Bowel Cancer

There are several different types of bowel (colorectal) cancer.

Adenocarcinomas
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.

Carcinoid tumours
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
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
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 http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/types-of-bowel-cancer
^[vi] Cancer Research UK, Types of bowel cancer http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/types-of-bowel-cancer

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:

Your age
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.

Your ethnicity
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 http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/risks/high-risk-groups-for-bowel-cancer
^[viii] Cancer Research UK, Types of bowel cancer http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/types-of-bowel-cancer
^[ix] Cancer Research UK, Types of bowel cancer http://www.cancerresearchuk.org/cancer-help/type/bowel-cancer/about/types-of-bowel-cancer
^[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.

• Bleeding from your anus and/or blood in your poo
• Changes in your bowel movements that last for 3 weeks or more, especially if there is loose or runny poo
• Unexplained weight loss or extreme tiredness
• Pain or lumps felt in your tummy.

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.

The stages and grades of bowel cancer

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:

• T1 – the tumour is only in the inner layer of the bowel
• T2 – the tumour has grown into the muscle layer of the bowel wall
• T3 – the tumour has grown into the outer lining of the bowel wall
• T4 – the tumour has grown through the outer lining of the bowel wall.

Lymph node stages (N)
There are 3 stages that describe cancer cells in the lymph nodes:

• N0 – there are no lymph nodes containing cancer cells
• N1 – 1 to 3 lymph nodes close to the bowel contain cancer cells
• N2 – there are cancer cells in 4 or more nearby lymph nodes

Metastasis stages (M)
There are 2 stages of cancer spread (metastasis):

• M0 – the cancer has not spread to other organs
• M1 – the cancer has spread to other parts of the body

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.

• Stage 0 or carcinoma in situ (CIS)
  Stage 0 or CIS colorectal cancer means there are cancer cells just within your inner bowel lining, so there is little risk of any cancer cells having spread.
• Stage 1
  Cancer cells have grown through the inner lining of the bowel, or into the muscle wall, but no further. There is no cancer in the lymph nodes (T1, N0, M0 or T2, N0, M0)
• Stage 2
  This stage is divided into 2a and 2b
  Stage 2a 
  The cancer has grown into the outer covering of the bowel wall, but there are no cancer cells in the lymph nodes (T3, N0, M0)
  Stage 2b 
  The cancer has grown through the outer covering of the bowel wall and into tissues or organs next to the bowel (T4). No lymph nodes are affected (N0) and the cancer has not spread to another area of the body (M0).
• Stage 3
  Stage 3 is divided into 3 stages
  Stage 3a 
  The cancer is still in the inner layer of the bowel wall or has grown into the muscle layer, and between 1 and 3 nearby lymph nodes contain cancer cells (T1, N1, M0 or T2, N1, M0)
  Stage 3b 
  The cancer has grown into the outer lining of the bowel wall or into surrounding body tissues or organs, and between 1 and 3 nearby lymph nodes contain cancer cells (T3, N1, M0 or T4, N1, M0)
  Stage 3c 
  The cancer can be any size, has spread to 4 or more nearby lymph nodes, but there is no cancer spread to any other part of the body (any T, N2, M0)
• Stage 4
  This means your cancer has spread to other parts of the body (such as the liver or lungs) through the lymphatic system or bloodstream (any T, any N, M1).

BMI Healthcare bowel screening clinics

Regular bowel cancer screening has been shown to reduce the risk of dying from bowel cancer by 16% ^[xi].

At BMI Healthcare, 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:

• Stool testing
• Colonoscopy
• Virtual colonography (CT Scan).

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.

BMI Healthcare 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:

• If you’re worried about bowel cancer but not eligible for the NHS screening programme
• If you have a strong family history of bowel cancer or polyps
• If you’re worried about any other abdominal or bowel problems

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 BMI 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 BMI Healthcare consultant will consider when planning the best cancer treatment for you, these include:

• The type and size of the cancer
• Your health and fitness for treatment
• Whether the cancer has spread – this is called the cancer stage
• What the cancer cells look like under the microscope – this is called the cancer grade.

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