Bowel cancer

Thank you for joining us today, I'm joined by Mr. Shahnawaz Rasheed, who is a bowel cancer surgeon and we're gonna be having a conversation about all things bowel cancer.

So welcome.

First question.

What do we actually mean by bowel cancer?

So the bowels are the whole intestines which go all the way, really from the mouth to the bottom.

But when we talk about bowel cancer, we really talk about colon and rectum cancer.

Sometimes we say Colorectal cancer.

Exactly, that's the large intestine.

So the small intestines, the bit where you absorb the goodness of the food and the large intestines main job is to really absorb water.

So we don't get dehydrated, but also some vitamins to keep us healthy.

So when they talk about bowel cancer, really what they mean is colorectal cancer.

Okay. Great.

And how many people does bowel cancer affect here in the UK?

The numbers are increasing, but actually, it' s about 42,000 people per year Is that 42,000 people each year Who get it, who get bowel cancer and then about a third of those are rectum and the rest of them are the remainder of the colon.

Right, okay. So it's fairly common then as far as cancers go.

It's common. I mean, they talk about one in 15 men and one an 18 women in the whole population.

So it's, you know, one of the common cancers. In fact, is the fourth commonest cancer, but it results in the second largest number of deaths because lung cancer is commoner and it also causes deaths. Whereas prostate and breast are more common but they don't result in deaths as frequently.

And other some people that are more at risk more susceptible to getting bowel cancer than others?

Yeah, about a third of people have got a genetic link to it so they've got a relation who's got polyps or cancers and 70% of people just get it by itself.

Although it does cause some genetic abnormality.

It's not an inherited one.

And I think something that's important for us all to know is what are the typical signs and symptoms that we can look out for?

The commonest ones, commonest two are bleeding from the bottom and change your bowel habit and that normally means either more loose or more frequent.

So people often think it's constipation, I'm bit constipated and that means I’ve got bowel cancer, it's actually the opposite, It's actually looser and it's actually more frequent.

So if that remains for a period of time, obviously, we gone out for a night out and we've had a curry the night before, we're not talking about that we're talking about a sustained period of time where your bowels just become a little bit looser.

And there are other there are other symptoms, you can get bloating, you can feel abdominal pain, you can pass mucus from your button, but the two commonest things, bleeding from your bottom and change your bowel habit towards looseness.

And how important is it to tackle these signs early?

So if anybody is noticing that they're having these symptoms, how quickly should they act really, It's really, really vital.

The earlier you pick up on these things, the better your outcome will be.

Every single time.

So what we know is that bowel cancer, colorectal cancer starts off life as a polyp.

So it goes from normal bowel to polyp to cancer and there's a period of time between those different steps.

So if we can pick up something at the stage where it hasn't become cancerous and it's a benign polyp, then will prevent the cancer happening completely.

But even if it has become cancer, then the earlier you pick it up the earlier you deal with it, the better the outcome, you know, always.

So the difference between a benign polyp and a cancer is two things.

One thing is the ability of that thing to invade deeply into where it started off life and the second bit of it is the ability to spread elsewhere.

So those two features are what defines cancer but the benign polyp hasn't invaded.

So if you can just remove it as it is it doesn't become cancerous.

And where you get the cancers is the inner lining of the bowel wall, the very inner most lining, and that's the lining where glands are and the glands make mucus.

And so you have the change from normal to polyp and that creates the mucus and that makes your bowel looser on the whole.

So the polyp has got the similar symptoms to the cancer.

In this country, we do have screening available for bowel cancer, which is really good news because that is another tool to help us identify changes early on.

Can you tell us a little bit about the screening?

The screening is normally every two years for everyone in this country from the age of 60 onwards.

Many people are offered it at 56 as well in most areas and you have it every two years.

And what that does, it's not a test for cancer, but it's a test for the presence of blood in your poo.

That's an important thing to recognise because even if it comes back positive, the vast majority of people with a positive test doesn't mean they've got cancer.

It just means there's blood in the poo.

Now remember, the commonest cause for blood in the pool isn't cancer is haemorrhoids and other things in the bottom.

So although people might think.

Oh, I've just got haemorrhoids, with bleeding, you might be right.

But you want to be sure and you want to make sure that there's nothing else worse than that and so that's why we encourage the test to happen.

Now the new test, something called a FIT, which is stands for Faecal Immunochemical Test is a really accurate way of picking up the presence of microscopic blood in the poo.

So remember when we're looking at the picture, sometimes you don't see it looks normal, you know, some people look at their poo more than others as we know.

But people generally might not see anything, but the test will pick it up at a very sensitive level.

If it comes above a certain level and we that number is 10 above 10, then we would want to investigate with something like a colonoscopy or something like that.

And I wonder what your thoughts are as a GP, I sometimes will ask patients about their poo, particularly, you know, have you had a change of bowel habit?

Have you noticed any blood in your stool?

And often patients will say, Well, I don't look at my poo and almost seem quite embarrassed.

We need to change that, don't we?

Because we need to look at our poo.

I mean generally people are quite embarrassed to talk about these things aren't there I mean who wants to talk about their toilet habits.

Nobody does, really and so I think to raise that awareness is particularly important.

