Bowel Cancer

Bowel cancer (also known as colorectal cancer) is the fourth most common type of newly diagnosed cancer in Australia but remains the second most common cause of death of cancer in Australia. 15,531 Australians are told they have bowel cancer each year (299 a week), including 1,716 people under the age of 50.
If you are over the age of 50 (without a family history) or 40+ (with a family history of colon cancer or polyps), please don’t wait. Colonoscopy could save your life. Contact us to schedule an appointment with Dr. Peerbaccus.

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What is bowel cancer?

Bowel cancer, also known as colorectal cancer or colon cancer, is a type of cancer that develops in the colon (large intestine) or rectum. It usually begins as small, noncancerous growths called polyps on the inner lining of the colon or rectum. Over time, some polyps can become cancerous.

Bowel cancer typically progresses slowly over several years, starting as benign polyps and eventually developing into cancerous tumours. If left untreated, these tumours can grow and invade nearby tissues and organs, as well as spread to other parts of the body, a process known as metastasis.

What are the symptoms of bowel cancer?

Symptoms of bowel cancer can vary depending on the location and size of the tumour, as well as the stage of the cancer. Some individuals may experience no symptoms, especially in the early stages of the disease. However, common symptoms of bowel cancer may include:

Changes in bowel habits: Persistent changes in bowel habits, such as diarrhea, constipation, or changes in stool consistency (e.g., narrower stools), may occur. These changes may persist for several weeks without improvement.
Rectal bleeding or blood in the stool: Blood in the stool or rectal bleeding, which may appear as bright red blood or as dark, tarry stools, can be a sign of bowel cancer. This symptom may be intermittent or persistent.
Abdominal discomfort or pain: Abdominal pain, cramping, bloating, or discomfort may occur, particularly in the lower abdomen. This discomfort may be persistent or intermittent and may worsen over time.
Unexplained weight loss: Unexplained weight loss, without changes in diet or physical activity, can occur in individuals with bowel cancer. Significant weight loss may occur over a relatively short period.
Fatigue or weakness: Persistent fatigue, weakness, or a feeling of tiredness that doesn't improve with rest may be a symptom of bowel cancer, especially in advanced stages of the disease.
Anaemia: Anaemia, characterised by a low red blood cell count, may develop in individuals with bowel cancer, leading to symptoms such as fatigue, weakness, and shortness of breath.
Bowel obstruction: In some cases, bowel cancer may cause a bowel obstruction, resulting in symptoms such as severe abdominal pain, nausea, vomiting, and inability to pass stool or gas.

It’s important to note that these symptoms can also be caused by other, less serious conditions. However, if you experience persistent symptoms or any concerning changes in bowel habits, it’s essential to seek medical attention promptly for evaluation and diagnosis. Early detection and treatment of bowel cancer can significantly improve outcomes and increase the chances of successful treatment.

How is bowel cancer diagnosed?

Bowel cancer is diagnosed through a combination of medical history evaluation, physical examination, and various diagnostic tests. Here’s an overview of the diagnostic process for bowel cancer:

Medical history and physical examination: Dr. Peerbaccus will start by taking a thorough medical history, including asking about your symptoms, risk factors, and family history of cancer. They will also perform a physical examination to assess for any signs of bowel cancer or other medical conditions.
Blood tests: Blood tests may be performed to assess your overall health and check for signs of anaemia or other abnormalities that may suggest bowel cancer. These tests may include a complete blood count (CBC) and liver function tests.
Stool tests: Stool tests, such as faecal occult blood tests (FOBT) or faecal immunochemical tests (FIT), may be used to detect the presence of blood in the stool, which can be a sign of bowel cancer or other gastrointestinal conditions.
Colonoscopy: Colonoscopy is a procedure that allows a gastroenterologist to examine the inside of the colon and rectum using a flexible tube with a camera attached (colonoscope). During the procedure, any suspicious areas or polyps can be visualised and biopsied for further examination.
Flexible sigmoidoscopy: Like colonoscopy, flexible sigmoidoscopy allows for visualisation of the lower part of the colon and rectum using a flexible tube with a camera. This procedure may be used to evaluate the rectum and left side of the colon.
Imaging tests: Imaging tests, such as computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, or positron emission tomography (PET) scans, may be performed to assess the extent of the cancer and determine if it has spread to other parts of the body (metastasis).
Biopsy: If abnormal tissue is found during colonoscopy or other imaging tests, a biopsy may be performed to obtain a sample of tissue for examination under a microscope. A biopsy can confirm the diagnosis of bowel cancer and provide information about the type and stage of the cancer.

