Introduction
Bowel Cancers are malignant diseases of the Colon and Rectum. They are very common particularly in the Western World. The chances of developing a bowel cancer at sometime during life in the United Kingdom are 1 in 15 for men and 1 in 19 for women. The vast majority of these are adenocarcinomas which are formed as a result of uncontrolled abnormal growth of the glandular tissue (within mucosa) that lines the large bowel. Why the lining of the large bowel should be particularly prone to such abnormal growth over and above that of the rest of the gut is not fully understood.
A number of environmental, dietary and social factors may play a part in developing bowel cancer and be considered a risk but the effect of a positive family history of the disease is much more significant. The majority of people who develop bowel cancer have no particular identifiable excess risk outside that of the population at large. It most commonly affects people over the age of 65 years although this is by no means always the case.
Symptoms
- Change in bowel habit – usually to looser and or more frequent stools
- Rectal bleeding – often mixed into the stools and dark in colour
- Anaemia – showing a deficiency in the body’s iron stores
- Abdominal pain
- Weight loss
- Abdominal lumps
Many people diagnosed with bowel cancer will have none of the symptoms above. They may be diagnosed by a screening programme or have disease identified when examined further after abnormalities are detected in routine blood or stool investigations.
Treatment
The mainstay of treatment for bowel cancers, where possible, is with surgery and this still offers the only realistic chance of a cure. Colon cancer is treated with surgery, then if necessary (in around half of cases) with a variety of different types of chemotherapy. This is known as adjuvant treatment. Rectal cancer is also treated with surgery but in many cases before this is undertaken radiotherapy is given over a short or long course with or without chemotherapy. This is known as neo-adjuvant treatment.
This pre-treatment may be to make an otherwise impractical operation possible, or more commonly be used to reduce the chances of a fully treated rectal cancer returning at the same site in the future. Chemotherapy and (much less commonly) radiotherapy may be given as further adjuvant treatment after rectal cancer surgery depending upon the final stage of disease identified.
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An ulcerating cancer of the lower rectum (raised, rolled, red edges) with surrounding normal (pink) lining mucosa.
Follow Up
The purpose of follow up after treatment for bowel cancer is to detect any recurrent disease as early as possible in the hope that it may be removed with further surgery or treated with chemotherapy or radiotherapy. The outlook for patients with recurrent bowel cancer has improved greatly over the last twenty years with the acceptance that liver and lung surgery for metastases can offer a cure for the disease. Chemotherapy, radiotherapy and novel therapies like radiofrequency ablation and injection of radioactive microspheres have all been shown to improve survival although their ability to cure disease is less likely.
Follow up seeks to idenfify recurrent disease of three different kinds:
- Disease occuring in the vicinity of the previous surgery (Local recurrence) in the abdomen or pelvis
- Disease occuring at sites distant to the original surgery (Distant recurrence) particularly the liver and lungs
- Development of further bowel polyps or tumours
The common modalities employed are:
- CT scan of chest abdomen and pelvis yearly for the first 3 years of follow up (Idenfifying 1. and 2. above)
- Colonoscopy within 6 months of surgery if not performed before, then at 2 and 5 years after surgery and 5 yearly thereafter until 75 years of age (Identifying 3. above)
- Blood tests of CEA (carcino-embryonic-antigen) if raised before operation at 6 monthly intervals for 5 years (Identifying 1. and 2. above)
Contact with your surgeon and nurse specialist may be by clinic visit or by telephone.
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