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Bowel cancer is one of the most common types of cancer diagnosed in the UK.
Bowel cancer is the fourth most common type of cancer in the UK[i]. It’s also the second biggest cause of cancer deaths, with over 16,000 people dying from bowel cancer each year.
On average, about one in 16 people will develop bowel cancer in their lifetime, with the risk slightly higher for men[ii].
Here you can find out more about the different types of bowel cancer, the risk factors, what causes it and your options for treatment.
What is bowel cancer?
The bowel is the engine of our digestive system, which processes everything we eat and converts it into energy. It also gets rid of any solid waste matter from the body.
The bowel is divided into the small bowel (also called the small intestine) and the large bowel, which is made up of the colon and the rectum.
Confusingly, the large bowel is actually the shortest part of the bowel, measuring about 5 feet long, while the small bowel is about 20 feet long [iv].The reason it’s called a small bowel is simply because it’s narrower than the large bowel. You might sometimes hear bowel cancer referred to as colorectal or colon cancer. Nearly all bowel cancers begin in the large bowel, so when people talk about bowel cancer, they usually refer to cancer of the large bowel.
It’s important to know that the symptoms of bowel cancer do not necessarily mean that you have bowel cancer – they could also be other conditions.
Bleeding from your bottom, blood in your poo, loose bowel movements over a long period of time, unexplained weight loss, tiredness and pains or lumps in your tummy are all possible symptoms of bowel cancer.
If you are experiencing any of these symptoms, you should make an appointment with your doctor.
[i] Bowel Cancer UK, Bowel cancer statistics, https://www.bowelcanceruk.org.uk/information-resources/bowel-cancer-facts-figures/
[ii] Bowel Cancer UK, Bowel cancer statistics, https://www.bowelcanceruk.org.uk/information-resources/bowel-cancer-facts-figures/
[iii] Bowel Cancer UK, Bowel cancer statistics, https://www.bowelcanceruk.org.uk/information-resources/bowel-cancer-facts-figures/
[iv] Cancer Research UK, The bowel https://www.cancerresearchuk.org/about-cancer/bowel-cancer
There are several different types of bowel (colorectal) cancer.
Over 95% of diagnosed bowel cancers are adenocarcinomas. When doctors refer to bowel cancer, this is usually the type of cancer they refer to.
An adenocarcinoma is a cancer that has started in the large bowel, within the gland cells that line the bowel wall. These glands usually produce a slimy lubricant called mucus that eases stools (waste matter) through the colon and towards the rectum.
There are two rarer types of adenocarcinoma, called mucinous and signet ring tumours. Mucinous tumours are where cancer cells are contained within pools of mucus, while signet ring tumours have mucus inside the cancer cells. Only about 1 to 2% of bowel cancers are of these types, which are treated the same way as adenocarcinomas of the large bowel[v].
Squamous cell cancers
This is a rare type of bowel cancer, which affects the squamous cells that make up the bowel lining, along with the mucus gland cells.
Another rare type of bowel cancer, a carcinoid tumour (also called a neuroendocrine tumour) is a slow growing cancer that forms in hormone producing tissues, often within the digestive system.
Around 4 to 17% of diagnosed carcinoid tumours start in the rectum, while 2 to 7% begin in the large bowel. Because this type of cancer behaves differently to colorectal cancer, it is treated differently[vi].
Sarcomas are cancers of supporting cells in the body, like bone or muscle. The special term for sarcomas found in the large bowel are leiomyosarcomas, which means the cancer began in the smooth muscle. Sarcomas are treated differently to adenocarcinomas of the large bowel.
Lymphomas are cancers of the lymphatic system. Only about 1% of cancers diagnosed in the large bowel are lymphomas, and they are treated differently to other colorectal cancers.
[v] Cancer Research UK, Types of bowel cancer https://www.cancerresearchuk.org/about-cancer/bowel-cancer/stages-types-and-grades
[vi] Cancer Research UK, Types of bowel cancer https://www.cancerresearchuk.org/about-cancer/bowel-cancer/stages-types-and-grades
In the UK around 41,600 people are diagnosed with bowel cancer each year[vii],and there are several known risk factors that may cause bowel cancer:
The single biggest risk factor associated with bowel cancer is age. Over 80% of bowel cancers are diagnosed in people over 60 years of age. Research seems to suggest that many bowel cancers can be prevented through changes in our diets and lifestyle.
Your family history
If you have several relatives who have been diagnosed with bowel cancer, especially if they are in different generations, this can indicate a strong family history of bowel cancer.
