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Bowel cancer

Bowel cancer (also known as colorectal cancer) is the name for any cancer that starts in your large bowel, rectum (back passage) or appendix. It’s the third most common cancer in the UK; about 40,000 people are diagnosed with it each year.

How cancer develops
Cells begin to grow in an uncontrolled way

Details

  • About About bowel cancer

    You can get bowel cancer at any age but you’re more likely to get it if you’re over 40. Usually, large bowel cancer develops from small, non-cancerous (benign) growths of tissue called polyps that can develop in your bowel or rectum. These polyps can sometimes become cancerous (malignant) over time.

    Bowel cancer includes any cancer that starts in your large bowel. It also includes cancer in your small bowel but this is rare – only about 1,000 people get this type each year in the UK. The earlier bowel cancer is diagnosed, the better your chance of a cure. If you don't get treatment, the cancer can grow through the wall of your bowel and spread to other parts of your body.

    Image showing the large and small bowels
  • Symptoms Symptoms of bowel cancer

    An image showing the symptoms of bowel cancer An image showing the symptoms of bowel cancer An image showing the symptoms of bowel cancer An image showing the symptoms of bowel cancer An image showing the symptoms of bowel cancer

    If you have any of these symptoms, see your GP.

  • Diagnosis Diagnosis of bowel cancer

    Your GP will ask about your symptoms and examine you, and they may ask you about your medical history. Your GP may need to examine your rectum (back passage). They’ll do this by inserting a finger into your rectum to feel for any lumps or swellings. They’ll wear a glove to do this.

    If your GP thinks you might have bowel cancer, they’ll refer you to a doctor or surgeon who specialises in colorectal disease.

    Tests for bowel cancer include the following.

    • A colonoscopy is a test that allows your doctor to look inside your large bowel. They’ll use a narrow, flexible, tube-like telescopic camera called a colonoscope to do this. Your doctor may need to take a biopsy (small sample of tissue), which they’ll send to a lab to see if it’s cancerous.
    • A sigmoidoscopy is a procedure to look inside your rectum and the lower part of your bowel.
    • A barium enema involves putting a fluid that contains barium (a substance that shows up on X-rays) into your bowel via your rectum. X-ray images of your abdomen then show the inside of your bowel more clearly.
    • A virtual colonoscopy uses a CT scan to create a three-dimensional image of the inside of your bowel. This is an option if you aren’t well enough to have a colonoscopy.

    If these tests find you have bowel cancer, you may need further tests to find the size and position of the cancer. This is called staging.

    These tests may include:

    • an ultrasound scan of your abdomen (tummy) to see if the cancer has spread to your liver
    • a CT scan to show where the cancer is and whether it has spread
    • an MRI scan to give detailed pictures of your rectum if the cancer is lower down in your bowel
    • blood tests to check your general health
  • Screening Screening for bowel cancer

    Screening is important as it may detect bowel cancer in its early stages. There are different bowel cancer screening programmes running in different parts of  the UK.

    • In England, Wales and Northern Ireland, if you're between 60 and 74, you’ll be sent a bowel cancer screening kit. You can also request a kit if you're over 74.
    • In Scotland, you will get a kit through the post if you’re between 50 and 74.You can also request a kit if you’re over 74.  

    The screening kit contains a faecal occult blood (FOB) test that can detect small amounts of blood in your poo. The FOB test doesn't diagnose bowel cancer – the results show if you need to have your bowel examined. Even if you have a screening test with a normal result, if you have symptoms, you should still see your doctor.

    The Department of Health is also rolling out a bowel scope screening programme in some parts of England. If you live in one of these areas, you’ll be invited to have a sigmoidoscopy test around your 55th birthday. You’ll still be sent a bowel cancer screening kit after you're 60.

    Ask your GP for information about the screening programme in your area.

    Screening for people at a risk of bowel cancer

    If you're more at risk of developing bowel cancer than the general population, you may have more regular tests to check for bowel cancer. This could be because you have a close relative who has had bowel cancer or a health condition puts you at risk. See our section below on people with other bowel conditions.

    Ask your GP how often you need to be screened for bowel cancer.

  • Treatment Treatment of bowel cancer

    The type of treatment you have will depend on the size of your cancer, its position and whether it has spread. You may have treatment to:

    • cure bowel cancer
    • shrink or slow down the growth of bowel cancer to prolong your life
    • reduce the symptoms caused by bowel cancer – this is called palliative therapy

    It’s possible you could be cured with surgery and medicines if you find out you have bowel cancer early on. But if you’re diagnosed later and the cancer has spread, this might not be possible.

