We asked Professor Brian Saunders, consultant gastroenterologist at St Mark’s Hospital, Harrow and adjunct professor of endoscopy at Imperial College, London, for an update on new developments and treatments for bowel cancer.
Q: What is bowel cancer?
A: When we talk about bowel cancer we are referring to colorectal or rectal cancer. Almost all bowel cancers develop in the large bowel – two thirds are in the colon and one third in the rectum.
Q: How common is bowel cancer?
A: Bowel cancer affects about 5 per cent of the population in the western world. According to Cancer Research UK, in 2010 40,695 people in the UK were diagnosed with bowel cancer.
Bowel cancer is the second most common cause of cancer death in the UK, accounting for 10 per cent of all cancer deaths in 2011.
Q: What are the symptoms?
A: There are a number of symptoms to look out for. These include: bleeding from your rectum or blood in your stools, a persistent change in bowel habit lasting three weeks or more (especially diarrohea/looser stools), unexplained weight loss, extreme tiredness for no obvious reason and/or a pain or lump in your tummy.
Iron deficiency anaemia in someone aged over 50 also needs investigating. One of these factors on its own doesn’t necessarily mean you have bowel cancer, but if you have several of these ‒ this may be a red flag and warrant investigation.
Q: Who is most at risk?
A: Bowel cancer can affect anyone at any age but 80 per cent of people affected are aged over 60, and 95 per cent are over 50.
In 20 to 25 per cent of cases there is a genetic element, although in most cases a specific gene won’t have been identified, but there may be a family history of a close relative with the disease.
Other risk factors include being overweight, smoking or excessive alcohol intake. A high intake of processed meat (bacon, ham, meat pies etc.) may also increase your risk factors.
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Q: Do some medical conditions put you more at risk of bowel cancer?
A: People with diabetes, a history of the inflammatory bowel diseases Crohn’s Disease and Ulcerative Colitis or who have had previous polyps removed may be at higher risk of bowel cancer.
Q: Can you screen for bowel cancer?
A: Yes. This is the good news – bowel cancer can begin as a benign polyp which can grow slowly (sometimes over 10 to 15 years) before they turn cancerous and without any symptoms at all sometimes.
These polyps can be easily removed if detected at an early stage. In the UK, we already have a national screening programme for those aged 60 to 75 – where people are sent a home fecal blood test to test for blood in their faeces every two years.
We are now rolling out a new programme offering flexi bowel scope investigations (a 10 minute flexible sigmoidoscopy) to the over 55s to examine the left side of the bowel (where 70 per cent of tumours are found). This investigation can be used to find and remove polyps before they turn cancerous.
Research published in the Lancet has found this reduces the incidence of cancer in the left side of the bowel by 45 per cent.
This will eventually have a big impact on mortality rates for bowel cancer as we will be preventing cancer cases.
Although around one in 300 people screened in this way will already have cancer, we will hopefully be detecting it at an earlier stage than if they had waited for symptoms to appear.
Q: Have there been significant advances in surgery?
A: Yes – bowel cancer is now extremely treatable and curable if it is caught in the early stages. We can now remove large polyps, some containing very early cancer endoscopic ally avoiding the need for surgery and larger cancers are now removed via keyhole surgery which means patients recover more quickly and there is less risk of complications.
Q: What about other treatments for bowel cancer?
A: We now have more effective radiotherapy techniques which much more accurately target the tumours without damaging surrounding tissue.
There are also a number of drug therapies available which have had a significant impact; these include monoclonal antibodies which can slow down or control the tumour growth.
There are more drugs being developed all the time; some of these will be highly personalised and designed to target particular genetic tumour types.
Q: What’s next on the horizon?
A: We’re already at the stage where most bowel cancers can be cured if they are detected at an earlier stage.
According to the NHS five year survival rates for early stage bowel cancer are over 90 per cent and the chances of a cure are high, compared to only 6 per cent at later stages.
As the population ages and people live longer, we will, unfortunately, see more cases of bowel cancer as it is a disease associated with old age, but by screening people to detect cancers early, we will be able to treat and cure the disease in many more cases.
As the national flexible sigmoidoscopy screening programme is extended across the UK, we are going to be able to prevent more cases of cancer by removing polyps. Where we do discover cancer, it will be more likely to be at a stage when it can be successfully treated. This will have a significant impact on mortality and quality of life after treatment.
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Our bodies do the
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Things like this often go unnoticed, but there are some signs we do need
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