Bowel Cancer

Bowel cancer is the third most common cancer in Northern Ireland and the second biggest cancer killer. Over 1,100 people every year in Northern Ireland are diagnosed with the disease and over 400 will die. Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon or rectal cancer. Symptoms often develop late in the disease, leaving limited scope for treatment and potential cure, however bowel cancer is treatable and curable. If detected at a very early stage treatment can be 90% successful.

Symptoms

The three main symptoms of bowel cancer are:

persistent blood in the stools that occurs for no obvious reason or is associated with a change in bowel habit
a persistent change in your bowel habit, going more often or with looser stools
persistent lower abdominal (tummy) pain, bloating or discomfort which is always caused by eating and may be associated with loss of appetite

Causes of bowel cancer

It’s not known exactly what causes bowel cancer, but there are a number of things that can increase your risk. These include:

age – almost 9 in 10 cases of bowel cancer occur in people aged 60 or over
diet – a diet high in red or processed meats and low in fibre can increase your risk
weight – bowel cancer is more common in people who are overweight or obese
exercise – being inactive increases your risk of getting bowel cancer
alcohol – drinking alcohol might increase your risk of getting bowel cancer
smoking– smoking may increase your chances of getting bowel cancer
family history – having a close relative (mother or father, brother or sister) who developed bowel cancer under the age of 50 puts you at a greater lifetime risk of developing the condition; screening is offered to people in this situation, and you should discuss this with your GP

Some people also have an increased risk of bowel cancer because they have other conditions, such as extensive ulcerative colitis or Crohn’s disease in the colon for more than 10 years.

Bowel cancer screening

Bowel cancer screening is the third cancer based screening programme in Northern Ireland, following breast cancer and cervical cancer screening. It is the first cancer screening programme to include men. Currently, the bowel cancer screening programme involves the use of a home testing kit to collect a sample of bowel motion. All men and women aged 60 to 74 are invited to carry out the Faecal Occult Blood (FOB) test. Every two years, they’re sent the kit, which is used to collect a stool sample. Completed tests kits are returned to a laboratory which looks for traces of blood in the sample. Blood indicates that further investigations, usually a colonoscopy, are required.

If you’re 75 or over, you can ask for this test by calling the free phone helpline on 0800 707 60 60.

In January 2016, the UK National Screening Committee recommended that Faecal Immunochemical Test (FIT) should be adopted by the Bowel Cancer Screening Programme as the primary screening test for bowel cancer. In April 2019 it was announced that FIT bowel screening test will be introduced in Northern Ireland in 2020, this will replace the Faecal Occult Blood (FOB) test as the primary screening test for bowel cancer.

What is the difference between these two tests?

FIT is sensitive to a much lower concentrations of blood than FOB and therefore can detect cancers much more reliably and at an earlier stage. It can also detect more pre-cancer lesions.
FIT requires a single faecal sample (whereas FOB requires three) and therefore less intimidating to those invited to screening. Pilot studies of FIT testing carried out in England and Scotland reported markedly increased participation rates. Currently uptake in NI is lower in more deprived groups, and therefore the more deprived groups could gain the greatest benefit from the introduction of FIT, helping to address health inequalities and potentially save lives.

Treatment for bowel cancer

Bowel cancer can be treated using a combination of different treatments, depending on where the cancer is in your bowel and how far it has spread.

The main treatments are:

Surgery the cancerous section of bowel is removed; it’s the most effective way of curing bowel cancer and in many cases is all you need
Chemotherapy where medication is used to kill cancer cells
Radiotherapy where radiation is used to kill cancer cells
Biological treatments a newer type of medication that increases the effectiveness of chemotherapy and prevents the cancer spreading

As with most types of cancer, the chance of a complete cure depends on how far it has advanced by the time it’s diagnosed. If the cancer is confined to the bowel, surgery is usually able to completely remove it. Keyhole or robotic surgery is being used more often, which allows surgery to be performed with less pain and a quicker recovery.

Recovering from surgery

A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home within a few days. Most people are well enough to go home within a week of their operation. The timing depends on when you and the doctors and nurses looking after you agree you’re well enough to go home. You’ll be asked to return to hospital a few weeks after your treatment has finished so tests can be carried out to check for any remaining signs of cancer.

You may also need routine check-ups for the next few years to look out for signs of the cancer recurring. It’s becoming increasingly possible to cure cancers that recur after surgery.

Please click here for various publications regarding diet, regaining bowel control and other helpful topics post surgery.

Living with-Bowel cancer

Bowel cancer can affect your daily life in different ways, depending on what stage it is at and the treatment you’re having. How people cope with their diagnosis and treatment varies from person to person. We encourage everyone to seek the support they need, here are some links to some of the support available:

Bowel Cancer UK: living with and beyond bowel cancer
Healthtalk.org: Colorectal cancer
Macmillan Cancer Support: cancer support groups
Beating Bowel Cancer offers support services to people with bowel cancer. They run a nurse advisory line on 08450 719 301 or 020 8973 0011, available 9am to 5.30pm Monday to Thursday and 9am to 4pm on Fridays. You can also email a nurse at nurse@beatingbowelcancer.org. The organisation also runs a national patient-to-patient network called Bowel Cancer Voices for people affected by bowel cancer and their relatives.