1 in 20 people will develop bowel cancer during their lifetimes (more than 38,000 in the UK each year) making it the third commonest cancer. As a result, more than 16,000 people die from bowel cancer in the UK every year (the second commonest cause of cancer death). When diagnosed early, >90% of people are cured. Unfortunately, only 9% of people with bowel cancer are currently diagnosed at this early stage. The key to improving survival is diagnosis and removal of pre-cancerous polyps (adenomas) and early diagnosis when cancer develops.
The most effective test for diagnosing bowel cancer or removing adenomas is called colonoscopy. This involves taking medication to clear out the bowel before passing a special camera around the large bowel. If adenomas are found, they can usually be removed during the test without the need for an operation and before they become cancerous.
Whilst most people with bowel symptoms do not have bowel cancer, symptoms which might suggest bowel cancer include a change in bowel habit lasting four weeks or more, bleeding from the bottom or in the stools, pain or a lump in the abdomen, unexplained extreme tiredness and/ or unexplained weight loss. More information on the symptoms of bowel cancer can be found on the Bowel cancer UK website (http://www.bowelcanceruk.org.uk/home/side-panels/downloads/download-files/knowing-the-symptoms-and-who-is-at-risk2010.pdf).
Bowel cancer screening has been introduced in many countries around the world to improve early diagnosis using a number of different methods. In the UK, the first screening test introduced is called faecal occult blood testing (FOBt). A stool sample is tested every 2 years from the age of 60-75. Those people testing positive go on to have a colonoscopy (a camera test to look around the large bowel). The main advantages of this test are that it is not invasive, will detect most large cancers and reduces the risk of dying from bowel cancer by 17%. The main disadvantages are that it misses approximately half of cancers and most adenomas.
There are also plans to introduce a test called flexible sigmoidoscopy (a camera test looking around the first part of the large bowel) in people aged 55 to diagnose cancers early and remove and adenomas. This test reduces the risk of dying from bowel cancer by 31-43% and also reduces the risk of developing bowel cancer in the future by 21-33%. The other main advantage of this test is that it only requires a more limited bowel cleansing with an enema and the camera does not need to be inserted so far into the bowel. The main disadvantage is that only half of the large bowel is examined meaning that cancers in the far side will be missed.
In some parts of the world (particularly the USA), screening tends to be carried out with colonoscopy which has the benefits of flexible sigmoidoscopy but examines the entire bowel.
Colonoscopy is also useful for diagnosing other bowel conditions including inflammatory bowel disease (ulcerative colitis and Crohn’s disease).
Click here for more about treatments for bowel cancer. You can also visit www.bowelcanceruk.org.uk or call the bowel cancer advisory service on 0800 8 40 35 40.
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