Can bowel cancer be prevented?

Written by: Mr Muti Abulafi
Edited by: Lisa Heffernan

Bowel cancer or colorectal cancer is the 4th most common cancer in the U.K. Approximately 41,000 people develop the disease every year. It accounts for about 12% of all cancers diagnosed, with 1 in 14 men and 1 in 19 women experiencing bowel cancer during their lifetime. Top Doctor Muti Abulafi walks us through bowel cancer, the symptoms and how we can prevent it.


What is bowel cancer and what are the symptoms?

Bowel cancer is an abnormal growth of the inner lining of the large bowel. It usually starts as a small, harmless and benign polyp, which slowly grows over the period of a few years before becoming cancerous. Most patients experience no symptoms, even when the polyp turns cancerous. The first symptom that patients may notice is rectal bleeding. However, bleeding after passing a stool doesn’t have to mean cancer. The most common cause of rectal bleeding is usually associated with piles.

Other symptoms of bowel cancer include; an unexplained change in bowel movements when making loose stools, unexplained or long-lasting abdominal pain, weight loss, anaemia and abdominal swelling. By the time patients experience symptoms, the cancer is usually well established, so it’s important to report any changes in bowel movements and abdominal pain to your doctor as soon as possible.

It’s also important to note that not all of these symptoms signal cancer. The chance of having cancer with these symptoms is about 15%. The earlier the cancer is detected, the more likely it is that it will be cured. Unfortunately, ¼ of patients with bowel cancer present as an emergency, which means that the cancer is already well advanced. Therefore, it is important when you develop symptoms, that you see your doctor.

Can bowel cancer spread to other body parts?

Bowel cancer can spread if not detected and treated early. The cancer can spread locally by growing outwards, outside the bowel and invading the nearby organs, like the lungs, abdomen and the liver. It can also grow inside the bowel causing the bowel lumen to narrow which leads to blockage. Blockage means that your bowels no longer open and your abdomen becomes distended and painful. Sometimes it can cause vomiting.

Is bowel cancer preventable?

Bowel cancer can be prevented. Doctor Abulafi talks about primary and secondary prevention.

Primary prevention aims to prevent the cancer before it develops, so before the polyp develops. Primary prevention is reliant on the patient making certain lifestyle changes. Leading an active life and regular exercise has been shown to reduce the risk of bowel cancer by up to 50%. A low-fat diet, rich in fruit and vegetables has also proven effective.

The role of chemoprevention drugs in preventing cancer is unclear, so it’s tricky to use medication as a method of prevention. Some reports show that aspirin or certain non-steroidal anti-inflammatory drugs can reduce the risk of polyp formation.

Secondary prevention aims to prevent cancer at the polyp stage before the polyp grows and turns into cancer. This usually requires the polyp to be removed, either by a colonoscopy which allows us to look at the whole bowel, or by a flexible sigmoidoscopy; which is an examination of the lower third of the bowel. Flexible sigmoidoscopy is often used because 70% of polyps and cancers arise in this part of the bowel.

What screening programmes are in the U.K to detect bowel cancer?

The UK has excellent screening programmes which are dedicated and focused on secondary prevention.

Screening detects disease that is too early to cause symptoms in otherwise healthy individuals who have no risk factors for disease. There are two screening programmes in the UK. The first is the faecal occult blood screening programme which was introduced about 12 years ago. This programme relies on testing stools for blood using the faecal occult blood test. If the test is positive, patients are invited to have a colonoscopy examination to ensure that there are no abnormalities present. If the test is negative, the test is repeated every two years.

The programme targets patients between the ages of 61 and 75. When people turn 61 they are invited to take part in the screening programme. Those who are above 75 can opt to take part in the programme by request. Sometimes the test can miss cancers, so even if results come back negative, it is vital to return to your doctor if you experience any symptoms.

The second screening programme is called the Bowel Scope screening programme. This involves carrying out a sigmoidoscopy examination at the age of 55 which allows the doctor to see the lower third of the bowel. If polyps are present, then you are invited for a colonoscopy to have the polyp removed and the rest of the bowel examined. Colonoscopies have vastly improved in the last 10 to 15 years and are now done under conscious sedation, so the patient can remain awake and experiences little discomfort.

If you are experiencing symptoms of bowel cancer as mentioned in the article, visit a specialist to have them checked out. Early detection could just save your life.

By Mr Muti Abulafi
Colorectal surgery

Mr Muti Abulafi is a highly skilled consultant surgeon with over 30 years' experience in both colorectal and general surgery. He has a special interest in colorectal cancer care and currently acts as lead for the colorectal cancer multidisciplinary team at Croydon University Hospital. His other specialist interests include colorectal and keyhole surgery, colonoscopy, inflammatory bowel disease, pelvic floor dysfunction, and hernia operations.

Mr Abulafi takes a keen interest in research, and has published extensively on colorectal cancer and cancer genetics. He is actively involved in training and education, having helped found and establish the annual M25 colorectal course, which teaches trainee surgeons and educates them on all aspects of colorectal surgery. Mr Abulafi is a member of several specialist surgical associations in the UK and Europe and is the current Chair of the Colorectal Cancer Pathway Group at the Royal Marsden Partners Cancer Vanguard.

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