Common colorectal problems

Bowel cancer

Cancer research UK estimates there are around 37,500 new cases of colorectal cancer annually in the UK.

About two thirds of tumours occur in the colon (in the tummy). The remainder in the rectum and rectosigmoid (in the pelvis, by the back passage).

Colon cancer occurs at roughly the same rate in men and women but rectal cancer is more common in men. It is a cancer of the western world. It is suggested that environmental factors, particularly a diet high in red meat and low in fresh fruit and vegetables are responsible.

A small number of patients (around 5%) have a genetic predisposition. Recognised examples include familial polyposis coli and the Lynch syndrome.

Most tumours are thought to arise from polyps which may be present for some years before malignancy develops.

The NHS has recently introduced bowel screening for all men and women between the age of 60 and 69 aiming to diagnose cancer earlier, preferably at the pre-malignant polyp stage, to reduce the incidence of cancer and for those with cancer to detect the cancer earlier, increasing the probability of cure.

We would strongly recommend that if invited, you should do the test sent to you (as often you will have no symptoms).

The most common presenting symptoms are:

  • blood on or mixed with stools
  • change in bowel habit to diarrhoea or constipation
  • low blood count (anaemia) – makes some people breathless, unable to walk as far
  • weight loss
  • loss of appetite (anorexia)
  • feeling sick (nausea)
  • abdominal pain

These symptoms are not clear cut and have a variety of other causes leading to problems with diagnosis. The diagnosis may only become apparent when the cancer is advanced and treatment is palliative.

The ideals of treatment for cancer of the bowel are:

a) to remove all the tumour at surgery – which gives best chance of long term cure

b) reduce the chance of cancer coming back (e.g. in the tummy, pelvis or elsewhere) – this is why some patients have chemotherapy and radiotherapy treatment before surgery. It is also why we recommend certain patients have extra treatment (e.g. chemotherapy) after the operation

c) to pick up cancer coming back early (“recurrence”) – as some patients might be able to have further operations and generally all other treatments have more chance of working the earlier cancer recurrence is identified. For this reason, we follow patients up regularly three to six-monthly in clinic with blood tests for up to five years.

d) to help you recover quickly from surgery (all surgeons aim to do your operation using keyhole surgery – “laparoscopically”)

e) to give you the best quality of life after surgery or other treatments – to this end we try to avoid patients having permanent stomas (“bag on the tummy”) – although for some patients this is either necessary or gives them a better quality of life

f) to support you and your family through these very difficult times. Getting the diagnosis is always a shock – and even with successful treatment, we need to keep a close eye on you in clinic for 5 years following surgery – so you get used to seeing us and hopefully we can allay your concerns and answer your questions at every step

Links to further information and national support groups