The symptoms of bowel cancer include the following.
- Blood in your faeces. This may be mixed into your faeces or flecks on the surface, or you may see it in the toilet or on toilet paper. It’s a good idea to get into the habit of checking in the toilet before you flush.
- Persistent changes in your bowel habit that last for longer than several weeks. This could be going to the toilet more often or having diarrhoea.
- Weight loss without any obvious reason and/or losing your appetite.
- Tiredness or breathlessness for no apparent reason. This may be caused by the small amount of blood loss from your bowel, which can result in anaemia. Anaemia is when there are too few red blood cells or not enough haemoglobin in your blood.
- Pain, or a lump or swelling in your abdomen (tummy).
If you have any of these symptoms, see your GP.
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.
Your GP may examine your rectum. He or she will insert a finger (wearing a glove) into your rectum to feel for any lumps or swellings.
Your GP may 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 will allow a doctor to look inside your large bowel. He or she will use a narrow, flexible, tube-like telescopic camera called a colonoscope.
- A sigmoidoscopy is a procedure to look inside your rectum and the lower part of your bowel.
- A barium enema involves placing a fluid containing barium (a substance which 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.
If your doctor diagnoses bowel cancer, you may need further tests to find the size and position of the cancer.
These tests may include:
- an ultrasound scan of your abdomen 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 your bowel
- a chest X-ray to check the health of your heart and lungs
- blood tests to assess your general health
Screening for bowel cancer
Screening is important as it may detect bowel cancer in its early stages. There is a bowel cancer screening programme in England. If you're between 60 and 69, you will be sent a bowel cancer screening kit. In most areas, this has been extended to people aged between 70 and 75 but you can also request a kit if you're over 69. There are different programmes running in the rest of the UK. Ask your GP for information about the screening programme in your area.
The screening kit contains a faecal occult blood (FOB) test that can detect small amounts of blood in your faeces. The FOB test doesn't diagnose bowel cancer, but the results show if you need to have your bowel examined. However, even if you have a screening test with a normal result, if you have symptoms, it's important to see your doctor.
The Department of Health is also running a pilot screening programme in some parts of England. If you live in one of these areas, you will be invited to have a sigmoidoscopy test around your 55th birthday. You will still be sent a bowel cancer screening kit after you're 60.
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 regular tests to check for bowel cancer. For example, this may be because you have a close relative who has had bowel cancer or a health condition puts you at risk.
Ask your GP for advice and see our frequently asked questions for more information.
The type of treatment you have will depend on the size of your cancer, its position and whether it has spread.
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. Alternatively, you may be able to have keyhole surgery.
If you have cancer in your bowel, your surgeon will remove the part that is affected and join the two open ends together. He or she may also remove your lymph nodes. These are glands found 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 immediately join the two ends of your bowel. He or she will then bring the end of your bowel out to the surface of your abdomen and create a stoma 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 our frequently asked questions for more information.
If you have cancer in your rectum, your surgeon will remove the cancer and the surrounding tissue. He or she may also remove 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 for more information.
Chemotherapy and radiotherapy
Sometimes it's not possible to remove all the cancer by surgery, so you may need to have treatment with chemotherapy and/or radiotherapy too. Chemotherapy uses medicines to destroy cancer cells and radiotherapy uses radiation.
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 or after surgery. They can also kill any cancer cells that might be left after surgery or help to reduce your symptoms.
Monoclonal antibodies are medicines designed to recognise specific proteins on cancer cells. Monoclonal antibodies used to treat bowel cancer include:
These medicines seek out cancer cells and stop them growing. They are sometimes used alongside chemotherapy. They can be used for various stages of cancer – ask your doctor for more advice.
The exact reasons why you may develop bowel cancer aren't fully understood at present. However, your risk of bowel cancer is higher if you:
- have a family history of bowel cancer
- 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 is low in fibre, fruit and vegetables and high in red and processed meats
- have an inactive lifestyle
- are obese
- have type 2 diabetes
- drink excessive amounts of alcohol
You’re also more likely to get bowel cancer as you get older.
If you take the following steps, it may help to reduce your risk of getting bowel cancer.
