A Patient Journey for Bowel Cancer

Bowel cancer, otherwise known as colorectal cancer, is the general term for cancer that forms in the large intestine. It is the third most common cancer in the UK, with 41,265 new cases being reported in 2014 alone. The majority of people who are diagnosed with the disease are over the age of 60. Rectal cancer and colon cancer are also terms used in reference to bowel cancer, depending on where the cancer forms. Bowel cancer is one of the most treatable types of cancer, however as symptoms can be subtle it is important to be aware of the warning signs so it can be diagnosed early.

Symptoms

Symptoms of bowel cancer can be difficult to detect. They are common and can be easy to ignore however if they are persistent then it may be worth visiting your GP to have a check-up.  The three symptoms most commonly associated with bowel cancer are:

  • Persistent blood in your stools for no apparent reason.
  • A change in your bowel habits – either more frequent and looser stools, or constipation, or a combination of the two.
  • Persistent pain/discomfort in your tummy,
  • Unexplained weight loss

Other symptoms include tiredness and breathlessness (anaemia). It is important to remember that bowel cancer symptoms are very common, and most people who have them do not have cancer. Symptoms such as this can otherwise be linked to other factors:

  • Blood in your stools could be linked to piles.
  • Changes to your bowel habits and to the frequency and consistency of your stools could be due to something you’ve eaten or a stomach bug.
  • Tummy pain could be due to something you’ve eaten.

If you are at all concerned about the symptoms you are experiencing you should make an appointment to speak with your doctor or other healthcare professional.

What are the causes?

Although there is no clear cause associated with bowel cancer, there are a number of factors which can put you at risk of developing the disease. Here are some of the factors that can put you in the high risk group:

  • Age - 90% of those with bowel cancer are aged 60 or over.
  • Diet - Red meats, processed meats, and diets lacking in fibre are commonly linked with bowel cancer.
  • Weight - Being overweight or obese puts you at greater risk of developing bowel cancer.
  • Exercise - Not getting enough exercise puts you at greater risk of developing bowel cancer.
  • Smoking and drinking alcohol - both can increase your risk of developing bowel cancer, as well as numerous other conditions.
  • A family history of bowel cancer - if a close family member has had bowel cancer under the age of 50, you are at high risk of developing bowel cancer. If you speak with your GP you should be eligible to undergo early bowel cancer screening.

Although certain factors such as age or family history can’t be altered, a number of lifestyle changes can be adopted to lower your chance of getting bowel cancer. Exercising regularly, eating a healthy diet, stopping smoking and limiting the amount of alcohol you drink can have a tremendous impact on your health and wellbeing.

Read more about the causes of bowel cancer here.

The road to diagnosis

If you have made an appointment with your GP, on first meeting you will be asked a few questions about the nature of your symptoms. Your doctor then may decide to carry out a number of physical examinations to determine what may be the underlying issue causing you to experience these symptoms. The tests and examinations may include:

  • A tummy and rectal examination - to check for lumps or irregularities.
  • A blood test - to check for anaemia and to ensure there is no bleeding in your bowel.

Hospital tests

If initial tests suggest that you may have bowel cancer, you may be required to undergo some tests in hospital to get a firm diagnosis. Procedures such as a Flexible Sigmoidoscopy, a Colonoscopy or a Computerised Tomography (CT) Colonography can allow doctors to get a full picture of your bowel health:

  • Flexible Sigmoidoscopy – this is an examination of your rectum using a small long tube with a camera and light on the end called a Sigmoidoscope. Doctors can also take a biopsy during this procedure which can be sent off to the laboratory for examination and a diagnosis. You will be required to eat a suitable diet in the run up to the procedure, and will need to take a laxative around 12 hours before to ensure your system is suitably cleansed.
  • Colonoscopy – this examination is conducted in the same way as a Flexible Sigmoidoscopy, but with a longer tube. You will be required to empty your bowels beforehand, and will be given a sedative to help you relax during the procedure. The examination is not likely to be painful, but it can be uncomfortable.
  • Computerised Tomography – otherwise known as a ‘virtual colonoscopy’, this procedure involves using a CT scanner to take three dimensional images of the rectum and bowel. A thin flexible tube is inserted into the rectum which then pumps gas into the bowel to inflate it. The empty space makes it easier for the CT scanner to take clear pictures of the inside of the bowel. This procedure is less invasive than a Colonoscopy and as such is suitable for those who otherwise would not be able to undergo a Colonoscopy.

To read more about diagnosing bowel cancer click here.

Treatment

Bowel cancer  is one of the most treatable forms of cancer. Bowel cancer is broken down into four stages  and treatment is entirely dependent on the stage of cancer that you have:

  • Stage 1 - the cancer is contained within the lining of the bowel or rectum.
  • Stage 2 - the cancer has spread beyond the layer of muscle which surrounds the bowel and may have penetrated the surface covering the bowel or nearby organs.
  • Stage 3 - the cancer has spread into nearby lymph nodes.
  • Stage 4 - the cancer has spread beyond the bowel into another part of the body, such as the liver.

The four main types of treatment are surgery (where the cancerous parts of the bowel are removed), chemotherapy (where medication kills the cancer cells), radiotherapy (where radiation kills the cancer cells), and biological treatments (which enhance the effect of chemotherapy, stopping the spread of the cancer). You may be required to undergo a number of these treatments depending on how far your cancer has spread. Bowel cancer survival rates are improving continuously, and have more than doubled in the last 40 years in the UK.

Living with bowel cancer

Bowel cancer can have an impact on you emotionally as well as physically. Whether you have just received your diagnosis or you are undergoing treatment, living with bowel cancer is difficult. It is important to discuss how you are feeling and get support during this time. Speaking to friends and family and speaking with others who are going through the same experiences (for example through patient support groups or forums) will allow you to talk about your feelings. There are many charities that you can also turn to for support such as Bowel Cancer UK, Beating Bowel Cancer, Bowel Cancer Support UK and Cancer Research UK, among others.

If you would like to speak with others who are living with bowel cancer, please do visit our talkbowel forum. Our community is constantly growing, and our members are always keen to offer support.

Sources used in writing this article are available on request.

Last revised: 10 February 2017