How is bowel cancer treated?

The treatment for bowel cancer depends on various factors, including the stage of the cancer, the location and size of the tumour, the overall health of the individual, and personal preferences. Treatment for bowel cancer may involve one or a combination of the following approaches:

Surgery:

Surgery is the primary treatment for early-stage bowel cancer. The goal of surgery is to remove the cancerous tumour along with a margin of healthy tissue (resection). The type of surgical procedure performed depends on the location and extent of the cancer. Common surgical procedures for bowel cancer include:

Local excision: Removal of small tumours or polyps from the inner lining of the colon or rectum.
Colectomy: Removal of a portion of the colon (partial colectomy) or the entire colon (total colectomy).
Rectal resection: Removal of a portion of the rectum and surrounding tissues.

Chemotherapy:

Chemotherapy involves the use of powerful drugs to kill cancer cells or prevent them from growing and dividing. Chemotherapy may be used before surgery (neoadjuvant chemotherapy) to shrink the tumour, after surgery (adjuvant chemotherapy) to kill any remaining cancer cells, or as a primary treatment for advanced or metastatic bowel cancer.

Radiation therapy:

Radiation therapy uses high-energy beams of radiation to target and destroy cancer cells. It may be used alone or in combination with surgery and/or chemotherapy to treat locally advanced rectal cancer or to relieve symptoms in cases of advanced disease.

Targeted therapy:

Targeted therapy drugs specifically target cancer cells by interfering with specific molecules involved in cancer growth and progression. These drugs may be used in combination with chemotherapy for advanced or metastatic bowel cancer, particularly if the cancer has specific genetic mutations.

Immunotherapy:

Immunotherapy works by stimulating the body’s immune system to recognise and attack cancer cells. It may be used in certain cases of advanced bowel cancer that have specific molecular features.

Palliative care:

Palliative care focuses on relieving symptoms and improving the quality of life for individuals with advanced or metastatic bowel cancer. It may include pain management, nutritional support, and psychosocial support for patients and their families.

In summary, treatment decisions are made based on a comprehensive evaluation of the individual’s specific situation and may involve a multidisciplinary team of healthcare providers, including surgeons, medical oncologists, radiation oncologists, and other specialists. The goal of treatment is to effectively manage the cancer, minimise side effects, and improve overall outcomes and quality of life.

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FAQS

What are the risk factors for developing bowel cancer?

Several factors can increase the risk of developing bowel cancer. While some risk factors are not modifiable, others can be influenced through lifestyle changes or medical interventions. Common risk factors for bowel cancer include:

Age: The risk of bowel cancer increases with age, with most cases diagnosed in individuals over the age of 50. However, bowel cancer can occur at any age, and the incidence is rising among younger adults.

Family history and genetics: A family history of bowel cancer or certain genetic syndromes, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer) or familial adenomatous polyposis (FAP), can significantly increase the risk of developing the disease.

Personal history of bowel polyps or inflammatory bowel disease: Individuals who have a history of precancerous bowel polyps (adenomas) or inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis, are at an increased risk of developing bowel cancer.

Lifestyle factors: Certain lifestyle habits and environmental factors can influence the risk of bowel cancer, including:

Unhealthy diet: A diet high in red and processed meats, and low in fruits, vegetables, and fibre, has been associated with an increased risk of bowel cancer.
Lack of physical activity: Sedentary behaviour and a lack of regular physical activity may increase the risk of bowel cancer.
Obesity: Being overweight or obese is a risk factor for developing bowel cancer, particularly for men.
Smoking: Tobacco smoking has been linked to an increased risk of bowel cancer, as well as other types of cancer.
Heavy alcohol consumption: Excessive alcohol consumption, especially beer and spirits, has been associated with an increased risk of bowel cancer.

Race and ethnicity: Certain racial and ethnic groups, such as African Americans and Ashkenazi Jews, have a higher risk of developing bowel cancer compared to other populations.

