When you see your doctor, they will ask about your symptoms and whether you have a family history of bowel cancer. Your doctor may carry out some or all of the following tests and procedures to check for bowel cancer:
rectal and abdominal examination
a test for blood in the bowel motions
CT colonography (also known as virtual colonoscopy).
The three main treatments for bowel cancer are surgery, chemotherapy and radiation treatment. Most people will have surgery, while some people receive a combination of treatments. Monoclonal antibodies may also be used if the cancer has spread to other parts of the body.
Treatment choice depends on the size of the cancer, its location and whether it has spread. Your general health and your wishes are also important in the decision making. In some cases you may want to seek a second opinion.
If bowel cancer is detected early enough, there is a good chance it can be removed successfully and stopped from coming back. However, a complete cure is not always possible and the cancer may return.
If the cancer has spread so far that it can not be removed completely by surgery, then a cure is very unlikely. In these cases, treatment focuses on controlling symptoms and slowing the spread of cancer.
There are some factors that increase your risk of bowel cancer that you cannot change, such as family history and age. However, there are other factors to do with your lifestyle which you can change and by doing so reduce your chance of developing bowel cancer.
There is strong evidence that certain lifestyle factors contribute to our risk of bowel and other cancers. To combat this, it is recommended that you:
Bowel cancer is the second highest cause of death due to cancer in New Zealand. When detected early, it can be successfully treated.
Bowel screening cannot prevent bowel cancer, but it can help the condition be detected earlier. People who are diagnosed with bowel cancer and receive treatment at an early stage, have a 90% chance of long-term survival. If there is a delay in diagnosis and treatment, the cancer can become more advanced and harder to cure.
In New Zealand in 2011, a study was begun to see whether a bowel screening programme should be rolled out nationally. As a result of the successful pilot, from July 2017 a programme is being rolled out around the country, so that by 2020 bowel screening will be available to everyone aged 60 to 74 who is eligible for publicly funded healthcare in New Zealand. Read more about bowel cancer screening.
Credits: Adapted from Cancer Society of NZ information. Reviewed By: Derek Luo, Counties Manukau DHB (5 May 2017)
Your doctor may carry out some or all of the following tests and procedures to check for bowel cancer.
Rectal and abdominal examination
During this examination, your doctor inserts a gloved finger into the rectum to feel for any lumps, swelling or bleeding. Your doctor will also gently feel the surface of the abdomen to check for anything abnormal. These tests can be uncomfortable and many people find the rectal examination embarrassing; however, they take less than a minute to do.
A sample of your blood may be taken to:
count the number of red cells in your blood. A low level, anaemia, can be a sign of bowel cancer.
look at a protein in the blood called carcinoembryonic antigen. This protein is sometimes raised in people with bowel cancer. However, it is not a reliable test to diagnose bowel cancer.
A test for blood in the bowel motions
The test used by the National Bowel Screening Programme is a faecal immunochemical test (FIT). It can detect tiny traces of blood present in a small sample of your bowel motion (poo). This may be an early warning sign that something is wrong with your bowel. A small amount of blood in your bowel motion can be caused by polyps (growths) or other minor conditions such as haemorrhoids (piles), which can easily be treated. Further investigation (usually a colonoscopy) is required to find the cause of bleeding.
If your GP can confidently rule out other causes such as piles (following a rectal examination) and you are experiencing symptoms of concern, you should be referred to your local hospital for further investigations.
The doctor examines your rectum and the lower part of your bowel using a short tube (usually straight but may be flexible) called a sigmoidoscope. The doctor may also take a biopsy (a small sample of tissue).
The doctor or nurse inspects the entire length of your large bowel by gently inserting a long, flexible tube with a video camera in it called a colonoscope. This is passed through your anus and rectum into your colon. A sedative may be given before the colonoscopy.
Removing polyps at colonoscopy
If any polyps or other pre-cancerous lesions are found on the lining of your colon or rectum, your surgeon or gastroenterologist will remove them during the colonoscopy. A border of healthy tissue will also be removed. This is called a 'local resection'.
The polyps will be sent to a lab for analysis and if any cancer cells are found within them, your surgeon may decide you need a second, larger operation. This is to remove any cells that may have been left behind and to make sure that the cancer is unlikely to come back.