One or more relatives who were diagnosed with bowel cancer at a young age can also indicate a strong family history; for instance, if a parent, brother or sister, son or daughter was diagnosed before the age of 45 years old[viii].
If you have a strong family history of bowel cancer, see your doctor, who may refer you to a specialist genetics service. They will look into your family background and ask about your relatives’ health – a blood test may also be part of this investigation.
If the geneticist agrees you have an above average risk of bowel cancer, you will be referred to a bowel specialist who will discuss regular tests (called screening) to monitor you for early signs of bowel disease.
An inherited condition
Two inherited conditions can increase your risk of bowel cancer. These are called familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC, also called Lynch syndrome). These are rare conditions that increase the risk of bowel cancer but together FAP and HNPCC are only responsible for about 5% of bowel cancer cases.
If you have Ashkenazi Jewish background then you may have a higher risk of bowel cancer, thought but not confirmed, to be attributed to a gene that is more common in this group – affecting 10% of Ashkenazi Jews.
If you have benign bowel polyps
Benign growths in the bowel, called polyps or adenomas, are not in themselves cancerous. However, polyps can sometimes develop into a bowel cancer over time. In fact, most bowel cancers develop from a polyp, and at least 25% of us will have at least one polyp by the age of 50, and 50% will have polyps by the age of 70[ix].
If you have ulcerative colitis or Crohn's disease
Ulcerative colitis and Crohn's disease are diseases that cause bowel inflammation, and having either of these conditions can increase your risk of bowel cancer. About 1% of bowel cancer cases are connected with ulcerative colitis.
The reason for this increased cancer risk is due to the fact that these diseases damage the bowel lining, which means the cells needs to repair themselves more than usual increasing the risk of a cancerous cell developing.
If you’ve had bowel cancer before
If you’ve already had bowel cancer, you have a greater risk of getting bowel cancer again. Research also shows that people who’ve had lymphoma, testicular or womb cancer may have an increased risk of bowel cancer, which could be a result of genetic changes or an effect of the previous cancer treatment.
If you have diabetes
People with diabetes have an increased risk of bowel cancer, but research has not identified the cause of this increased risk.
If you’ve been exposed to radiation
There are other factors that have been linked to the chance of getting bowel cancer too. It’s estimated that around 1% of bowel cancers are linked to radiation exposure through radiotherapy treatment or tests such as X-rays and CT scans[x].
If you have concerns about any of these risks, a specialist can talk to you about how often you may need screening.
[vii] Cancer Research UK, High risk groups for bowel cancer https://www.cancerresearchuk.org/about-cancer/bowel-cancer/about-bowel-cancer
[viii] Cancer Research UK, Types of bowel cancer https://www.cancerresearchuk.org/about-cancer/bowel-cancer/stages-types-and-grades
[ix] Cancer Research UK, Types of bowel cancer https://www.cancerresearchuk.org/about-cancer/bowel-cancer/stages-types-and-grades
[x] Cancer Research UK, Types of bowel cancer
It’s important to know that many of the symptoms of bowel cancer do not necessarily mean that you have bowel cancer – they could also be other conditions.
But, if you are experiencing any one of the following symptoms, you should arrange to see your GP as soon as possible.
If the symptoms do indicate bowel cancer, remember that early detection can make a big difference. Over 90% of people who are diagnosed in the early stages of the disease are successfully treated.
What cancer stages mean
The stage of a cancer simply means how big it is and whether or not it has spread. When your bowel cancer is diagnosed, the tests and scans you have will give you some information about the stage of your cancer.
Defining the stage of your cancer is important to determine what type of treatment you will have.
Tumour, Node and Metastasis stages of bowel cancer
The Tumour, Node, Metastasis (TNM) stages of bowel cancer refers to the size of a primary tumour (T stages), whether any lymph nodes contain cancer cells (N stages), and whether the cancer has spread to another part of the body, which is called metastasis (M stages).
Tumour size stages (T)
There are 4 stages of tumour size in bowel cancer:
Lymph node stages (N)
There are 3 stages that describe cancer cells in the lymph nodes:
Metastasis stages (M)
There are 2 stages of cancer spread (metastasis):
Number stages of bowel cancer
The number system uses the TNM stages to group bowel cancers. There are 5 main stages in this system.
When you’re diagnosed with bowel cancer, your consultant bowel surgeon will tell you what stage cancer you have. This describes the size of the tumour, and whether it’s spread to any other part of your body.
Circle Health bowel screening clinics
Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16% [xi].