- Try to do 150 minutes of moderate exercise over a week in bouts of 10 minutes or more. You can do this by carrying out 30 minutes on at least five days each week. Alternatively, do 75 minutes of vigorous intensity activity twice a week.
- If you smoke, stop.
- Maintain a healthy weight.
- Eat five or more portions of fruit and vegetables every day.
- Cut down on the amount of processed and red meat you eat.
- Eat foods high in fibre such as wholegrain bread, cereals and pasta.
- Drink alcohol in moderation – no more than two to three units a day for women and three to four units a day for men.
Why are people with bowel conditions such as Crohn's disease and ulcerative colitis more likely to develop bowel cancer?
Crohn's disease and ulcerative colitis are both chronic diseases that cause your bowel to become inflamed. A chronic illness is one that lasts a long time, sometimes for the rest of your life. When describing an illness, the term 'chronic' refers to how long you have it, not to how serious a condition is.
Research suggests that over time, the damage caused to the lining of your bowel increases the risk of cancerous cells developing. If you have had Crohn's disease or ulcerative colitis in your entire bowel for more than eight years, you're particularly at risk of bowel cancer. If only the left-hand side of your bowel is affected by ulcerative colitis (not all of it), your risk of developing bowel cancer is lower. This is also true if only your small bowel is affected by Crohn’s disease.
About four in every 100 people diagnosed with ulcerative colitis get bowel cancer.
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. Therefore, you will 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 for advice on your risk of bowel cancer.
Screening may involve having a colonoscopy. A colonoscopy is a test that allows a doctor to look inside your large bowel. The test is done using a narrow, flexible, tube-like telescopic camera called a colonoscope. If you do develop bowel cancer, screening aims to detect and treat it early.
If you have any questions about Crohn's disease, ulcerative colitis or bowel cancer, talk to your GP.
What is 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 an artificial opening (stoma). The difference between them is in the part of the bowel that the stoma joins. 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.
Procedures with a name ending in 'ostomy' usually involve part of your bowel being joined to an artificial opening called a stoma in your abdomen. The first part of the word refers to the part of the bowel affected, ie 'col' in the word colostomy refers to your colon (large bowel) and 'ile' in ileostomy refers to your ileum (small bowel). A bag is worn over the stoma to collect bowel movements. The stoma is usually placed low down on your abdomen so it's hidden under your clothing.
An ileostomy is an opening from the small bowel, to allow faeces to leave your body without passing through your large bowel. A colostomy is an opening from your large bowel to allow faeces to leave your body without passing through your anus.
These procedures are carried out if parts of your bowel can't be rejoined after having surgery for conditions such as Crohn's disease, bowel cancer or diverticulosis. A colostomy is usually temporary when used after surgery for bowel cancer. An operation is normally carried out a couple of months after your initial treatment to rejoin your bowel and remove the stoma. This is called a stoma reversal. Occasionally, if your bowel can't be rejoined, the stoma is permanent.
Having a stoma can be both physically and mentally challenging. However, most people are able to carry on with their lives as they did before and participate in activities such as swimming. There are patient support group’s available, such as the Colostomy Association and the Ileostomy and Internal Pouch Support Group that can provide support and advice on having a stoma.
If you have any questions or concerns about colostomy or ileostomy, talk to your surgeon, GP or nurse.
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. However, no research has directly shown that taking calcium supplements has any effect on your risk of getting bowel cancer.
Calcium is an important part of your diet. It helps build strong bones and teeth, regulates your muscle contractions (including your heartbeat) and makes sure your blood clots normally. More recently, research has suggested that it may also help prevent certain cancers, including bowel cancer.
People who have high amounts of calcium in their diet may be less likely to develop bowel cancer than those who have little calcium. 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.
Ask your GP for more information about how your diet may affect your risk of developing bowel cancer.
