April is Bowel Cancer Awareness month. Over 90% of cases of bowel cancer could be successfully treated if diagnosed early, yet at the moment almost half of the 100 people diagnosed every day in the UK will die from the disease. People are dying unnecessarily of bowel cancer when it is, in fact, preventable, treatable and curable.
Many patients self-medicate in the early stages of the disease because they, and sometimes other health professionals, don’t recognise their symptoms as important. Bowel cancer is also called colon, rectal or colorectal cancer and typically develops in the large bowel. The condition starts when cells in the bowel multiply out of control before invading surrounding tissues and spreading to other parts of the body. There are a number of factors that can increase the risk of getting bowel cancer. These include:
Age—according to the NHS, 72% of people diagnosed are over 65 years of age
Diet—a diet high in red and processed meats and low in fibre and saturated fat
Weight—slim people are less likely to develop bowel cancer
Exercise—being active reduces your risk
Lifestyle—alcohol and smoking can increase your risk
Genes—if a family member has the condition, this increases your chances.
Symptoms of bowel cancer include blood in stools (faeces), an unexplained change in bowel habits, such as prolonged diarrhoea or constipation, and unexplained weight loss. Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer.1 The most common symptoms are:
A lump or pain in the stomach
Unexplained weight loss
Blood in your stools or from your rectum
A change in bowel habits
Why screen for bowel cancer?
Currently, everyone between the ages of 60 and 69 is offered bowel cancer screening every two years, and the screening programme is currently being extended in England to those aged 70 to 75. Screening is carried out by taking a small stool sample and testing it for the presence of blood (faecal occult blood test).
Yet charities such as Beating Bowel Cancer urged more people to come forward, and Public Health England to make it a priority to increase screening rates. Figures show that uptake among the eligible 60- to 74-year-old age group was 58% in 2012-15.
In addition, an extra screening test is being introduced over the next three years for all people at age 55 years. This test involves a camera examination of the lower bowel called a flexible sigmoidoscopy. Public Health England recently released new figures that show almost 37% of bowel scope screening centres in England are operational, which surpasses the 30% target set by the Department of Health.
Screening plays an important part in the fight against bowel cancer because the earlier the cancer is diagnosed, the greater the chance it can be cured completely. Bowel cancer screening aims to detect bowel cancer at an early stage in people with no symptoms. The earlier cancer is found, the more likely treatment is to be effective.
Screening can also detect polyps (overgrowths of cells in the lining of the bowel). Polyps are usually harmless but over time they can change and become malignant (cancerous). Polyps can usually be removed, reducing the risk of bowel cancer developing. This is particularly important as bowel cancer is highly treatable when it is found early. Research shows that regular bowel cancer screening reduces the risk of dying from bowel cancer by 16%.2
Why is awareness important?
Bowel Cancer UK recently highlighted a shocking lack of surveillance screening and called for this to be addressed to ensure early detection of the disease, particularly for younger people who are at higher risk of bowel cancer.
Genetic factors contribute to up to 30% of bowel cancer cases, that’s 8,000–12,000 people. Genetic factors mean a family history of bowel cancer or a genetic condition. People with inflammatory bowel disease may also be at higher risk.
People in the higher risk groups are likely to develop bowel cancer much younger than the general population. Clinical guidance recommends that people in high-risk groups should be in a surveillance screening programme, which is proven to reduce deaths in these groups.
However, recent evidence shows that:
People diagnosed are not routinely tested for genetic conditions, and only a third of centres identify and manage high risk patients through a registry. Even when they are in a surveillance programme, patients may have to wait a long time for their screening colonoscopy. Thirty-five hospitals which undertake surveillance have a waiting time of over 26 weeks (six months) for people at higher risk.
More than half of centres do not have a programme for managing high risk groups. 64% of clinicians believed that someone else should be carrying out the surveillance work.
Bowel Cancer UK has five recommendations to improve services for people in high risk groups:
1. Better surveillance screening for those at high risk of developing bowel cancer.
2. Clear information for GPs and the public on who may be at higher risk of bowel cancer.
3. As people with a genetic condition such as Lynch syndrome typically develop bowel cancer at a young age, anyone diagnosed with bowel cancer under the age of 50 should have a genetic test for these conditions, so they and their families can be included in a surveillance programme.
4. Adequate endoscopy service capacity to ensure that people at high risk do not have a long wait for their colonoscopy.
5. Designation of a person in each hospital trust with responsibility for a registry of people at higher risk.
Treatment and outlook
Bowel cancer can be treated using a combination of surgery, chemotherapy, radiotherapy and, in some cases, biological therapy. As with most types of cancer, the chance of a complete cure depends on how far the cancer has advanced by the time it is diagnosed. If bowel cancer is diagnosed in its earliest stages, the chance of surviving a further five years is 90%, and a complete cure is usually possible. However, bowel cancer diagnosed in its most advanced stage only has a five-year survival rate of 6% and a complete cure is unlikely.1