    Surgery

    Surgery is the most common treatment for bowel cancer. You can have open surgery, in which your surgeon will make one large cut in your abdomen. Or you may be able to have keyhole surgery (laparoscopic surgery).

    If you have cancer in your bowel, your surgeon will remove the part that’s affected and join the two open ends together. They may also remove some of your lymph nodes that are close by. Lymph nodes are glands throughout your body that are part of your immune system. They are often the first place the cancer spreads to.

    It's possible your surgeon may not be able to join the two ends of your bowel together straight away. They’ll then bring the end of your bowel out to the surface of your abdomen and create a stoma (an opening) through your skin. If it's your large bowel, this is called a colostomy and if it's your small bowel, it's called an ileostomy. See the section on differences between a colostomy and an ileostomy, for more information.

    If you have cancer in your rectum (back passage), your surgeon will remove the cancer and the surrounding tissue. They may also remove some of your lymph nodes. Depending on how much of your rectum your surgeon needs to remove, you may need to have a colostomy.

    A colostomy or ileostomy can be temporary, or it may need to be permanent. This will depend on your operation – ask your surgeon what you’re likely to have.

    Non-surgical treatments

    Chemotherapy and radiotherapy

    You may need to have treatment with chemotherapy and/or radiotherapy as well as surgery.

    Chemotherapy and radiotherapy aim to destroy any remaining cancer cells and prevent the cancer spreading further. They are sometimes used to shrink the tumour before surgery. They can also kill any cancer cells that might be left after surgery or help to reduce your symptoms.

    Monoclonal antibodies

    Monoclonal antibodies are medicines designed to recognise specific proteins on cancer cells. They use the power of your immune system to attack the cancer. Monoclonal antibodies used to treat bowel cancer include:

    • bevacizumab
    • cetuximab
    • panitumumab

    These medicines seek out cancer cells and stop them growing. They’re sometimes used alongside chemotherapy. They can be used at various stages of cancer – ask your doctor for more advice.

  • Direct Access to support

    If you are experiencing the symptoms of suspected bowel cancer and have Bupa health insurance, there is usually no need for a GP referral. Call our team to speak to a specialist advisor or nurse.

    Excludes some company schemes. Subject to member’s underwriting terms and any pre-existing conditions. Eligibility checks are required for pre-authorisation.

  • Causes Causes of bowel cancer

    The exact reasons why you may develop bowel cancer aren't fully understood at the moment. But doctors do know that your risk of bowel cancer is higher if you:

    • have a family history of bowel cancer – you’re twice as likely to get it if your brother, sister or one of your parents has it
    • have an inherited bowel condition, such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome
    • have a long-term bowel condition, such as Crohn's disease or ulcerative colitis
    • have a diet that’s low in fibre, fruit and vegetables and high in processed and red meats
    • don’t do any exercise
    • are obese
    • have diabetes
    • smoke
    • drink a lot of alcohol 

    You’re also more likely to get bowel cancer as you get older.

  • Prevention Prevention of bowel cancer

    If you make the following changes to your lifestyle, it may help to reduce your risk of getting bowel cancer.

    • Try to do some regular exercise.
    • Stop smoking.
    • Keep to a healthy weight.
    • Eat plenty of fruit and vegetables every day and cut down on the amount of processed and red meat you eat. For more information about this risk, see red meat, processed meat and bowel cancer risk.
    • Eat foods that are high in fibre such as wholegrain bread, cereals and pasta.
    • Only drink alcohol in moderation. Don’t go over the recommended limits of two to three units a day for women and three to four units a day for men.
  • FAQ: Bowel conditions Why are people with bowel conditions more likely to develop bowel cancer?

    Inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis can damage the lining of your bowel over a long period of time. This could make you more likely to develop bowel cancer.

    More information

    Crohn's disease and ulcerative colitis both cause your bowel to become inflamed over a long time, sometimes for the rest of your life.

    Over time, the damage caused to the lining of your bowel increases the risk of cancer developing. Around four in 100 people with ulcerative colitis get bowel cancer and the risk increases the longer you have it. It also depends on how much of your bowel is affected by inflammatory bowel disease. The risk for people with Crohn's disease is similar to that of ulcerative colitis (if the same amount of bowel is affected).

