Bowel or colorectal cancer is cancer of the large bowel, which is made up of the colon and rectum. Most bowel cancers will develop from polyps or pre-cancerous growths. These are very common and not all polyps will develop into cancer.

Bowel cancer is now the fourth most commonly diagnosed cancer in the UK. Although, more than 90% of bowel cancer cases are diagnosed in those over 50, mainly affecting men and women over the age of 70, it can affect younger people.

Bowel cancer affects men very slightly more than women. If it is diagnosed and treated early, bowel cancer is highly curable, but this drops significantly as the disease progresses. Overall over 50% of people will survive their bowel cancer but this goes up to 95% if caught in the early stages. Of course prevention is far better than cure and this is where bowel cancer screening is important.

Bowel cancer is the UK’s second biggest killer so seeking medical advice if you’re suffering from certain symptoms is essential.

Frequently Asked Questions

The early signs of bowel cancer are often the same as many other conditions affecting the colon or rectum, but it’s important to seek medical advice to rule out anything more serious.

Possible symptoms include:

  • Bleeding from rectum or blood in your stools (sometimes appearing black or dark red)
  • Changes in your bowel habit usually more towards explosive stools and runny stools
  • A feeling of constantly wanting to open your bowels
  • A lump in your back passage or tummy
  • Pain in your back passage or tummy
  • Fatigue, breathlessness and signs of anaemia
  • Bowel obstruction (acute onset sever abdominal pain and distension and an inability to pass wind or open bowels). This is an emergency.

Please be aware that many of the symptoms have perfectly benign less serious causes behind them so don’t panic but get checked out.

Although it is called bowel or colorectal cancer, there is a distinction depending on where in the large bowel the cancer starts. The colon is first part of the large bowel and is separated into several sections. Cancer can develop in any of these. The most common areas are the caecum, sigmoid colon and rectum. The rectum is the last part of the large bowel, also known as the back passage, and its where the body stores faeces before they are ready to be passed out of the body. Separately, you can have anal cancer which starts in the anus. This is rare although commoner in homosexual men, HIV patients and patients who have other reasons to have a reduced immunity.

Firstly, there will be a physical examination of your rectum, known as a digital rectal exam. A Faecal Immunochemical Test or FIT may be performed to look for small traces of blood in a stool sample as that might indicate cancer and blood tests can also help diagnose bowel cancer.

Mr Stellakis can also perform a number of internal examinations of the large bowel. These include colonoscopy or flexible sigmoidoscopy. Various scans, including a CT colonography, also known as a virtual colonoscopy, are available.

If a diagnosis of bowel cancer is made, then you are likely to have to undergo further tests including scans in order that the correct treatment can be decided.

Click here for more information on bowel cancer screening.

Your treatment depends on whether you have colon or rectal cancer and how advanced your cancer is and whether it has spread elsewhere in the body. The main treatment for colon cancer is surgery with or without chemotherapy. For rectal cancer again it is surgery with or without chemotherapy and radiotherapy. Combinations of therapy are commonplace and the treatment regime will be decided at a team level (MDT) and is based on giving you the best chance of a cure if possible. The staging scans and treatment decisions can take a few weeks and this is often an agonising wait for the patient. That said a few weeks will make no difference to the outcome of your disease but embarking on the wrong treatment  certainly can. So whilst it is difficult, patience whilst information is collated and your case is discussed is really important.

This is often one of the first questions a patient asks when told they have bowel cancer. Stomas as they are called come in different guises but the common ones are colostomy (the colon empties into a bag on the abdomen) and ileostomy (small bowel empties into bag on the abdomen). The first thing to say is the vast majority of patients undergoing surgical removal of a colon cancer will not need a stoma at anytime unless a complication develops. The only exception to this is if your surgeon has recommended removal of all of your bowel  which is rare and even then there are things that can be done to avoid a permanent stoma.

Rectal cancer is different and whether you have a stoma depends very much on how advanced your cancer is and how low (proximity to anal verge or exit) it is. If your cancer is so low that to safely remove it the anal sphincters have to be removed then unfortunately you will have to have a permanent colostomy. This is called an AP resection and accounts for about 15% of all rectal cancer treated in the best units. If your rectal cancer is high enough to avoid removing the sphincters (85% of cancers) then it is unlikely you will need permanent stoma. This is called an anterior resection. That notwithstanding the surgeon may elect to give you a temporary stoma (ileostomy) at the time of the anterior resection to protect the delicate join (anastomosis) in the bowel that is made. The vast majority of these temporary stomas are successfully removed (or reversed) a few weeks after the major surgery and is a relatively simple and straightforward operation. The surgeon is is much more likely to give you a temporary ileostomy  if you have had radiotherapy for your rectal cancer prior to its removal.

Stomas temporary  or permanent are understandably feared but appliances are so much better theses days and there are dedicated teams of nurses whom will help and guide you through this difficult time.