Spotting the early signs of bowel cancer

Unfortunately, the early signs of bowel cancer are not specific and are similar to many other conditions of the bowel. The presence of blood in the stools, in the form of either dark or bright blood, is the most common sign of bowel cancer. Mr Giovanni D. Tebala talks about bowel cancer symptoms, diagnosis and treatment.

Signs of bowel cancer

Colon tumours tend to bleed, therefore the most frequent symptom of a benign or malignant bowel growth is the passage of blood with motion. A sudden change in bowel habits must be considered a “red flag” for a malignant condition of the large bowel. Symptomatic or asymptomatic anaemia (low level of haemoglobin in the blood) may be a sign of constant bleeding, as it happens with large polyps and cancers of the bowel. Unintentional weight loss is also related to malignant conditions.

What other conditions can these symptoms indicate?

The most frequent reasons for rectal bleeding are diseases of the anus, such as haemorrhoids, rectal prolapse and fissures. In those cases, the bleeding is usually bright red and mostly separated from the stools, whereas, in the case of more proximal bleeding, the blood can be mixed with the stools.

However, cancers of the lower rectum or anus may bleed like any other anal condition. Anal fissures are usually responsible for bleeding associated with pain at defecation. Rectal or anal prolapses bleed frequently and are associated with the feeling of a lump in the anus (tenesmus), but unfortunately, rectal or anal cancers may behave similarly.

A change of bowel habits can be due to any disease of the large, and sometimes small bowel, such as diverticular disease, irritable bowel syndrome (IBS), inflammatory bowel disease, or simply a change of lifestyle or diet. Also, some medical conditions, such as diabetes or hypothyroidism, and medications like metformin and antibiotics may cause irregular bowel motions, in the form of loose stools and/or constipation.

Low levels of haemoglobin must always be investigated as this may be due to continuous bleeding, in particular, if it is associated with other symptoms like fatigue, breathlessness and dizziness. However, this may be due to a long list of conditions, most of them totally benign, like coeliac disease or gastritis, or even heavy periods and a poor diet.

Unintentional weight loss is sometimes associated with a malignant disease, in particular, if it accompanies other symptoms like anaemia or anorexia (reduced appetite), but can also be due to an overactive thyroid or an infectious disease, or more simply to a change in diet or lifestyle.

All these symptoms must also be considered along with the demographics of the patient, as, for instance, rectal bleeding in a 20-year-old man is unlikely to be caused by a tumour but probably to some proctological disorder, and chronic anaemia in a 25-year-old lady may be due to her periods. However, any new symptom must prompt a visit to the GP and possibly a referral to a specialist colorectal surgeon.

What should you do if you discover some of these symptoms?

Your GP should be your first point of contact. He or she will evaluate if your condition presents any red flags for cancer, and if this is the case you will be urgently referred to a specialist.

If your symptoms do not present any worrying signs, your GP may decide to start an initial treatment, usually for basic conditions like haemorrhoids and fissures, or to refer you to a specialist. Some specialists working in the private sector may also accept self-referrals, so if you experience any of these symptoms you can decide to be seen by a specialist colorectal surgeon straight away.

Before going to the GP or to the specialist, please take note of your symptoms, of your medical history and of any treatment you have been having or have had in the past, to avoid forgetting any important details that can help with the diagnosis.

If you’re diagnosed with bowel cancer, what’s the treatment process like?

The direct visualisation of your bowel with a colonoscopy (a camera introduced into your back passage and gently pushed upwards to explore the whole large bowel) with a biopsy is usually necessary to identify bowel cancer, but a CT scan and sometimes an MRI must be performed for a complete staging of the disease.

The treatment options depend very much on the degree of local infiltration of the tumour and the eventual spread into the lymph nodes and distant organs. Once the diagnosis has been confirmed and the staging complete, your case would be discussed in a colorectal cancer multidisciplinary team meeting between surgeon(s), radiologist(s), oncologist(s) and pathologist(s) to establish the best treatment for your particular case. Afterwards, the surgeon would contact you to inform you of the MDT outcome and discuss various options.

Is surgery the most common form of treatment?

Fortunately, the vast majority of cancers of the bowel can be treated with an operation and with radiotherapy and chemotherapy to obtain the best result in terms of long-term survival and quality of life.

Nowadays, surgery for colorectal cancer is performed with laparoscopy (keyhole surgery) in more than 70% of cases (in selected centres). In most cases, keyhole surgery, if it is performed by an experienced colorectal surgeon with specific training in advanced laparoscopic surgery, and if it’s done within an Enhanced Recovery programme (that is a new protocol to improve the postoperative recovery of surgical patients), guarantees an optimal outcome with low risk of complications, minimal postoperative pain and a very quick recovery.

The specimen removed during the operation will be sent for analysis under a microscope and patients with more advanced tumours will be offered postoperative chemotherapy and/or radiotherapy. Some forms of treatment, such as immunotherapy, are still in their experimental phase, whereas other more established procedures, such as contact radiotherapy may be available in selected circumstances.

However, surgery remains the mainstream of treatment and the colorectal surgeon should be the key consultant in charge of the treatment and postoperative follow-up, in cooperation with the oncologist.

If you’re experiencing any of the symptoms described above and have concerns, get in touch with Mr Giovanni D. Tebala through his Top Doctors profile.