Content Starts Here
Bowel cancer
Written by Prof. Jonathan Rhodes, consultant gastroenterologist
Anaemia
Iron deficiency anaemia indicates that someone has been losing small amounts of blood over a long time. Causes include heavy menstruation (periods), coeliac disease (gluten intolerance), oesophagitis (inflammation of the gullet), Crohn's disease and cancer of the stomach. Iron deficiency because of lack of iron in the diet is an uncommon cause, except in adolescents with a poor diet.
Abdominal pain
Bowel cancer may cause lower abdominal pain that is typically colicky. Similar pain occurs in irritable bowel syndrome, but is often associated with diarrhoea that alternates with formed or even constipated stools, whereas bowel disturbance in bowel cancer is usually more persistent.
Irritable bowel syndrome may be triggered by stress or by an episode of infectious gastroenteritis. It most commonly presents in adolescents or young adults at an age when bowel cancer is rare.
Crohn's disease, a form of inflammatory bowel disease, can also present with colicky pains with or without diarrhoea. Diagnosis is usually based on barium radiology or colonoscopy when it can be readily distinguished from cancer. Crohn's disease commonly affects the small intestine, a part of the bowel that is exceptionally rarely the site of cancer.
Pain at the very lowest part of the abdomen (suprapubic pain) can indicate a bladder problem such as cystitis, and pain low down to the right or left in a woman can indicate disease of the ovaries. Urine testing and pelvic ultrasound examination are usually done if these are possible alternative diagnoses.
What can your doctor do?
You should see your doctor promptly if you have:
Your doctor will probably feel your abdomen and perform an internal rectal examination using a gloved finger. He or she might also send off blood tests, especially a full blood count to check for anaemia. Occasionally, the doctor's practice might be equipped for sigmoidoscopy.
Unless your symptoms are considered low risk for cancer (perhaps because of a combination of your youth and the lack of recurrence or persistence of symptoms), you are likely to be referred to your district hospital.
You will usually be seen either by a physician who specialises in bowel diseases (a gastroenterologist) or by a surgeon with a gastroenterological practice. In either case, the procedures they use to make a diagnosis are likely to be the same. They will consist of some form of endoscopic examination (either sigmoidoscopy or colonoscopy), often followed by a barium enema radiological examination.
In the UK, the July 2000 two week cancer guidelines suggest that anyone over 55 with rectal bleeding, or anyone with a combination of rectal bleeding and altered bowel habit, should be seen at a hospital within two weeks of referral by their GP.
Fortunately, bowel cancers are fairly slow growing; estimates are that it takes about 10 years on average for a small polyp to develop into an invasive cancer. Nevertheless, even if your symptoms and age do not put you into the category of people needing to be seen within two weeks, a delay of more than about two months should be regarded as unacceptable.
What can you do yourself?
Treatment
You should:
Do not hesitate to nag, or have someone nag on your behalf, if you feel you are not being investigated or treated appropriately or speedily.
What can your doctor do?
If the cancer is in the rectum, the operation will usually be accompanied by radiotherapy (by external beam irradiation) to reduce the risk of tumours reappearing in the same area. The radiotherapy may sometimes be given first, followed a few months later by the surgery.
For cancer of the colon, radiotherapy is not routinely used, but if examination of cells from the removed cancer shows that the cancer has spread to lymph glands, then some form of chemotherapy will normally be given, usually oral 5-fluorouracil combined with either folinic acid
or levamisole. Chemotherapy is very likely to cause side effects, including nausea and hair loss, but the nausea can usually be well controlled by drugs.
In any form of bowel surgery, the patient is normally warned that the surgeon might have to create a colostomy stoma (opening of the bowel onto the abdomen that is covered by a bag). This might be a temporary measure to divert faeces from the site of the bowel that has been repaired after removal of the tumour.
If the tumour is very low down in the rectum, then the primary operation will include cutting out and closing the anus (abdomino-perineal resection) so the stoma will be permanent. Fortunately, modern stoma accessories are excellent, and colostomies are generally well managed and odour free.
In most cases, a bowel cancer higher up the colon can be surgically removed and the bowel repaired without the need for a colostomy.
The average length of stay in hospital for bowel cancer surgery is about 7 to 10 days. The abdominal wound is usually in the middle of the abdomen. Stitches will be removed by about 7 to 10 days, but the scar will usually cause some discomfort for four to six weeks. Pain relief immediately after the operation should nowadays be very effective and is often under the patient's own control.
The best way to monitor patients after surgery is not yet clearly established, but some surgeons review patients at regular intervals to have a blood test done (carcino-embryonic antigen) to look for any evidence that the cancer has returned. This test is partly done because tumours that have re-appeared in the same area can be removed and partly because surgeons are now more optimistic about the chances of curing bowel cancer that has spread to the liver, provided it is caught early.
Prognosis (outlook)
Complications
Surgery
Patients are routinely given antibiotics to prevent infection from any minor leakage of the repaired bowel, and preventive anticoagulation (blood thinning treatment) with heparin to protect against possible deep vein thrombosis.
Once a cancer has developed, treatment is aimed at removing the original (primary) growth and at preventing secondary spread. This will be with some combination of surgery, chemotherapy or radiotherapy.
Once the diagnosis of bowel cancer has been made, the first treatment is usually surgical removal of the cancerous tumour under general anaesthetic.
Colorectal cancer has a relatively good prognosis compared with most other solid cancers. Between 50 and 60 per cent of people with colorectal cancer survive for five years, after which a return of the cancer is uncommon. If the disease is caught at a time when the tumour has not spread through the bowel wall (so-called Dukes grade A), then the cure rate is over 90 per cent.
About 5 in every 100 patients will die by 30 days after an operation to remove bowel cancer. Possible complications after surgery include:
<<Go To Page 1
The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care or attention by a qualified practitioner. The materials in this web site cannot and should not be used as a basis for diagnosis or choice of treatment. Conditions for use
© Copyright 1998 - 2004 NetDoctor.co.uk - All rights reserved
Related Links
StayQuit is a medically proven smoking cessation programme that gives you the tools you need to quit smoking for good.
Advertisement starts
Advertisement ends
Font size
Mail
My account
Help
CommunityPage Footer
Print now
Send to a friend
Related articles
Related products
Access keys
You will need to use different key combinations in order to use access keys depending on your internet browser, find out which on our accessibility page.
- (0) Navigate to Accessibility page.
- (1) Navigate to Home page.
- (2) Navigate to My email.
- (3) Navigate to My Account.
- (4) Navigate to Site Map page.
- (5) Navigate to Contact us page.
- (6) Navigate to Members channel.
- (7) Navigate to Services channel.
- (8) Navigate to News & Info channel.
- (9) Navigate to Entertainment channel.
- ([) Skip down to the Primary navigation block.
- (]) Skip down to the more links within this section block.
- (=) Bypass all navigation and jump to the content.