Bowel Cancer

• Changes in bowel habits e.g. if you generally have good bowel movements but now become constipated or have diarrhoea

• Bleeding from your bum or blood in your poo

• Tiredness, insomnia, fatigue

• Loss of appetite

• Feeling sick or bloated

• Losing weight (without trying to)

• Painful stomach

• Lump in the stomach area or rectum

These symptoms are also present in lots of other health conditions such as irritable bowel syndrome or Crohn’s disease, so it is important to see your GP for a diagnosis, and try not to panic if you think you may have bowel cancer symptoms.

Read more about bowel cancer symptoms.

If you have issues affecting your gut or think you may have symptoms of bowel cancer, visit your GP. It is important to be honest and clear with your GP, despite any embarrassment you may feel when it comes to talking about your bowels. They are likely to ask lots of questions and may examine your abdominal area, to see if they can feel any lumps or swelling, and to check if you are in pain. They may order a blood test to check if you have any iron-deficiency anaemia or to ensure your liver and kidneys are functioning well. They may also ask you to provide a sample of your poo and your GP may send you for further testing.

In the UK, there is a national screening programme for bowel cancer, where people of a certain age are invited to be checked for signs of the condition. The age at which this is offered differs from country to country. In Scotland for example, you are offered this service at 50, whereas the rest of the UK is offered this service at 60. Everyone is then eligible for screening every two years.

Read more about bowel cancer screening and diagnosis of bowel cancer.

Bowel cancer is really an umbrella term for different types of cancer within the bowel area, determined by which specific type of cell the cancer began in. There are also different stages of bowel cancer, which indicate how advanced the cancer is (if it has spread and where to). During the process of bowel cancer diagnosis, a person will be told what type of bowel cancer they have and what stage their cancer is at, which will determine the course of bowel cancer treatment they are offered.

The most common type of bowel cancer is adenocarcinoma, which begins in the cells that line the wall of the bowel. Rarer types of bowel cancer include:

• Squamous cell tumours – develop in the skin cells within the bowel

• Carcinoid tumours – develop in the gut within neuroendocrine cells which are responsible for releasing hormones

• Sarcomas – develop within the muscles in the bowel

• Lymphomas – develop within the lymph glands

• Melanoma – develop within the rectum and are a type of skin cancer

Read more about bowel cancer types.

Once a person has been given a diagnosis of bowel cancer, their doctor is likely to be able to confirm what stage their cancer is at, and the stages of bowel cancer are as follows:

• Stage 1 – cancer has not spread outside of the bowel/rectum area

• Stage 2 – cancer has spread to other nearby areas such as muscles or organs

• Stage 3 – cancer has spread to lymph nodes

• Stage 4 – cancer has spread to other areas of the body and possibly other major organs

Bowel cancer is often graded and this grade defines the type of cancer cells present and how fast they are growing or spreading. Cells are graded as follows:

• Grade 1 – Relatively normal and not showing growth

• Grade 2 – Growing at a more rapid rate

• Grade 3 – Abnormally growing cells that are likely to spread quickly

Read more about what cancer stages and grades mean.

Early stage bowel cancer within the colon or rectum can sometimes be removed with surgery. The type of surgery will differ according to where the cancer is.

Colon cancer surgery is called a colectomy, and this removes part of the colon affected by cancer. Sometimes, a stoma is necessary whilst the bowel heals. A stoma is a small section of the bowel that is pulled onto the stomach surface, to allow waste (that would normally be excreted as poo through the bottom) to be collected in an attached bag, then emptied every few days. If surgery is carried out on the small bowel, the procedure is called an ileostomy, and if it is carried out on the large bowel it is a colostomy.

Rectal cancer may require resection surgery, which removes part of the rectum or the entire rectum. This usually requires the remaining parts of the colon and rectum to be joined together, to create a replacement rectum. If the surgery removes the lowest part of the rectum, surgery may have to close the anus, which results in having a permanent stoma. Read more about bowel cancer surgery.

Radiotherapy and chemotherapy may be used as treatments for bowel cancer, sometimes before surgery to try and make cancer cells smaller and easier to remove, sometimes instead of surgery, or to try and make cancer cells stop spreading and ease symptoms for those at a late stage of the disease. There are side effects of radiotherapy such as nausea, fatigue, and diarrhoea, and chemotherapy causes similar side effects as well as a possibility of hair loss.

