About Bowel Cancer
Bowel cancer is a lump or growth created by an uncontrolled and abnormal multiplication of cells within the lining of the bowel. Bowel cancers are often painless in their early stages, and symptoms can take time to develop. Worrying features to look out for include: bleeding from the rectum, particularly altered blood that is coating or mixed with the faeces, a significant change in bowel habit that goes on for more than 2-3 weeks, unexplained weight loss, lethargy, loss of appetite, ongoing abdominal pain or a swelling/lump in your abdomen. With early recognition and diagnosis of bowel cancers, there is a high likelihood that the condition can be cured.
The vast majority of bowel cancers are sporadic, however, approximately 20% of bowel cancers can be related to a family history. We can review this history to assess whether or not you should be having surveillance or monitoring, if you are concerned that you have a first or second degree relative who has suffered from bowel cancer.
Approximately 1 in 20 people in the United Kingdom will develop a bowel cancer. These cancers tend to be slow growing and usually arise from polyps, which are possible to identify at an early stage and treat, preventing the development of bowel cancer. In 2004 the Government introduced the National Bowel Screening Programme for all people between the ages of 60-69. Participants are invited to submit a stool sample for testing, known as the Faecal Occult Blood Testing (FOB) every two years. This detects tiny quantities of blood within the stool. Screening can continue after the age of 69 if your local doctor is contacted. The vast majority of people will have a normal test. Those who have a positive test, however, will be advised to undergo colonoscopic evaluation of the large bowel. For more information, please visit the National Screening website www.cancerscreening.nhs.uk/bowel.
Bowel polyps are small growths on the inner lining of the colon or rectum. They are common and affect 15-20% of the UK population. Bowel polyps are not normally cancerous, although if they are found, they will need to be removed, as if left untreated, some may eventually turn into cancer.
Surgery for Bowel Cancer
Right Hemicolectomy – Removal of the right side of the colon (ileum, caecum and appendix) with a primary join (anastomosis) and very low potential for stoma bag formation.
Extended Right Hemicolectomy – Removal of the entire right colon and transverse colon with a join between the last part of the small bowel and the left colon. Again, there is a small chance of stoma bag formation.
Sigmoid Colectomy – Removal of the left colon and associated blood vessels and lymph glands, usually performed for complicated diverticular disease or left sided bowel cancer. This comes with an approximately 10% chance of a temporary ileostomy (stoma bag) on the right hand side.
Anterior Resection – This involves removal of the rectum with a join fashioned low in the pelvis. This can be performed either by the open or laparoscopic methods and comes with a higher chance of stoma formation, but the individual risks depends upon the height of the join.
Abdominoperineal Excision of the Anus and Rectum (APER/ELAPE) – This is a major surgical intervention involving the complete removal of the rectum and anus and all associated muscles, resulting in the formation of a permanent colostomy bag on the left hand side. This surgery is reserved for low and very low tumours and is often preceded by chemo radiotherapy treatment.
TEMS (Transanal Endoscopic Microsurgery) – TEMS is a procedure using specially designed instruments and a microscope to allow surgery to be performed through the back passage. This requires no surgical cuts on the outside of the anus or abdomen. This is most often used to remove non-cancerous polyps from the rectum.
Anal cancer is a very rare type of cancer, affecting less than 1200 people per annum in the UK. It is associated with the human papilloma virus (HPV) and can be spread by sexual contact. It can also be associated with a history of cervical, vaginal or vulval cancer. It is more common in people who smoke heavily or have a weakened immune system, for example in patients with HIV. The symptoms include persistent bleeding from the bottom, itching or pain around the anus, small lumps around the anus, uncontrolled discharge of mucus from the anus or potentially a loss of bowel control. Treatment is usually with a combination of chemotherapy and radiotherapy, with surgery reserved for the very small minority of patients who do not respond to their primary treatment.
Follow Up for Colorectal Cancer
Having had your surgery for bowel cancer, you will be followed up for the next five years in accordance with National Guidelines. This involves three monthly review for the first year, with a CEA blood test (bowel cancer marker) at each appointment. At the first anniversary of your original treatment, you will undergo a CT scan of the chest, abdomen and pelvis and a colonoscopy. From years 2-5 you will be followed up every six months with a CEA level. At the second anniversary you will undergo a CT scan of the chest, abdomen and pelvis and finally at the fifth anniversary of your original treatment you will undergo a completion CT scan and colonoscopy. Should you have any concerns, or develop new worrying symptoms between follow up, it is essential that you seek medical advice early, no matter how trivial you think your symptoms are.