    If you have Crohn's disease or ulcerative colitis, you may be offered regular bowel cancer screening. How often you’re tested will depend on your risk. For example, if you have ulcerative colitis in just the left side of your bowel, your risk of getting bowel cancer is low. You’ll be screened every five years. If you have severe ulcerative colitis that affects all of your bowel, you’re considered high risk and will be screened every year. Ask your doctor about your risk of bowel cancer.

  • FAQ: Colostomy vs. ileostomy What’s the difference between a colostomy and an ileostomy?

    A colostomy and ileostomy are both surgical procedures to bring part of your bowel to your abdomen (tummy) wall and create a stoma (an artificial opening). The difference between them is in the part of the bowel that the stoma joins.

    More information

    A colostomy is when your large bowel is joined to the opening, whereas an ileostomy is when your small bowel is joined to the opening. You’ll need to wear a bag over the stoma to collect your bowel movements. The stoma is usually placed low down on your abdomen (tummy) so you can hide it under your clothes.

    An ileostomy is an opening from your small bowel, to allow poo to leave your body without passing through your large bowel. A colostomy is an opening from your large bowel to allow poo to leave your body without passing through your anus.

    If you have a colostomy after surgery for bowel cancer, it’s usually temporary. You’ll usually have another operation called a stoma reversal a couple of months later to rejoin your bowel and remove the stoma. Sometimes, if your bowel can't be rejoined, your stoma will be permanent.

    Having a stoma can be both physically and mentally challenging but most people are able to carry on with their lives as they did before. For more information about stomas, see stoma care.

  • FAQ: Calcium and bowel cancer Can calcium help reduce the risk of developing bowel cancer?

    Possibly. Some research suggests that people who have more calcium in their diet are less likely to develop polyps in their bowel. A polyp is a small growth of tissue that may develop into cancer over a long period of time. But no research has directly shown that taking calcium supplements has any effect on your risk of getting bowel cancer.

    More information

    People who have high amounts of calcium in their diet may be less likely to develop bowel cancer than those who have little. On average, adults need around 700 milligrams (mg) of calcium per day. The research found that taking 1,200 milligrams (mg) of calcium supplements a day helps to prevent polyps developing in your large bowel. These polyps are potentially dangerous because over time they can change and become cancerous.

    So far, these findings have only shown that calcium supplements may contribute to the prevention of bowel polyps. It's also important to note that other studies have had conflicting results. At this stage, it's too early to say whether extra calcium in your diet will help protect against bowel cancer. More research needs to be done.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Colorectal cancer. BMJ Best Practice. www.bestpractice.bmj.com, published 5 February 2015
    • Information about bowel cancer. Core. www.corecharity.org.uk, accessed 23 November 2015
    • Map of Medicine. Colorectal Cancer. International View. London: Map of Medicine; 2015 (Issue 4).
    • Cancer registration statistics, England, 2012. Office for National Statistics. www.ons.gov.uk, published 19 June 2014
    • Colorectal cancer. PatientPlus. www.patient.info/patientplus, reviewed 20 January 2015
    • Bowel cancer. Cancer Research UK. www.cancerresearchuk.org, reviewed 24 August 2015
    • Colorectal cancer: diagnosis and management. National Institute for Health and Care Excellence (NICE), 1 November 2011. www.nice.org.uk
    • Bowel cancer screening: programme overview. Public Health England. www.gov.uk, published 13 November 2015
    • Screening for the early detection of colorectal cancer. PatientPlus. www.patient.info/patientplus, reviewed 5 June 2015
    • Colon cancer. Medscape. www.emedicine.medscape.com, published 30 October 2015
    • Having a stoma. The Association of Coloproctology of Great Britain and Ireland. www.acpgbi.org.uk, accessed 24 November 2015
    • 2010 to 2015 government policy: harmful drinking. Department of Health. www.gov.uk, published 8 May 2015
    • Colonoscopic surveillance for preventing colorectal cancer in adults with ulcerative colitis, Crohn's disease or adenomas. National Institute for Health and Care Excellence (NICE), 23 March 2011. www.nice.org.uk
    • Ulcerative colitis. PatientPlus. www.patient.info/patientplus, reviewed 15 July 2013
    • Ulcerative colitis. BMJ Best Practice. www.bestpractice.bmj.com, published 27 January 2015
    • Weingarten MA, Zalmanovici A, Yaphe J. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database of Systematic Reviews 2008, Issue 1. doi:10.1002/14651858.CD003548.pub4
    • Calcium counts! British Nutrition Foundation. www.nutrition.org.uk, published September 2014
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    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, Bupa Health Content Team, November 2015.

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