Bowel Cancer

What is Bowel Cancer?

Bowel cancer is the development of malignant cells on the walls of the intestine or rectum.

Most cancers begin as a small growth called a polyp or adenoma and develop into a solid tumour. Research suggests that most bowel (colorectal) cancers can take 5 to 10 years or more to develop.

Bowel cancer typically arise in the colon or the rectum of the large bowel (large intestine). It is for this reason that it is also referred to as Colorectal Cancer.

Bowel cancers start in the lining or the innermost tissue layer of the bowel walls.

If left untreated, they may become cancerous and grow into the muscle layers under the lining of the bowel. Then through the bowel wall the malignant cells can then spread into organs that are close to the bowel, such as the bladder, womb, prostate gland or nearby glands (lymph nodes).

Risks of Developing Bowel Cancer

The underlying cause of bowel cancer is not known. It is more common in developed countries and is thought to be due to the food we eat slowing the transit of stools through the bowel.

Bowel Cancer affect more than 4% of Australians with over 12,000 sufferers annually and about 5,000 deaths. Bowel Cancer impacts many people in their older years, especially those over 85.

Lifestyle issues may be important in reducing the risks. Actions to lower risk factors can include:

regular exercise,
maintaining ideal weight and
eating a diet low in fat and high in fibre
consuming a large amount of tobacco or alcohol

Known factors that will increase your risk are:

Age - typically over 50
Having a family history of bowel cancer
Abnormal growth of cells or polyps on the bowel wall
Ongoing Inflammatory bowel diseases (Ulcerative Colitis, Crohn’s Disease)
Genetic conditions like Familial Adenomatous Polyposis - FAP or Hereditary Non Polyposis Colorectal Cancer (HNPCC)

Symptoms of Bowel Cancer

Common symptoms of bowel cancer include:

Change in bowel habit like onset of diarrhoea or constipation
Bleeding from the back passage or blood mixed in the stool
Abdominal pain that persists
A low blood count or anaemia

Colon cancers rarely cause symptoms until very late.

Rectal cancers may result in bleeding, and can be mistaken for haemorrhoids. Rectal cancers may also cause rectal pain on straining or urgency to defecate (tenesmus).

All cancers, if large enough, can cause obstruction, with abdominal bloating and pain very similar to that experienced from constipation.

Stages of Bowel Cancer

Colorectal Cancer if often referred to in stages. These indicate the progression in your body.

Stage I - is a local cancer and still on the inner bowel wall layer
Stage II - has not broken through the bowel wall but is in the bowel muscle
Stage III - is when the cancer have spread beyond the bowel outer wall
Stage IV - is when the cancer have spread beyond the bowel wall and into the lymph nodes

Cancers cluster cells spread to lymph glands or other organs are called metastases or secondary cancers.

Due to significant improvements in the treatment of Bowel Cancer over the past decade, excellent results can now be achieved with modern combination treatments.

So despite a poor prognosis with late stage III cancer where metastasis has spread to the liver, bones, lung and beyond, a discussion with an EEC Surgeon is suggested as there could still be a role of surgery or combination treatments for late stage bowel cancer.

Bowel Cancer Survival

The outcome (prognosis) for Bowel Cancer will depend on several factors including:

The growth pattern of the primary bowel cancer
The depth the cancer has spread through the bowel wall
The presence of cancer cells in lymph glands and other organs
A patient's general health and well-being

In patients with cancer confined to the bowel and who undergo an operation, the overall chances of cure are approximately 55%.

About 20% of all patients with bowel cancer present with liver metastases and a further 20% will develop liver metastases at a later stage.

Many patients are suitable for surgery to remove their liver tumours. In patients with isolated liver metastases and who undergo complete resection, approximately 50% will be cured of their disease. This is a dramatic improvement in survival outcome over the past 20 years compared with the past.

It is a condition that has a good prognosis, with a good chance of cure, if detected in the early stages.

Treatments for Bowel Cancer

The treatments depend on different factors, including the type of bowel cancer you have, its size and whether it has spread (the stage).

Surgery is the main treatment for most people with bowel cancer. You may also have chemotherapy or radiotherapy.

