Bowel cancer is the fourth most common cancer in the UK. It is more common in the over-50s but it can affect people of all ages. More than 2,700 people under 50 are diagnosed with bowel cancer in the UK every year, according to Bowel Cancer UK. And research suggests rates are rising in younger adults (aged 25 to 49) globally.
“It is the UK’s second biggest cancer killer – around 17,700 people die from bowel cancer in the UK every year,” says Genevieve Edwards, chief executive of Bowel Cancer UK. “However, it shouldn’t be because it is treatable and curable, especially if diagnosed early.
Nearly everyone survives bowel cancer if diagnosed at the earliest stage — more than nine in 10 people will survive their disease for five years or more. However this drops significantly to one in 10 people when the disease is diagnosed at the latest stage.”
The earlier bowel cancer is detected, the greater the chance of surviving. But sadly, fewer than four in 10 people are diagnosed at the early stages (stage one and two). Almost half of people are diagnosed at the later stages (stage three and four).
It’s vital, then, that people are aware of the early signs of bowel cancer, as some symptoms may come and go, or are easily confused with other conditions.
“When diagnosed at an early stage, treatment is more likely to be less invasive, too,” explains consultant colorectal surgeon Dr Rajnish Mankotia. “Late-stage cancers have spread and require more extensive treatment with lower survival rates. Regular screening detects precancerous polyps before cancer even develops.”
The NHS runs a national bowel cancer screening programme to find bowel cancer early, before symptoms develop, when treatment is most effective. In England, people aged 50 to 74 who are registered with a GP are automatically sent a home stool test (FIT kit) every two years and those aged 75 and over can request a kit.
“The FIT kit checks for tiny traces of blood in the stool. If the level is above a set threshold, the person is invited for further tests, usually a colonoscopy, where any polyps can be removed and early cancers detected,” Mankotia explains.
“Bowel cancer can affect anyone, whatever your age,” Edwards says. “Taking part in the screening is one of the best ways to spot the disease early or remove polyps that might develop into cancer, even before symptoms appear.”
Symptoms of bowel cancer
Blood in the stool
Blood in the stool is one of the most widely recognised symptoms of bowel cancer. This can include bleeding from the back passage or seeing blood mixed with or on the surface of the stool, notes Mankotia.
“Blood in the stool does not always look the same, and is not always obvious,” adds Dr Marie Edison, head of medical policy at Vitality Health. “Bright red blood, which may be seen on the stool itself, on toilet paper or in the toilet bowl, can suggest bleeding from the lower bowel or rectum. Dark red or black, tarry stools, may indicate bleeding higher up the bowel. Black stools can also have a strong, unpleasant smell. In some cases, blood may be present but not visible to the eye (known as occult blood) and only detected through testing.”
Change in bowel habits
A change in usual bowel habits is another key symptom. This can include looser stools, going more often, or new‑onset constipation, Mankotia says. “Another is a persistent feeling of needing to strain to open the bowels, even after having a poo; or a lump that a doctor can feel in the back passage or in the abdomen; or pain or discomfort in the abdomen or back passage lasting for four to six weeks, with weight loss.”
Unexplained weight loss
Unintentional or unexplained weight loss is another red flag. When should you be concerned? “In the context of bowel cancer, this often involves losing weight unintentionally, without changes to diet or activity, over a relatively short period, typically weeks to a few months,” Edison says. “Also weight loss that is noticeable or ongoing, rather than just a few pounds that fluctuate naturally; or weight loss that occurs alongside other symptoms, such as loss of appetite, tiredness or changes in bowel habit.”
There is no single amount of weight loss that defines a problem, he says, but losing several kilograms, or clothing becoming looser without explanation, should be taken seriously.
Tiredness
Feeling very tired all the time, but you’re not sure why, or feeling breathless, are other potential symptoms to be aware of. “This can be a sign of anaemia, which can be caused by bowel cancer (due to blood loss),” explains Edwards. “Anaemia (iron deficiency) is when the number of healthy red blood cells in the body is lower than normal.”
Pain or lump in your stomach
Signs of bowel obstruction include nausea, vomiting, and a swollen abdomen from a partial or complete blockage. “These can occur particularly with larger colon tumours. In some cases, a palpable mass may be felt by a clinician,” Mankotia says.
If you have one or more of the above symptoms for three or more weeks, it’s important to visit your GP and find out what’s causing them, Edison stresses. “Bowel cancer symptoms can sometimes be confused with other conditions, like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), Crohn’s disease, or ulcerative colitis.”
The most important thing is to be aware of what’s “normal” for you, she adds. “Keeping a symptom diary of when they started and how long they last will give your GP a really good idea of the extent of your issues.”
How is bowel cancer usually diagnosed?
Your GP will typically make some initial assessments, go through your medical history, perform a physical examination and run some blood tests (including a full blood count and to check for anaemia), Mankotia explains. “Stool-based tests, which can be done from home, can detect hidden blood and prompt further investigation. A colonoscopy is the gold standard diagnostic test, which uses a camera to examine the inside of your bowel and take biopsies of polyps or tumours. If a colonoscopy is not possible, a CT colonography (virtual colonoscopy) or CT scan can help.”
What is the treatment for bowel cancer?
Treatment depends on a number of factors, including the stage of cancer, location (colon vs rectum) and patient health, Mankotia notes. Surgery is the most common treatment for bowel cancer, including a polypectomy to remove polyps; or colectomy to remove part of the involved colon and rejoin the bowel.
“For higher-risk stage two/three, chemotherapy is incorporated after surgery to shrink tumours or prolong survival,” she says. “Radiotherapy is the standard for rectal cancer to shrink tumours and improve resectability, less commonly used for colon cancer. For advanced cancer, the focus is on palliative care, such as symptom control and quality of life.”
Reducing your risk of bowel cancer
It’s estimated that around half of all bowel cancers could be prevented by having a healthier lifestyle.
Certain lifestyle factors can reduce your risk of developing bowel cancer, Edison points out. “Stop smoking – around seven per cent of bowel cancer cases in the UK are linked to smoking. Cut back on alcohol; alcohol consumption increases your risk of certain cancers, including colorectal. Aim for 30g of fibre each day, as well as helping your bowels to stay healthy,” she says, noting that studies suggest fibre-rich diets significantly reduce your risk of developing bowel cancer.
Avoid processed meats, too, which are classified as a carcinogen 1 – high consumption is closely associated with an increased risk of cancer, particularly colon cancer. She advises to aim for less than 500g of cooked red meat a week.
”Also keep active and maintain a healthy weight,” Edison says. “Roughly 11 per cent of bowel cancers in the UK are linked to being overweight, as excess body fat can release extra growth hormones and cause inflammation in your cells. Finally, attend screenings.”
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