And particularly in younger people, I must say, something like 6% of people with colorectal cancer are under the age of 50.

So I think raising that awareness in all generations is really, really important isn't to say.

People justify the symptoms to themselves.

They say, oh it's this, it's that or hey it's something funny and all sorts of things that you've heard hundreds of times before thousands of times before, as I have, that you're just you justify it, because you don't want it to be those things.

So you make up something Oh, it's because I had something funny to eat, or I've got piles, or you say all these things, but actually having that awareness to say.

You know what, I can't look at somebody and say you've got bowel cancer, you know, none of us can.

So what we have to do is say, well, there's an index of suspicion you might have it you might not, but it's definitely worth investigating and finding out whether you do or not.

And the really important reason why is well, if it's not bowel cancer, that's reassuring, you don't have to worry about it anymore.

But if it is, finding it early means the chances of curing it essentially, are so much higher than if you you know, leave it for months to get worse.

Definitely and people say that to me that Explain to people, it's not that bad, the whole process of diagnosis of coming to the answer.

People are very scared of being examined or having tests that might be they might perceive to be difficult, or painful.

But if we can, I suppose make them feel more at home with us as clinicians and don't feel we break down those barriers between us.

I think that's really important.

Generally not just for bowel cancer.

I agree, coming back to screening.

I've actually got one of the little tests here.

I thought it might be quite nice to demonstrate just how easy this is to do.

So these if you're eligible for screening, and then people receive one of these in the post, and it's so simple.

All you do is when you've had poo in the toilet before you flush the toilet, take out this little stick and the end of it.

You just get a little bit of poo on the end of it Put it in there, flush the loo, Put it in an envelope, send it off.

And that's a screening test done.

But it surprises me, I'm looking at statistics here, it says just over half of people, and 58% in England and 56% in Wales, who received the screening test, complete it.

I look at that number. I think that's very low.

Remember people if they haven't got symptoms they'll think that's not for me, I'm alright. Thank you.

It's any when people have symptoms, they start seeking medical advice.

You're talking about people who are asymptomatic.

Yeah, On the whole aren't you so people who might have blood on their poop without realising it.

But they've got no change of their bowel habit.

They've got no pain, their alright.

So what most people think is if it ain't broke, don't try and fix me.

I'm alright. Thank you.

I think that's an important distinction to make isn't it?

Screening tests like this are designed for people who don't have symptoms to try and pick up in this case, any blood in the poo.

At such an early stage before it's even given symptoms.

So if people do have symptoms, don't hang around waiting for this, go and see a doctor straightaway.

This is not the test Exactly so if you have bleeding and you’ve seen it.

That trumps this, because you’ve actually seen blood.

What are the risks then of delaying, going to see a doctor in terms of I mean, I think the nitty gritty is survival.

So the earlier you pick up something, the better the outcome across the board.

if you pick up something in the polyp stage before it becomes cancerous, you just won't get cancer.

So you'll have 100% survival.

As you go further along that point, and we talked about stage a stage means a how bad it is or how advanced it is, or how spread it is.

So the further you are on your stage, the worst your outcome is going to be.

And that's purely time, a lot of the time.

So the longer you leave it, the thing might be growing invading and starting to spread.

So it's sort of it's sort of obvious that the further you leave something, the worse it gets.

And remember bowel cancer is one of the most treatable of all cancers.

And it's preventable, because you can pick it up before it becomes cancerous.

So some some cancers, they become so advanced so quickly, before any symptoms come and by the time They are hidden inside the body and they don’t you know have bleeding for example into the poo.

How is bowel cancer diagnosed?

First thing is somebody seeking medical advice, seeing primary care doctor, GP, and then getting referred to a specialist for further tests and the two sort of commonest test are a specialist kind of a CT scan called a virtual colonoscopy or a colonoscopy.

The colonoscopy means a tube up bottom, which looks and can identify and remove polyps and also see potential cancers for biopsy.

A CT scan can identify things bigger than about 4 or 5 millimeters but obviously can't remove them, or test them as it were.

So that the, the gold standard has a colonoscopy.

But if people really don't want to colonoscopy, they can have an alternative, which is a CT scan.

And we've spoken about how bowel cancer is actually quite common.

It's the fourth most common cancer.

So really, we're all potentially at risk.

So what can we all do to prevent or reduce our risk of getting it?

I suppose it’s a healthy lifestyle, reduction of smoking, drinking less alcohol, more activity trying to lose weight if you've put on a bit of weight.

And having a general awareness that you may have bowel cancer and seeking advice early. It's the same advice that I’d give to anyone in general really. The only additional thing was fibre in the diet and having more fruit, vegetables, those things are known to have a reduction in bowel cancer.

There's some evidence which is relatively weak, but red meats can increase your chance of bowel cancer, so wouldn't have red meat every day.

I mean, if you need to eat red meat, have it slightly more sparingly.

Okay. So I think that's really interesting.

That was you can't change your genetics.

You can't be more vigilant if you think you're at higher risk.

And then there's some healthy living things that that we can all do.

Shahnawaz, thank you so much for joining us.

I hope you found that as informative, interesting and useful as I did, and we'll see you again next time.

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