A patient journey for bowel cancer
Bowel cancer is the general term for cancer that forms in the large intestine. It is the third most common cancer in the UK, with 268,000 people currently living in the UK with a bowel cancer diagnosis.
The majority of people who are diagnosed with the disease are over the age of 50, with nearly six out of ten cases being diagnosed in people aged over 70. Bowel cancer (AKA colorectal cancer) can originate in either the colon or rectum. It's one of the most treatable types of cancer if caught in time; because symptoms can be very subtle, it's absolutely vital that you're aware of the signs.
Symptoms of bowel cancer can be difficult to detect. Some of them are quite common and can be easy to ignore but that's why it's so important to know what's normal for you. As soon as you notice a change in bowel movements, weight or you find blood in your poo, you need to visit your GP for 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 can include tiredness and breathlessness (anaemia). It is important to remember that bowel cancer symptoms are very common and most people who have them don't 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
But it's always worth getting checked out. By knowing what is normal for you, you'll be able to act much sooner when things change.
What are the causes?
Although there is no clear cause associated with bowel cancer, there are a number of factors that 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 - 94% 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 may be 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.
The road to diagnosis
On the first meeting with your GP, 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.
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.
Bowel cancer is one of the most treatable forms of cancer if caught early. 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. Nearly everyone survives bowel cancer if diagnosed at the earliest stage but this rate drops significantly as the disease develops. Although it's still the second biggest cancer killer in the UK, more people are surviving and that may be due to earlier diagnosis and better treatment.
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 any kind of 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, Bowel Cancer Support UK and Cancer Research UK.
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: 17 April 2020
Next review: 17 April 2023