Colorectal cancer (bowel cancer) is the fourth most common cancer diagnosis in the United Kingdom, with more than 40,000 new diagnoses per year. Fortunately, outcomes are generally good with more than 56% of patients surviving 10 years or more following diagnosis. Outcomes can be significantly improved by early diagnosis.
In the UK there are screening programmes to try and identify patients with colorectal cancer at an earlier stage. As most bowel cancers start off as a small polyp, if these are detected and removed it is possible to reduce the likelihood of developing a cancer. The screening programmes consist of Bowel Scope, in which patients are offered a one-off flexible sigmoidoscopy at the age of 55, and faecal occult blood testing (FOBT), which is offered every 2 years to patients aged 60 – 74. These services will offered to you automatically, so long as you are registered with a GP.
There are a number of symptoms that can be associated with bowel cancer. These include a change from your normal bowel habit, the presence of blood, unexplained weight loss or abdominal pains. Should these symptoms be present, you should discuss them with your GP at the earliest opportunity. In addition, the presence of iron deficiency anaemia on a blood test can be a sign. Sometimes, your GP may identify a lump in the abdomen or on undertaking a rectal examination. A referral can then be made to a colorectal surgeon for further assessment.
The colon and rectum are usually assessed with either a colonoscopy (“camera test”) or CT virtual colonoscopy (CT enema). Should a tumour be found at the time of a colonoscopy, small biopsies (tissue samples) will be taken to confirm the diagnosis. If a tumour was identified on a CT scan, it may be necessary to undergo a sigmoidoscopy or colonoscopy in order to get a biopsy for confirmation. You will need to undergo staging CT scans to see whether there are any signs the tumour has spread elsewhere. For tumours in the rectum an MRI scan is also performed.
All patients diagnosed with colorectal cancer are discussed in a multi-disciplinary team (MDT) meeting. This is attended by colorectal surgeons, gastroenterologists, radiologists, oncologists, pathologists and clinical nurse specialists. This allows us the opportunity to tailor the treatment plan for individual patients based on the information available from your investigations, together with knowledge about your general health.
The majority of patients with bowel cancer can be treated surgically. For some rectal tumours it may be necessary to have chemotherapy and radiotherapy as the initial treatment, with surgery deferred until after this has been completed. Surgery is usually performed as a laparoscopic (keyhole) operation, and most patients are able to go home after about 5 days. A stoma (a bag) is not normally necessary, but under some circumstances one will be required either as a temporary measure, or permanently. If it is likely that a stoma will become necessary, this will be discussed with you in the outpatient clinic.
Following surgery, some patients may require chemotherapy. This is decided when the post-operative results are reviewed in the MDT. Should this be necessary, you will be informed in the first post-operative surgical clinic and a referral made to an oncologist. Patients are routinely followed for 5 years following bowel cancer treatment. If, at the end of this period, all is clear, you will be discharged back to the care of your GP.
Cancer Research UK. Link
Beating Bowel Cancer. Link
Ileostomy Association. Link
The Colostomy Association. Link
Bowel Scope. Link
Faecal occult blood testing. Link