At Circle Health, we offer specialised bowel screening at our clinics across the country. Because our specialists are highly experienced, you’ll get expert advice and excellent care.
There are a number of screening options. These are reviewed on a personal patient-by-patient basis through a personal discussion with a specialist consultant. Examples of screening methods are:
The age at which screening should start depends largely on family history and the number and age of affected relatives.
What are the benefits of bowel cancer screening?
Screening for early bowel cancer can increase the survival of patients. Several international guidelines state that regular colonoscopies should begin at age 50 for people at average risk of colon cancer.
Circle Health welcome referrals of people who wish to be screened, this includes adults who are at an increased risk – for example, those with a strong family history of bowel cancer, or people over 50 years of age. At point of screening, your specialist nurse or consultant will decide which screening method is most appropriate.
What to do next
If you’re 60 to 69, you fall into the age range for the NHS bowel cancer stool testing kit, which you’ll get in the post every two years. Over 55s are also starting to be invited for a bowel scope screening, which looks at your lower bowel and rectum. If you fall into these age ranges, you should accept bowel cancer screening invitations.
If any of the following apply to you, you can contact one of our bowel cancer screening clinics to talk about your concerns:
We will make sure you are seen as quickly as possible to talk through the best screening and treatment options for you.
Paying for your treatment
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.
If you visit a Circle Health clinic for bowel cancer screening, please check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.
If you are paying for your own bowel cancer treatment the cost of the procedure will be explained and confirmed in writing at time of booking.
Ask the hospital for a quote beforehand, and ensure that this includes the consultants' fees and the hospital charge.
[xi] Cancer Research UK, Types of bowel cancerCochrane Database of Systematic Reviews, 2006. Screening for colorectal cancer using the faecal occult blood test: an update
If you’ve been diagnosed with bowel cancer, there are several treatment options for you to consider. You might need one or a combination of different treatments, which your colorectal consultant, and specialist nurse can talk through with you.
There are several factors that your Circle Health consultant will consider when planning the best cancer treatment for you, these include:
As you talk to your consultant, it is a good idea to take notes and write down any questions you have.
You can also take a close friend or relative with you when you see your specialists so they can help you remember everything that is said in your meeting.
Treating colon cancer
For cancer of the colon, surgery is the most common primary treatment. A specialist colorectal (bowel) surgeon will discuss with you the type of bowel cancer operation you need.
Keyhole surgery (also called laparoscopic surgery) is now more common as results are equal to conventional surgery, with a much faster recovery time as the procedure is far less invasive.
However, in some instances keyhole surgery might not be an option, and you may first be offered chemotherapy, though this treatment is less common for bowel cancer.
Chemotherapy is treatment with special drugs that aim to get rid of cancer by killing cells that divide rapidly – one of the main properties of most cancer cells. The chemotherapy drugs circulate in the bloodstream around the body and work by disrupting cancer cell growth.It’s given either to try to cure your cancer, to help you to live longer or to reduce your symptoms.
After your bowel surgery, unless the cancer is detected in its early stages, chemotherapy is often recommended as a follow-up treatment.
Your oncologist (a specialist in cancer treatment and care) can discuss your treatment plan, including any other possible therapies.
Treating rectal cancer
Treating cancer of the rectum often involves a short course of radiotherapy and chemotherapy (together called chemoradiation) before your surgery to help shrink the cancer and reduce the risk of cancer returning to the rectum.
Chemotherapy drugs make cancer cells more sensitive to radiotherapy, and are given shortly before radiotherapy.
Radiotherapy uses high-energy rays to kill cancer cells. Doctors don't often use it to treat cancer in the large bowel (colon cancer). But they often use it to treat cancer that started in the back passage (rectum).
Having chemoradiation (chemotherapy and radiotherapy together) can make the side effects of the two different treatments worse. Your doctor or specialist nurse will talk to you about chemoradiation treatment and its potential side effects.
You may also need a temporary or permanent colostomy, which your surgeon will discuss with you before your surgery.
Paying for your treatment
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.
Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.
If you are paying for your own treatment the cost of any surgery and treatment will be explained and confirmed in writing at time of booking.
Ask the hospital for a quote beforehand, and ensure that this includes both the consultants’ fees and the hospital charge for your procedure.
Want to know more?
If you’d like to read more about bowel cancer, treatment or living with bowel cancer, please visit bowelcanceruk.org.uk
David shares his story of the shocking discovery that at 43 years old he had bowel cancer, and the roller-coaster of emotions that journey took him on.
David has gone through a full treatment plan with us and is now clear of the disease.