Bowel Cancer Awareness – The Food Medic

April 18, 2022

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This article was written by one of The Food Medic team; London-based GP Dr Nirja Joshi

April is Bowel Cancer awareness month. Through this article, we hope to promote awareness of the disease, how to notice the signs and symptoms, discuss screening and how you can get involved in raising awareness.

What is bowel cancer?

Bowel cancer refers to cancer of the large bowel. This can also be called colon or rectal cancer depending on whereabouts in your gut the cancer may be.

Bowel cancer most commonly affects people over the age of 60 and is one of the most common cancers diagnosed in the UK (1).

The main risk factors for bowel cancer include age, weight, smoking and family history (1). There has been research into the increased consumption of processed meat or red meat with bowel cancer. The recommendation is to eat less than 70g of processed meat per day to reduce your risk of bowel cancer (2).

What are the main symptoms of bowel cancer?

There are three main symptoms to look out for when it comes to bowel cancer [1]:

[1] Persistent blood in your poo

[2] Persistent change in bowel habit [e.g. looser stools or going more frequently]

[3] Persistent abdominal bloating or pain [caused by eating and may be associated with loss of appetite or unintentional weight loss]

It is important to remember that in most cases, these symptoms do not represent bowel cancer. If you have any of these symptoms, you should see your doctor, as it may represent a different medical condition.

What will happen when you go to your doctor?

When you see your GP, they may first ask you about your symptoms in detail. It is important to think about the timeframe of your symptoms, any triggering factors and if you ever see blood and have any photographs, this can be helpful. Your doctor may also then want to feel your abdomen to see if they can note any points of tenderness or feel any masses. Lastly, they may want to conduct a rectal exam (3). This examination can feel worrying for some, so we will do our best to explain it in more detail. Prior to a rectal examination, the doctor will first ask for your consent as well as offer you a chaperone if you would like. They will then ask you to lower your trousers and underwear to your knees and lie on your side with your knees brought up to your chest. The examination is quick, and will generally only last a few seconds. It will likely be uncomfortable, but should not be painful. It will involve a single, lubricated, gloved finger to examine your rectum. This will allow your doctor to feel for any lumps and see if there are any signs of bleeding.

After this, if your doctor is concerned, they may ask you to have a simple blood test to check for anaemia (low iron), which could indicate that you may be losing blood. Thereafter there is a test called the ‘FIT test (4)’. This stands for faecal immunochemical test. It involves bringing a stool sample to your doctor and this can be analysed for blood which may be otherwise difficult to see.

What happens next?

If after your consultation, your doctor feels that you need to be referred to hospital, this would be done under the ‘two week rule’. This is a fast track type of referral which is used for patients with suspected cancer to ensure that they are seen quickly (5). The aim of this referral is that patients will be contacted for their first appointment within two weeks of their GP referring them. Thereafter, the hospital doctors may suggest further investigations such as a colonoscopy. A colonoscopy is a day procedure which involves a camera to look at your bowel (6). This procedure is conducted under sedation, and will require you to have bowel cleansing prior as well as ensuring that there is someone to take you home on the day. Aside from a colonoscopy, there are a range of other tests which may occur including a flexible sigmoidoscopy (a camera test looking at part of the bowel), CT scans and ‘capsule endoscopies’ (which involve swallowing a pill which has a camera which can capture images of the bowel).

The colonoscopy allows a chance to look directly at the bowel and any evidence of any growths; these can have samples taken (biopsies), which can take a few weeks to process. After this, your doctor will be able to let you know whether the sample represents cancer (6).

It is important to remember that the majority of people who go through this procedure are not found to have cancer.

What about screening?

In England, every adult is sent a bowel cancer screening kit through the post every two years between the ages of 60 and 74. After the age of 75, one can obtain a kit by phoning 0800 707 60 60 (1).

What can you do to help raise awareness of bowel cancer?

Bowel Cancer UK are running a charity event to help raise awareness for bowel cancer. The challenge is called ‘Step up for 30’ and suggests participants gain sponsorship for doing a physical activity each day throughout April (7).