Colorectal cancer

15 October 2012

Our expert Pawan Mathur is a Colorectal and Laparoscopic Surgeon who has worked as a Consultant for 8 years and is the Clinical Lead for Colorectal Cancer in his Trust – meaning he was well placed to answer your questions on colorectal cancer.

With everything from treatments of colon and bowel cancer, to similar colorectal conditions discussed, Mr Mathur answered a broad spectrum of questions in a busy and fast paced live chat.

This is what he had to say:

Jo asked:Hi could you please describe the symptoms of bowel cancer?

Pawan Mathur:Hello Jo. These may be varied but commonest is bleeding from the bottom end and a chnage in the bowel habit. The blood maybe mixed in with the stool and you may be going more often than usual, sometimes diarrhoea. Sometimes however there very few symptoms but your GP may notice anaemia (a drop a haemoglobin) on your blood tests

Adz asked:I get a cramp like pain every so often a couple of days apart maybe longer from what seems to feel like the back if my gut towards my bottom! Any sign of anything dodgy?

Pawan Mathur:Hi Adz. I would need to know a bit more but the symptoms don’t sound too worrying but you should see your GP about them. Are you opening your bowels normally?

Adz asked:Yeah I suppose! I seem to have IBS so it’s hard to tell! My GP and all in my surgery are so useless I have lost faith in talking to them! They don’t listen much these days! I told the doc I had gall stones, as I lost 9 stone in weight and seem a reasonable assumption, he told me I had indigestion, and 4 months later I’m rushed into hospital with pancreatitis and had my gall bladder removed! That’s just one case! There’s so many!!!!

Pawan Mathur:I'm sorry to hear that. I would say you have 3 options: 1) change GP, 2) your GP still has to refer you to a specialist if that is what you want 3) book yourself in to see someone...but this would have to be private. Suggest you see a Gastroenterologist

Jo asked:What can we do to avoid bowel/colon cancer?

Pawan Mathur:The first thing is awareness, mainly of the symptoms and if you are worried to seek advice straight away. A sensible balanced diet should be part of everyone’s life style with plenty of fruit, vegetables and water. You don’t have to eradicate red meat from your diet altogether but it a matter of keeping it balanced. Smoking and obesity have also been linked to bowel cancer. There is a some recent evidence to show that a junior Aspirin every day can prevent certain cancers including bowel cancer. If you are of the age when bowel screening would apply then do the stool test that you will be sent.

Jo asked:Thanks, can you explain why red meat might be a problem?

Pawan Mathur:Hi Jo. It has been shown that the breakdown products of red meat can be harmful. There are some good articles on the Beating Bowel Cancer website which I recommend about diet. And red meat stays in your system for months Jo! Which can’t be good!

Jo asked:Thanks - I'll check out the diet guides, I don't eat red meat myself (for ethical reasons) but it's good to know that this is helping keep me healthy!

Adz asked:My mum died 2 years ago from pancreatic cancer. She survived for three years with no chemotherapy! Chemo is a killer! I don’t believe in it for some cases! If you don’t put the goodness back in your body, or you find it hard to put on weight then I don’t recommend it. What do you think??

Pawan Mathur:Hi Adz. I am sorry to hear about your Mum and I can see your point. Chemotherapy is not my specialty but I deal with and refer patients for it. There are different drugs and regimes for different cancers and nowadays more drugs on offer not all of which have the nasty side effects that we all know. It is very much a matter of taking each individual case and balancing what the pros and cons of treatments are

Adz asked:Are we all just playing the game of pharmaceutical companies making us ill and then trying to cure us? And of course making trillions on the way? Ever heard of a therapy called Scenar? If so what do you think?

Pawan Mathur:I have not heard of Scenar

Adz:Scenar teaches your body to heal itself! It resends the signals to the brain by electronic pulses through your back which clears the path for the brain to heal your body!

fionad asked:Hi there - what are the treatments for bowel cancer? Does it in anyway differ from other cancers?

Pawan Mathur:Hi Fionad. I think one of the most important things to remember is that bowel cancer can actually be CURED if the patient presents to us in time. This is not true for all cancers. The treatments for bowel cancer are surgery +/- radiotherapy or chemotherapy

fionad asked:What does surgery involve? I imagine there would be a long recovery period?

Pawan Mathur:Fionad, things have changed now so that most hospitals undertake keyhole (laparoscopic) surgery for bowel cancer. So the same operation is done to remove the cancer but the patient all has small scars. Hence they have less pain afterwards and so can mobilise quicker. Their bowel function also returns quicker so overall they are out of hospital quicker and even at home their recovery is smoother.

Surgery overall involves removing all the cancer with a safe 'margin' and also removing tissue around the cancer containing lymph glands or nodes

740502 asked:Hi, I was wondering what the common signs of bowel cancer are?

Andy_T asked:I too would like to know what the common signs are

Pawan Mathur:Hi 740502 and Andy T. The symptoms/ signs of bowel cancer may be varied but commonest is bleeding from the bottom end and a change in the bowel habit. The blood maybe mixed in with the stool and you may be going more often than usual, sometimes diarrhoea. Sometimes however there very few symptoms but your GP may notice anaemia (a drop a haemoglobin) on your blood tests

queeny asked:Could the symptoms you describe be due to ulcerative colitis too?

Pawan Mathur:Hi Queeny. Yes they could. More often with UC one sees diarrhoea and blood or mucus mixed in with stool depending on its severity. UC is commoner in the 20-30 yrs age bracket whereas bowel cancer in 50-60 age group roughly

fionad asked:What is UC?

Pawan Mathur:Sorry, Ulcerative Colitis.

fionad asked:Is that a form of bowel cancer?