New drugs designed to stop cancer cells from growing are currently available, mostly through private healthcare rather than the NHS. These medications do not work on every type of bowel cancer but are effective for some. These drugs are referred to as ‘targeted’ or ‘biological’ because they specifically target the cells. Examples include cetuximab and panitumumab. Read more about this type of bowel cancer treatment. Read more about all types of treatments for bowel cancer.

Living with bowel cancer, experiencing bowel cancer treatment, or recovering from treatment can have a big impact on daily life, and here, we talk about some of the ways bowel cancer may affect a person.

• Symptoms – bowel cancer symptoms can cause pain, discomfort, fatigue and problems going to the toilet, which can all have a significant impact on daily life. Some people also find their symptoms or their diagnosis causes anxiety or depression

• Treatment – most people with bowel cancer will be able to have some form of treatment, and this can be a difficult process, involving a big team of specialist doctors and nurses, and possibly involving radiotherapy, chemotherapy or surgery. The course of treatment prescribed may take some time to undertake, come with side effects and result in significant recovery time. Some people may find that their treatment was not successful, or some may be told their cancer is not treatable, and is terminal. Some people may find that their treatment was successful and that their cancer has gone. Treatment is then a mix of emotions, and each person will find it affects them differently. Read more about the effects of bowel cancer treatments

• Living with a stoma – some people may need to have a stoma and stoma bag fitted after bowel cancer surgery, which is usually temporary but, for some people, will be permanent. This can impact a person in lots of ways. Using a stoma and bag requires lots of practical activities such as emptying and cleaning the bag, which may take a little time to get used to. Some people find that wearing a colostomy or ileostomy bag affects the way they feel about themselves and their body image. Some people may also need to change their diet to ensure their stoma functions well. Read more about living with a colostomy and living with an ileostomy

• Sex and relationships – sometimes, living with bowel cancer causes changes to occur in a person’s close relationships with a partner or loved one. Some people find that the stress of treatment, symptoms, and inevitable changes that cancer brings to their life can cause difficulties in a relationship. Many people find that they become even closer to their partner. Bowel cancer can affect a person’s sex life, as physical changes due to surgery or radiotherapy may sometimes occur, or they may find that they have less desire for sex or body image issues. There is lots of advice about bowel cancer and sex life available. Sometimes, people just need a little time to get used to the changes cancer has brought about, and many people get through it together. The charity Relate provide lots of support, advice and therapy options for couples experiencing problems due to ill health

• Diet – bowel cancer can affect a person’s appetite and some people do not feel like eating or find eating uncomfortable. Some people who need to use a stoma and colostomy or ileostomy bag may need to alter their diet to ensure their stoma functions effectively. Some people recovering from bowel cancer or living with the disease, choose to change their diet in order to live more healthily and help their body deal with the disease. Read more about bowel cancer diet issues

• Fatigue – lots of people with cancer or recovering from cancer surgery will experience intense fatigue. This is often because the body is fighting the disease and healing. Fatigue can be challenging to deal with, but there are ways to cope with this and options for getting help and support

• Emotional and mental health effects – bowel cancer, in fact any type of cancer, can inevitably affect your emotions, thoughts and feelings. It’s really important for people with bowel cancer to nurture their emotions, and this may mean talking about how they feel, keeping a journal to help unload their thoughts, talking things through with a charity support worker, counsellor or therapist, or finding a bowel cancer support group. Read more about how to cope with mental health effects of living with bowel cancer diagnosis

NRS Healthcare are experts in daily living aids, which are products that are designed to make everyday tasks easier for people who have mobility difficulties or other health conditions.

Some people who are recovering from bowel cancer treatment or living with late-stage bowel cancer, may need some equipment at home to help them get around, assist with everyday tasks, such as using the toilet, or enhance their comfort:

o Raised toilet seat

o Toilet frame and seat

o Commode

o Folding/travel commode

o Profiling (hospital style) bed

o Rise and recline chair

o Incontinence products

This is not an exhaustive list, and if you are looking for products that may help you with mobility, using the toilet or any other aspects of daily living, we have a team of professional Occupational Therapists at NRS Healthcare who can advise. Contact them by email productadvice@nrshealthcare.co.uk or telephone 0345 121 8111.

