Bowel cancer (colorectal)

Colorectal cancer, less formally known as bowel cancer, is a cancer characterized by neoplasia in the colon, rectum, or vermiform appendix. Colorectal cancer is clinically distinct from anal cancer, which affects the anus.

Colorectal cancers start in the lining of the bowel. If left untreated, it can grow into the muscle layers underneath, and then through the bowel wall. Most begin as a small growth on the bowel wall: a colorectal polyp or adenoma. These mushroom-shaped growths are usually benign, but some develop into cancer over time. Localized bowel cancer is usually diagnosed through colonoscopy.

Invasive cancers that are confined within the wall of the colon (TNM stages I and II) are often curable with surgery, For example, in England and Wales over 90% of patients diagnosed at this stage will survive the disease beyond 5 years. If left untreated, they spread to regional lymph nodes (stage III). In England and Wales, around 48% of patients diagnosed at this stage survive the disease beyond five years. Cancer that metastasizes to distant sites (stage IV) is usually not curable; approximately 7% of patients in England and Wales diagnosed at this stage survive beyond five years.

Colorectal cancer is the third most commonly diagnosed cancer in the world, but it is more common in developed countries. More than half of the people who die of colorectal cancer live in a developed region of the world. GLOBOCAN estimated that, in 2008, 1.23 million new cases of colorectal cancer were clinically diagnosed, and that this type of cancer killed more than 600,000 people.

How common is bowel cancer?

In England, bowel cancer is the third most common type of cancer. An estimated 38,000 new cases are diagnosed each year.

In 2007, about 17,600 cases of bowel cancer were diagnosed in women, making it the second most common cancer in women after breast cancer. There were about 21,000 cases in men, making it the third most common cancer after prostate and lung cancer.

Approximately 80% of bowel cancer cases develop in people who are 60 or over. Two-thirds of bowel cancers develop in the colon, with the remaining third developing in the rectum.

In England, an estimated 16,000 people die from bowel cancer each year.

Factors that increase your risk of getting bowel cancer include:

Age: around 80% of people diagnosed with bowel cancer are over 60.

Diet: a diet high in fibre and low in saturated fat could reduce your bowel cancer risk. A diet high in red or processed meats can increase your risk.

Healthy weight: leaner people are less likely to develop bowel cancer than obese people.

Exercise: being inactive increases the risk of getting bowel cancer.

Alcohol and smoking: high alcohol intake and smoking may increase your chances of getting bowel cancer.

Family history and inherited conditions: having a close relative with bowel cancer puts you at much greater risk of developing the disease.

Related conditions: having certain bowel conditions can put you more at risk of getting bowel cancer.

Bowel cancer screening

In 2006, the NHS launched a screening programme for bowel cancer. It is recommended that everyone between the ages of 60 and 69 is screened every two years.

Screening is carried out by taking a small stool sample and testing it for the presence of blood.

Screening plays an important part in the fight against bowel cancer because the earlier the cancer is diagnosed, the greater the chance that it can be cured completely.

For more information, see Bowel cancer ? screening.

What can you do yourself?

Prevention and early diagnosis

Ensure a regular daily intake of green vegetables, particularly brassicas (cabbage, broccoli, sprouts or cauliflower). Do not eat red meat (beef and lamb) more than about once per week. Keep your weight normal and take regular exercise.
See your doctor to discuss screening if you have a first-degree relative who has developed bowel cancer before the age of 45, or if you have two or more first-degree relatives who have developed bowel cancer.
See your doctor promptly if you notice rectal bleeding (other than very occasional spotting on the paper only), diarrhoea that persists for more than a week, recurring lower abdominal pain or persistent tiredness or shortness of breath.

Treatment

Once a cancer has developed, treatment is aimed at removing the original (primary) growth and at preventing secondary spread. This will be with some combination of surgery, chemotherapy or radiotherapy.
You should:

ensure that you seek advice as early as possible after symptoms develop.
get good nutrition.
stay positive, remembering that more than half of patients with bowel cancer are cured.

Do not hesitate to nag, or have someone nag on your behalf, if you feel you are not being investigated or treated appropriately or speedily.

What can your doctor do?

Once the diagnosis of bowel cancer has been made, the first treatment is usually surgical removal of the cancerous tumour under general anaesthetic.

If the cancer is in the rectum, the operation will usually be accompanied by radiotherapy (by external beam irradiation) to reduce the risk of tumours reappearing in the same area. The radiotherapy may sometimes be given first, followed a few months later by the surgery.

For cancer of the colon, radiotherapy is not routinely used, but if examination of cells from the removed cancer shows that the cancer has spread to lymph glands, then some form of chemotherapy will normally be given, usually oral 5-fluorouracil combined with either folinic acid (eg Leucovorin) or levamisole. Chemotherapy is very likely to cause side effects, including nausea and hair loss, but the nausea can usually be well controlled by drugs.

In any form of bowel surgery, the patient is normally warned that the surgeon might have to create a colostomy stoma (opening of the bowel onto the abdomen that is covered by a bag). This might be a temporary measure to divert faeces from the site of the bowel that has been repaired after removal of the tumour.

If the tumour is very low down in the rectum, then the primary operation will include cutting out and closing the anus (abdomino-perineal resection) so the stoma will be permanent. Fortunately, modern stoma accessories are excellent, and colostomies are generally well managed and odour free.

In most cases, a bowel cancer higher up the colon can be surgically removed and the bowel repaired without the need for a colostomy.

The average length of stay in hospital for bowel cancer surgery is about 7 to 10 days. The abdominal wound is usually in the middle of the abdomen. Stitches will be removed by about 7 to 10 days, but the scar will usually cause some discomfort for four to six weeks. Pain relief immediately after the operation should nowadays be very effective and is often under the patient?s own control.

The best way to monitor patients after surgery is not yet clearly established, but some surgeons review patients at regular intervals to have a blood test done (carcino-embryonic antigen) to look for any evidence that the cancer has returned. This test is partly done because tumours that have re-appeared in the same area can be removed and partly because surgeons are now more optimistic about the chances of curing bowel cancer that has spread to the liver, provided it is caught early.

The sources :

http://www.netdoctor.co.uk/
http://www.nhs.uk/
http://en.wikipedia.org/

Source: http://4-medic.com/blog/bowel-cancer-colorectal/

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