Bowel or Colorectal Cancer
Information about bowel cancer and the new keyhole operations available for selected patients.
Bowel cancer is common, especially in the Western World. It is the third most common cancer in the UK. It is also called colon cancer or rectal cancer. The prognosis has been very poor for bowel cancer patients in the past but fortunately cure rates are getting better and better. In my opinion this is for two main reasons. The first is that bowel cancer patients are being picked up earlier, due to better public education, which has helped raise awareness of potential bowel cancer symptoms. Colonoscopy screening is being instituted for all 60 to 74 year olds in the UK and this can pick up patients who have bowel cancer who do not yet have any symptoms. If the bowel cancer is picked up early enough then an operation to remove the bowel cancer can be curative.
The second reason why bowel cancer cure rates are getting better is that bowel cancer surgery is improving. Surgery is often the only chance of cure for most bowel cancers but some surgical techniques are more successful than others. The better techniques have been verified by large clinical trials. These surgical techniques have now been adopted by many practising surgeons and there is improved education and training of specialist colorectal surgeons in the UK. Some UK colorectal surgeons now offer specialist laparoscopic or keyhole bowel surgery which appears to offer equivalent bowel cancer cure rates to traditional open surgery but with better cosmetic results and quicker recovery rates.
Bowel cancer can be a difficult condition to diagnose. We now think that most bowel cancers arise from polyps which are like moles or little warty growths on the inner skin lining of the bowel. Just like most skin moles, most polyps never cause any trouble but occasionally they can turn cancerous. It is often obvious to a person that a skin mole is looking very different but they will be unaware if an internal bowel polyp has changed. This is why a national bowel cancer screening service is being introduced in the UK to pick up patients with polyps. The screening program is aimed at people over sixty years old because the majority of bowel cancers occur in older people. Initially bowel cancer does not give any symptoms, but as it grows it may give the symptoms of bleeding out of the bottom or blood in the stools, abdominal pains or a change in bowel habit. It can be quite normal to get a change in bowel habit or abdominal pain from time to time but if it lasts longer than three weeks you should seek medical advice from a qualified doctor.
Any patient with concerning bowel symptoms should have their history and examination taken by a qualified doctor. The doctor may need to insert a gloved finger into the anus to gain information about the lower bowel. A telescope test called a sigmoidoscopy is often carried out in the clinic and the doctor may then decide to arrange a colonoscopy test, which is a long camera inserted through the anus that looks around the colon and rectum. The colonoscopy test is able to take biopsies of anything suspicious and many polyps can be removed or destroyed at the same time to prevent them from causing any concern in the future. An X-Ray test such as a CT cologram scan (virtual CT colonoscopy) may be requested instead if a colonoscopy is deemed to be inappropriate for a variety of reasons including patient frailty.
If a GP has concerns that a patient may have bowel cancer then they will refer them to a specialist bowel (colorectal) surgeon in the first instance. The specialist surgeon (or their deputy doctor or nurse colleague for NHS referals) may institute further investigations or recommend treatment. Surgical treatment has traditionally been open surgery where a surgeon makes a large incision in the abdomen and uses their hands to remove the bowel cancer. Keyhole or laparoscopic bowel cancer surgery is now becoming more and more widely practised in the UK and it is bringing many benefits to patients. It is not suitable for all patients, but those that do undergo laparoscopic colorectal surgery benefit from quicker return to normal function, quicker return to normal diet, smaller wounds, reduced stay in hospital, reduced pain and reduced problems with wound hernias and adhesions. An Enhanced Recovery Program is often instituted for laparoscopic colorectal surgery patients (see link below). Large randomised controlled clinical trials have shown that cancer outcomes are at least as good for laparoscopic surgery as they are for open surgery.
If you have noticed unusual bleeding out of your bottom or an unusual change in your bowel habit or unusual abdominal pains over three weeks or more then please go to your GP or preferred bowel specialist doctor to seek advice about medical investigations to help explain your symptoms. When in doubt get yourself checked out! It is heartbreaking for me as a specialist bowel surgeon to meet at least one person every year who decided to leave it for quite a few months before they let their doctor know about their obvious symptoms and then when they are referred to me their bowel cancer has spread and it is too late to be able to cure them. I would much prefer to see a patient early on and be able to successfully treat them and cure them of their bowel cancer enabling them to get back to a normal and full life.
Useful links on bowel cancer :