Bowel Cancer Prevention

For patients with rare inherited genetic syndromes:

Familial Adenomatous Polyposis - FAP
Hereditary Non Polyposis Colorectal Cancer (HNPCC)

should speak with an EEC Surgeon and geneticist to discuss the role of preventative (prophylactic) colectomy.

Bowel Cancer Surgery

When bowel cancer has been diagnosed the affected parts of the colon and rectal should be removed quickly.

Bowel surgery is major surgery.

Colorectal cancers, if treated aggressively with surgery frequently do better than other cancers.

The procedures are called:

colectomy - removal of a portion of colon or bowel resection
procto-colectomy - removal of the rectum and a portion of colon

The procedures remove the cancer as well as the glands (lymph nodes) that the cancer can potentially drain to. The two ends of healthy bowel are then joined together creating an anastomosis.

In most cases surgery for colorectal cancer can be performed as as a keyhole or laparoscopic procedure. A small incision is then made at the end to deliver the specimen.

Most bowel surgery can usually be performed in an elective manner with the two resected ends of the bowel being connected together as an anastomosis without the need for a diversion to a colostomy bag.

When an emergency bowel surgery is performed due to a blockage a temporary colostomy bag is needed. This could result from the totally removal of the anus or rectum.

Pouch Surgery

A much rarer form of bowel surgery is where the entire large bowel and rectum is removed. This is occasionally needed for inflammatory bowel disease. In this case, small bowel is used to create a reservoir to take the place of the rectum.

Robotic Surgery

Robotic surgery are with the Da Vinci® robot, allows for the benefits of minimally invasive surgery, along with the fine precision, 3D vision and magnified view afforded only by robotic surgery.

Similar to laparoscopic surgery, robotic surgery results in the avoidance of a large incision, resulting in less pain, and earlier discharge and recovery.

The main advantage of robotic surgery over laparoscopic surgery is the improved visibility and fine dexterity of the robotic miniature graspers which allow for precise delicate surgery within a small confined place.

Combination Treatments

Bowel Cancer can be cured with a combination of surgery and

chemotherapy and/or
radiotherapy

Modern chemotherapy agents specifically target colorectal cancer and these have been extremely effective in helping treat this disease.

Patients with localised bowel tumours but with spreading to the lymph glands may receive chemotherapy or radiotherapy before or after their surgery with the aim of this treatment being to reduce: the size of the cancer, the chance of spread and the chance of the cancer recurring.

If patients have liver metastases at first presentation, in addition to their bowel cancer, then they are usually offered chemotherapy after the bowel surgery.

An EEC Surgeon may even offer surgery to remove the liver tumours first as long as there are no other signs of spread of the disease. When used to prevent the spread of cancer, it is called adjuvant treatment.

Occasionally chemotherapy is given on its own in a palliative setting. This is when there is widespread cancer metastasis and the cancer cannot be completely removed. This offers some relief of symptoms.

Preparing for Bowel Surgery

Before any procedure an EEC Surgeon or a staff member will advise you of the details but in general you will need to

Only consume clear liquids the day before your surgery.
Take a bowel prep, a laxative taken orally to clean out your colon
You need to fast (from midnight before if your morning surgery or from 6am if afternoon surgery.

Pre-admission for Bowel Surgery

If you are greater than 70 years of age or suffer diabetes, previous problems with your heart, lungs or kidneys you may need to attend the pre-admission clinic one week prior to your surgery.

Postoperative Recovery

A typical admission is anywhere from 3 days to 7 days.

Immediately after your procedure you will be commenced on free fluids
Pain management may be required (opioid and paracetamol analgesia)
If your procedure is performed laparoscopically you will be walking from day one
Then a light diet once you have passed flatus.

Patients can be discharged from hospital once you have opened your bowels.

Tiredness, discomfort and some bowel irregularity are common complaints whilst the body repairs itself and readjusts to the new arrangement of the bowel. These feelings may last for several months.

Those people in paid employment may be back at work within four weeks, but for some others it may be longer.

If chemotherapy or radiotherapy treatment is necessary this can be arranged around work commitments.