CT colonography (also known as virtual colonoscopy)
This x-ray technique is increasingly replacing barium enemas. The colon is emptied with a laxative. Air is then gently pumped into your bowel via your anus. CT scans are taken of your abdomen. If abnormalities are found, then this would usually lead on to a colonoscopy.
The three main treatments for bowel cancer are surgery, chemotherapy and radiation treatment.
Surgery for bowel cancer
The type of operation you have will depend on:
where the cancer is in the bowel
the type and size of the cancer
whether the cancer has spread.
How long you stay in hospital will depend on the type of operation you have. Surgery to remove the part of the bowel which contains the cancer is called a colectomy.
At the same time, 10 to 20 of the surrounding lymph nodes are removed so they can be examined under a microscope for signs the cancer has started to spread. At the end of surgery, the ends of the colon are joined back together. The place where they join is called an anastomosis.
Chemotherapy is the treatment of cancer using anti-cancer (cytotoxic) drugs. The aim is to destroy cancer cells while doing as little harm as possible to normal cells. Usually, treatment is given in cycles, spread over weeks or months.
Chemotherapy is given by injection or drip into a vein, or via a portable infusion pump worn on the body to deliver the drugs continuously into the veins. Some chemotherapy drugs are given as tablets or capsules.
Chemotherapy is usually given as an outpatient (you do not need to stay in hospital).
Radiation treatment is the use of high-energy radiation to destroy cancer cells or prevent them from reproducing. Radiation treatment only affects the part of the body at which the beam is aimed, so is very localised.
Radiation treatment is commonly used in rectal cancer. It is given most commonly before the operation to shrink the cancer so that the surgeon can remove it more easily. Less commonly, it is given after surgery to destroy any remaining cancer cells.
Radiation is usually given daily for five days a week. It can continue for 6–7 weeks, depending on the size of the tumour, the kind of treatment being used and the dose required. Blood tests and scans may be needed, and you will see your doctor once a week.
There is a wide range of services and support for people and families living with cancer at all stages of the journey.
To find courses and support groups near you the Cancer Society of NZ cancer information helpline 0800 CANCER (226 237).
The helpline is staffed by nurses and provides a wide range of services from telephone support to booklets, pamphlets, DVDs and signposting to credible internet sites, including:
CanTalk – online magazine.
Information about services in your area.
The range of support groups, programmes, workshops, seminars and online forum available.
A range of supports from help with transport, accommodation to limited financial assistance during treatment.
Living well programme – Cancer Society
The living well programme is a free cancer information and support programme that offers practical ways of supporting people affected by cancer to build knowledge, self-confidence and self-help skills.
It is open to people with a cancer diagnosis, carers and whanau.
Small groups are led by a trained facilitator and attendance is free.
Other people's experiences
To hear about other people who may have had a similar experience to you see the personal stories section on the Beat Bowel Cancer Aotearoa website.
Resources for health professionals
Risk stratification for people with a family history of colorectal cancer
Any person with one of the following risk factors:
Only one first-degree relative diagnosed at 55 years or older
Make healthy lifestyle choices and report any bowel symptoms to their health provider
One first-degree relative diagnosed between age 50 to 55 years
Two first degree relatives on the same side of the family diagnosed at any age
Make healthy lifestyle choices and report any bowel symptoms to their health provider. Colonoscopy should be offered every five years from age 50 years, or from ten years before the earliest family diagnosis
A family history of an inherited colorectal syndrome
One first degree relative diagnosed before age 50 years
One first-degree and two or more first or second degree relatives on the same side of the family diagnosed at any age
One first-degree and one or more first or second-degree relative diagnosed, one of whom was diagnosed when aged under 55 years, or had multiple colorectal cancers, or had cancer in other organs
Any relative diagnosed who also had multiple bowel polyps
People in this category should be either referred to a genetic service or the New Zealand Familial Gastrointestinal Cancer Registry for an accurate risk assessment. A colorectal cancer specialist will then construct a surveillance plan. Self monitoring of bowel symptoms and healthy lifestyle choices should also be emphasised