Pawan Mathur:No. It is one of the kinds of inflammatory bowel diseases. These are characterised by inflammation in the lining of the bowel. Another one you may have heard of is Crohn’s disease. However if someone has had either of these conditions for a long period of time (over 10 years) then there is a risk of developing bowel cancer. Sorry should have read Crohn’s Disease in previous text

queeny asked:Can you suffer Melaena with UC? Or is this more likely with cancer?

Pawan Mathur:No don’t worry queeny it is still relevant as my previous text shows. So, Melaena is the passage of black tarry stools. This is due to the presence of old blood in the stool and is usually due to bleeding coming from 'higher up' in the GI tract for instance the stomach, small bowel or right colon. Ulcerative Colitis does not usually cause Melaena but if there is a cancer in the right side of the colon then yes you may get Melaena.

queeny asked:So can bowel cancer be diagnosed using a colonoscopy? or is further investigation required?

Pawan Mathur:Yes queeny, a colonscopy is usually the way the bowel cancer is found; then biopsies are taken (small tissue samples) and then examined by a histopathologist who can tell us whether it is a bowel cancer

queeny asked:If a person has been noted to have proctitis and symptoms have become worse, is it most likely that there is colitis higher up also, causing the increase in symptoms? or could there be a different explanation? Many thanks Pawan for answering.

Pawan Mathur:Yes it queeny it is possible that the inflammation may be higher up. Also depends on what treatment is being given for the proctitis and the cause. Should really have a sigmoidoscopy

queeny asked:What is the difference between a sigmoidoscopy and colonoscopy? is a colonoscopy a good way check for uc as well as cancer?

Pawan Mathur:Queeny; sigmoidoscopy involves just looking at the rectum and can be done in the outpatient clinic. Colonscopy involves looking at the whole colon; this requires complete purging of the bowel the day before procedure. The examination is most often done in an endoscopy department and usually we give intravenous sedation and pain killers as it can be a bit painful. And yes a colonscopy is a good way to check for both UC and cancer

Choddy asked:What foods can aggravate colon cancers and the best nutritional all ways to reduce the initial inflammation or chance of developing inflammation????

Pawan Mathur:Hi choddy. In terms of diet please see my previous texts on the subject. Not sure what you mean about initial inflammation?

Choddy asked:Well if you are having minor symptoms when they first manifest such as blood, mucous...loose stools...if u see early signs what should u most avoid and are there any foods that can sooth the problem?

Pawan Mathur:Choddy are you taking about inflammatory bowel disease or bowel cancer...sorry to be pedantic

Choddy asked:Both...does it not begin as inflammation and progress to malignancy?!?

Pawan Mathur:Ok Choddy now I get you. So bowel cancer most often starts as a polyp (small outgrowth from the lining of the bowel). Certain polyps if left can grow into bowel cancer but over a long period of time. I am not aware of how diet can or cannot affect this process as it happens at a cellular level. When bowel cancer occurs in Ulcerative colitis or Crohn’s disease the cells in the lining of the colon begin to change and become cancerous. This can be picked up by colonoscopy and biopsy. Again don’t know about diet effects. There are some studies which show that taking a junior Aspirin daily can prevent the formation of bowel polyps. Also when people have UC or Crohn’s low residue diets are sometimes helpful in controlling their symptoms

Andy_T asked:Can you tell me generally how soon after a colonoscopy a diagnosis is made?

Pawan Mathur:Hi Andy T: I presume you are talking about a diagnosis of cancer. usually the person doing the endoscopy can tell if it looks like a cancer but we always wait for the biopsy results. On the NHS they take about 5-7 days; should be quicker privately

Andy_T asked:Many thanks. My wife is having an examination in a couple of weeks and I just wanted to get an idea of timescale. Much appreciated.

Wanda asked:Is it rare to have no sign of bowel cancer get pain in right side and die 11 days later.

Pawan Mathur:Hi Wanda. Unfortunately we do get cases like this although uncommon. Sadly bowel cancer can be almost completely asymptomatic and presents late. Would depend on the individual situation in the case you have described but does sound unusual

racheljones asked:Is it normal to pass mucous since I was 15 I'm 25 now

Pawan Mathur:Hello racheljones. I would say no, this is not normal

racheljones asked:What could cause that. Normal colonoscopy as well, have had a prolapse since then too

Pawan Mathur:Many things: piles, inflammation, diet; prolapse of what?

Racheljones:Rectum, there is always a tinge of blood as well. And also have horrible stomach pain nonstop, and chronic diarrhoea and constipation since then.

Mirandasnails asked:I have a large rectovaginal nodule, could that be cancerous? I too have had this mucous but normal colonoscopy

Pawan Mathur:Hello Mirandasnails: difficult to answer that but without knowing more about you and symptoms etc

Mirandasnails asked:I have stage 4 endometriosis, bowel heavily involved, in pain feel dizzy & sick, agony to pass a stool & very rare! I'm 29, normal colonoscopy, sister has Crohn’s, hope that helps

Pawan Mathur:Sorry to hear that Mirandsnails. It is most likely that the nodule is an endometritic deposit

Pawan Mathur:To both of you: did they take biopsies at colonoscopy?

Mirandasnails:No :(

Racheljones:Yes, normal

Pawan Mathur:Sometimes there is a condition called microscopic colitis which can only be picked up by biopsies at colonoscopy. Racheljones, have you seen a gastroenterologist?

Racheljones:Yes, lots of times, they think I might have a gluten allergy

Mirandasnails:Hmmm hope u get a diagnosis soon Rachel x

Pawan Mathur:Yes good luck Rachel

Racheljones:Thanks...tired of dealing with this and the pain.