Bowel Cancer Management

What is Bowel Cancer?

Bowel cancer is an abnormal growth of tissue lining the large bowel wall that has the ability to spread to lymph nodes and other organs. Once cancer spreads from it’s primary site it is called metastatic cancer.

How Common is Bowel Cancer?

Colorectal cancer is a major health problem in Australia with 1 in 20 Australians likely to develop the disease. The risk increases from 40 years of age but sharply rises from 50 years of age.

What is the Cause of Bowel Cancer?

Bowel cancer (adenocarcinoma) develops from an adenoma (polyp) usually over 5-10 years, however occasionally more aggressively. There are several risk factors associated with developing colorectal cancer including:

• Familial/Genetic
  • Personal or family history of adenomas (polyps) or bowel cancer
  • Genetic Syndromes
    • Familial Adenomatous Polyposis
    • Attenuated Familial Adenomatous Polyposis
    • Lynch Syndrome (HNPCC)
• Smoking
• Inflammatory Bowel Disease
• Increasing Age
• Dietary Factors
• Obesity
• Excess Alcohol

What are the symptoms of bowel cancer?

• Change in bowel habit i.e. a recent onset of diarrhoea or constipation
• Bleeding from the bowel
  • mixed with bowel motion
  • detected on faecal occult blood test (for patients being screened with no symptoms)
  • low blood count (Anaemia)
  • Iron deficiency
• Abdominal pain
• Weight loss
• Change in appetite

What are the Tests?

If your doctor suspects you may have bowel cancer, special tests will be organised and you will be referred to a surgeon. Your doctor or surgeon may perform:

• Basic blood tests
• CT Scan
• Colonoscopy and potentially upper gastrointestinal tract (gastroscopy)
  • Any abnormal tissue will be removed or biopsied and sent for confirmation of diagnosis
• Other imaging depending on findings- Endorectal ultrasound, MRI, PET Scan\

After the results of these tests are available, your doctor or specialist would discuss a plan of management.

How is Bowel Cancer Treated?

The most effective treatment, with the aim of cure, is surgically removing the affected bowel. Chemotherapy and/or radiotherapy may be given either before or after surgery depending on the type, severity and location of the cancer. The aims of this treatment are to reduce the size of the cancer, the chance of spread and the chance of the cancer recurring.

Why do some people have temporary or permanent bags (Ileostomy/Colostomy)?

An Ileostomy is when the end of the small bowel is brought up to the abdominal wall and a small opening is made to drain the bowel contents into a bag rather than allowing it to pass through the anus. A colostomy is the same except that it involves a piece of large bowel. This is usually dependent on the site of the cancer. Most bowel cancer resections do not require a temporary or permanent bag.

What are the Prospects of Cure After Treatment?

The outcome will depend on several factors including:

• The growth pattern of the primary bowel cancer
• The depth the cancer has spread through the bowel wall
• The presence of cancer cells in lymph glands and other organs
• Your general health and well-being

Two thirds of people with bowel cancer can be cured if the diagnosis is made early and treatment performed promptly. If cure is not possible, recent advances in treatment can significantly reduce symptoms.

What is the Recovery and Follow- Up After the Treatment?

Initially after a bowel resection patients experience irregular bowel habits that usually improve with time. Patients may also experience fatigue and some discomfort initially. Most patients are able to return to work within 4 weeks. Any follow up chemotherapy or radiotherapy will be arranged with the oncology specialist. You will need to continue to follow up with your surgeon for regular reviews and further colonoscopies over the following years.

Can Screening Tests Detect Bowel Cancer?

Australia recommends Faecal Occult Blood Test screening for people between 50-75 years every 2 years. This is a series of 3 faecal specimens that are collected at home for patients with no symptoms of bowel cancer and low risk of bowel cancer. If the results are positive it is important to be referred to a surgeon for further investigation including a colonoscopy. If the test is negative, this does not exclude bowel cancer and development of any symptoms in the future need to be investigated.