- About bowel cancer. Cancer Research UK. www.cancerresearchuk.org, published 6 August 2013
- Bowel cancer. World Cancer Research Fund. www.wcrf-uk.org, reviewed July 2013
- Small bowel cancer. Cancer Research UK. www.cancerresearchuk.org, published 18 September 2013
- Colorectal cancer: the diagnosis and management of colorectal cancer. National Institute for Health and Care Excellence (NICE), November 2011. www.nice.org.uk
- Colorectal cancer. American Cancer Society. www.cancer.org, published 30 July 2013
- Evidence summary: patient information for the NHS bowel cancer screening programme. NHS Screening Programmes. www.cancerscreening.nhs.uk, published November 2008
- Colon adenocarcinoma. Medscape. www.emedicine.medscape.com, published 16 September 2013
- Colorectal cancer – suspected. Map of Medicine. www.mapofmedicine.com, published 16 October 2012
- Bowel cancer symptoms. Beating Bowel Cancer. www.beatingbowelcancer.org, accessed 11 October 2013
- Anaemia – suspected. Map of Medicine. www.mapofmedicine.com, published 21 January 2013
- Causes and risk factors of colon and rectal cancer. Macmillan Cancer Support. www.macmillan.org.uk, published 1 July 2012
- Referral guidelines for suspected cancer. National Institute for Health and Care Excellence (NICE), June 2005. www.nice.org.uk
- Colorectal cancer – specialist management. Map of Medicine. www.mapofmedicine.com, published 16 October 2012
- Further tests for bowel cancer. Cancer Research UK. www.cancerresearchuk.org, published 8 August 2013
- Guidelines for the management of colorectal cancer. The Association of Coloproctology of Great Britain and Ireland. www.acpgbi.org.uk, published 2007
- The UK NSC policy on bowel cancer screening in adults. UK National Screening Committee. www.screening.nhs.uk, published April 2011
- Bowel cancer screening: the facts. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, published 2012
- Age extension to bowel cancer screening. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, accessed 4 November 2013
- Bowel cancer screening across the UK. UK National Screening Committee. www.screening.nhs.uk, published 28 March 2012
- Understanding bowel cancer. Bowel Cancer UK. www.bowelcanceruk.org.uk, published 4 November 2013
- NHS bowel scope screening. UK National Screening Committee. www.cancerscreening.nhs.uk, accessed 4 November 2013
- Cairns SR, Scholeﬁeld JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut 2010; 59:666–90. doi:10.1136/gut.2009.179804
- Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn’s disease or adenomas. National Institute for Health and Care Excellence (NICE), March 2011. www.nice.org.uk
- Treating bowel cancer. Cancer Research UK. www.cancerresearchuk.org, published 23 September 2013
- Laparoscopic colorectal surgery. The Association of Coloproctology of Great Britain and Ireland. www.acpgbi.org.uk, accessed 4 November 2013
- The lymphatic system. Cancer Research UK. www.cancerresearchuk.org, published 29 August 2013
- Right hemicolectomy. The Association of Coloproctology of Great Britain and Ireland. www.acpgbi.org.uk, accessed 1 November 2013
- Cetuximab, bevacizumab and panitumumab for the treatment of metastatic colorectal cancer after first-line chemotherapy. National Institute for Health and Care Excellence (NICE), January 2012. www.nice.org.uk
- How much is too much? Alcohol Concern. www.alcoholconcern.org.uk, accessed 4 November 2013
- Bowel cancer and IBD. Crohn's and Colitis UK. www.crohnsandcolitis.org.uk, published January 2013
- Diagnosis and management of colorectal cancer. Scottish Intercollegiate Guidelines Network (SIGN), December 2011. www.sign.ac.uk
- Weingarten MAMA, Trestioreanu AZ, 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. Food Standards Agency. www.eatwellscotland.org, accessed 4 November 2013
- Carroll C, Cooper K, Papaioannou D, et al. Supplemental calcium in the chemoprevention of colorectal cancer: a systematic review and meta-analysis. Clin Ther 2010; 32(5):789–803. doi: 10.1016/j.clinthera.2010.04.024
- Dai Q, Sandler RS, Barry EL, et al. Calcium, magnesium, and colorectal cancer. Epidemiology 2012; 23(3):504–05. doi: 10.1097/EDE.0b013e31824deb09
- UOAA ostomy FAQ. United Ostomy Associations of America. www.ostomy.org, accessed 4 November 2013
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