Type 2 diabetes: Individuals with type 2 diabetes may have an increased risk of developing bowel cancer, particularly if the diabetes is poorly controlled.

Radiation therapy: Previous radiation therapy to the abdomen or pelvis, often used to treat other types of cancer, may increase the risk of developing bowel cancer later in life.

Environmental factors: Exposure to certain environmental pollutants or carcinogens may increase the risk of developing bowel cancer, although the specific factors involved are not yet fully understood.

Does bowel cancer spread quickly?

Once bowel cancer develops, its progression can vary based on several factors, including the characteristics of the tumour, the stage of the cancer, and the individual’s overall health and response to treatment. While bowel cancer generally progresses slowly over time, it is a serious disease that requires prompt medical attention and appropriate treatment.

The progression of bowel cancer is typically classified into stages based on the extent of the disease and whether it has spread to other parts of the body. Early-stage colon cancer, such as stage I or II, may be confined to the inner layers of the colon or rectum and have a relatively favourable prognosis with appropriate treatment. Advanced-stage colon cancer, such as stage III or IV, may have spread to nearby lymph nodes or distant organs, making it more challenging to treat and potentially more life-threatening.

How long can I have bowel cancer without knowing?

Colon cancer typically develops from benign growths called polyps, which can take many years to transform into cancerous tumours. This slow progression from benign to malignant can occur over a span of several years without causing noticeable symptoms.

Even after the development of colon cancer, it may still take additional time, sometimes years before symptoms become apparent or before the cancer is detected through screening tests or medical evaluation. This is because early-stage colon cancer may not produce noticeable symptoms, or symptoms may be nonspecific and attributed to other less serious conditions.

What is the life expectancy for someone with bowel cancer?

The survival rates for bowel cancer vary depending on the stage of the cancer at the time of diagnosis. Generally, survival rates are expressed as the percentage of individuals who are alive at a certain time point after diagnosis, typically five years. It’s important to note that survival rates are estimates based on statistical data and may vary widely among individuals depending on various factors, including age, overall health, response to treatment, and other factors.

Here are the approximate five-year survival rates for each stage of bowel cancer:

Stage I: In stage I bowel cancer, the cancer is localised to the inner lining of the colon or rectum and has not spread beyond the mucosa or submucosa. The five-year survival rate for stage I bowel cancer is typically around 90% to 95%.
Stage II: In stage II bowel cancer, the cancer has grown through the muscle layer of the colon or rectum but has not spread to nearby lymph nodes or distant organs. The five-year survival rate for stage II bowel cancer is generally around 80% to 90%.
Stage III: In stage III bowel cancer, the cancer has spread to nearby lymph nodes but has not yet spread to distant organs. The five-year survival rate for stage III bowel cancer is approximately 60% to 70%.
Stage IV: In stage IV bowel cancer, the cancer has spread to distant organs or tissues, such as the liver, lungs, or other parts of the body. Stage IV bowel cancer is considered advanced or metastatic, and the prognosis is generally less favourable. The five-year survival rate for stage IV bowel cancer is typically around 10% to 15%.

Do I need a stoma bag after bowel cancer surgery?

In some cases of bowel cancer surgery, particularly when a large portion of the colon or rectum is removed or when the bowel cannot be immediately reattached, a colostomy may be necessary. A colostomy is a surgical procedure that creates an opening (stoma) in the abdominal wall through which stool can pass into a collection bag outside the body.

There are different types of colostomies, depending on the location of the stoma and the portion of the colon involved. Some colostomies are temporary, meaning they are created to allow the remaining bowel to heal after surgery, and can be reversed later. Temporary colostomies may be used when the bowel needs time to heal, such as after extensive surgery or if there is concern about anastomotic leakage (leakage at the site where the bowel is reconnected).

Permanent colostomies, on the other hand, are created when the portion of the bowel that is removed cannot be reconnected, or when there is significant damage to the remaining bowel. In these cases, the stoma becomes a permanent part of the digestive system, and the individual will need to use a colostomy bag to collect stool for the rest of their life.

Adjusting to life with a colostomy can be challenging, both physically and emotionally, but with time and support, many people are able to lead full and active lives. Education, counselling, and support from healthcare providers, ostomy nurses, and support groups can be invaluable in helping individuals adapt to life with a colostomy and manage any concerns or challenges that may arise.

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