A diagnosis of bowel cancer is likely to have an effect on a person’s ability to work. Some people may take time off for bowel cancer treatments and recovery, but many are able to return to work if their bowel cancer is successfully treated. Some people choose to leave their job, and this can be hard to adapt to. Others may feel that work is the last thing on their mind. Many people will have to adapt to a change in finances if they have bowel cancer and this may be tough, although a person may be eligible to claim benefits to help support them. Read more about bowel cancer and employment, finances and benefits.

Bowel cancer diet

There are several aspects in exploring diet for bowel cancer.

It is thought that bowel cancer risk can be affected by diet. Reducing the amount of red meat or processed meat (e.g. sausages), eating plenty of fibre and sticking to a healthy weight are the three best ways to improve diet to reduce bowel cancer risk. Read more about diet for bowel cancer prevention.

For people who have a bowel cancer diagnosis, food and diet can be challenging. Some people lose their appetite or are unable to keep food down whilst they are going through treatments such as chemotherapy or radiotherapy. Stress and anxiety can affect eating habits as well. After bowel cancer surgery, a person may need to adapt their diet. They may find that eating certain foods affects their digestive system, and it can take some time for them to be able to eat as they used to. It’s really important for someone recovering from bowel cancer surgery to eat a healthy, balanced diet in order to help their body avoid infection and to help the bowel get back to normal functioning. The NHS provide information on eating a balanced diet.

Read more about eating a healthy bowel cancer diet.

Exercise and bowel cancer

Exercise and being physically active is important to help reduce the risk of developing bowel cancer. Exercise is great for reducing bowel inflammation which may increase the chance of cancer developing.

It is safe for people to exercise if they have bowel cancer, even during or after their treatment, unless they are advised against this by their medical team. Exercise may help reduce fatigue and help the body to heal and recover quicker. Exercise also decreases stress, anxiety, and may alleviate depression. Bowel cancer exercise can be a simple walk, a yoga class, or any physical activity that the person can manage. If you think exercise would be beneficial to you, you may wish to discuss this with your cancer care team.

Bowel Cancer UK Forum – a forum for people with bowel cancer or their families to talk openly about the condition and its impact upon life, from the leading UK bowel cancer charity

Colon Cancer Support Group UK – Facebook group for people living with colon cancer to share stories, advice and experiences

Cancer Research UK Forum – an online forum for people with various types of cancer to discuss their condition, experiences, treatments, etc, with various threads and topics specific to bowel cancer

Bladder & Bowel Community – a charity providing advice and information on bladder and bowel conditions, including bowel cancer

Bowel & Cancer Research – a charity funding research into bowel diseases, including bowel cancer, with information online about the condition

Bowel Cancer UK – the leading UK bowel cancer charity, supporting people with a wealth of online information that’s available to download, a nurse-led signposting service to help people find further bowel cancer support, and real life stories

Cancer Research UK – a charity and leading research organisation supporting people with all types of cancer, with a website featuring detailed information about living with bowel cancer and related cancers, treatments, and practical advice, as well as information about current research projects

Guts UK – a UK charity for people with conditions affecting the gut (bowel), which includes information on bowel cancer

Macmillan Cancer Support – a charity supporting people with all types of cancer and their families, with online information about all aspects of the disease, plus practical matters, as well as a free support line run by specialist advisers, a network of volunteer-led local support groups, and mobile information centres that travel the country

NHS – provides official medical information on bowel cancer and related conditions

Anus

– the last part of the digestive system which is a short tube containing muscles (sphincters) that work automatically to push poo out of the rectum

Digestive system

– the gastrointestinal tract, which includes all the organs required for moving food through the body, using its nutrients and excreting it as waste

Large intestine

– part of the digestive system, which forms faeces (poo) from food waste

Lymph glands

– otherwise known as lymph nodes, these support the immune system

Rectum

– the last part of the large intestine which stores waste (poo) temporarily and tells the brain that the bowel needs to be emptied

Small intestine

– part of the digestive system through which food passes, which has the job of absorbing nutrients and minerals from food

Stoma

– a hole/opening on the skin surface of the abdomen which brings urine or poo through to be collected in a special bag on the exterior of the body

Tumour

– a mass of tissue cells that grow in the body, which may be cancerous or non-cancerous (benign)