than 60 and you experience bleeding, with or without the symptoms of piles, you should tell your doctor. Over this age, your overall risk of bowel cancer increases, so even if you do have piles, the bleeding may be due to another cause. Click here to purchase test

What if I see a changes to my bowel habits?

• If your bowel habit has changed - persistent diarrhoea or constipation that is unusual for you - check it out with your doctor
• A persistent change in bowel habit is more likely to be serious if it is accompanied by unexplained bleeding Click here to purchase test

What Other symptoms might I get?

• Persistent, colicky, severe stomach pain, especially if you are older. However, do remember that lots of people experience pain, and normally it isn't cancer
• Anaemia can sometimes be a sign of bowel cancer. Tiredness is sometimes a symptom of this
• Unexplained weight loss3,4

What should I do if I'm worried about a symptom?

Experiencing a potential symptom of bowel cancer can be very frightening, but try not to panic: most of the time, it will not be cancer.

If you've experienced a change in bowel habits, you could try experimenting with your diet - i.e. eating more or less fibre - to see if the symptoms go. If they do, it probably wasn't serious. You can also talk to your pharmacist about dietary changes - they may be able to recommend a helpful medicine.

If you have bleeding from the bottom, you do need to talk to your GP, especially if you have no symptoms of piles. Be direct with your doctor and bring up your concerns straight away. Although asking about bowel cancer may feel awkward, your GP is used to talking about "embarrassing" subjects. Tell your doctor if you have a family history of bowel cancer or any other known risk factor that worries you so it can be put in your notes. Click here to purchase test

Your doctor may refer you to hospital for further tests to screen you for bowel cancer.

What else could be causing your symptoms?

Most of the time the potential symptoms of bowel cancer will not turn out to be due to the disease. There are many other conditions that cause symptoms similar to those caused by bowel cancer. Your GP can help you with all of them, so it always worthwhile visiting your GP. Here are some of the common ones.

• Piles or haemorrhoids - These are swollen veins found in the wall of the rectum and around the anus. They usually cause pain and itching, as well as bleeding and are very common in pregnancy. Bright bleeding on toilet paper, or sudden large amounts of blood is most often caused by piles.
• Fissures - An anal fissure is a tear in the lining of the anus or the skin around it. This is sometimes caused by constipation.
• Polyps - Polyps are abnormal growths growing out of the lining of the large intestine. These don't usually turn to cancer but they can cause bleeding, mucous discharge and an alteration in bowel function
• Irritable bowel syndrome (IBS) - This refers to a collection of symptoms, including stomach pain and changes to the functioning of the bowel (diarrhoea and constipation) due to the gut becoming over-sensitised. There is no known cause for IBS and sufferers often have to employ a number of different coping techniques to live with it.
• Diverticular disease - Common in older people, diverticular disease is a condition of the large intestine. A diverticula is a small sac or pouch that forms in the wall of the large intestine. It may cause symptoms similar to irritable bowel syndrome. It can be partly controlled by diet. • Crohn's disease - A painful inflammation of the gut with no known cause, Crohn's disease may be lifelong. Crohn's disease increases the risk of bowel cancer so, if you have this condition, your doctor should monitor it.
• Ulcerative colitis - Symptoms of ulcerative colitis include bleeding and mucus in the stools. It is not as severe as Crohn's disease, but it increases the risk of bowel cancer so your doctor should monitor your condition if you have ulcerative colitis.

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