Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where in the bowel the cancer starts, bowel cancer is sometimes called colon cancer or rectal cancer.

Symptoms of bowel cancer include blood in your stools (faeces), an unexplained change in your bowel habits, such as prolonged diarrhoea or constipation, and unexplained weight loss.

Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer.

The large bowel

The bowel is part of the digestive system. It has two main purposes:

• to absorb energy, water and nutrients from the food you eat
• to pass out the remaining waste products from your body in the form of stools

The large bowel is made up of five sections:

• The ascending colon runs from the end of the small intestine and up the right-hand side of the abdomen.
• The transverse colon runs under the stomach and across the body from right to left.
• The descending colon runs down the left-hand side of the abdomen.
• The sigmoid colon is an S-shaped bend that connects the descending colon to the rectum. 
• The rectum is the final section of the bowel. It is a small pouch that is connected to the outside opening of the bowel (the anus), through which stools are passed.

How common is bowel cancer?

In England, bowel cancer is the third most common type of cancer. In 2008, there were 39,991 new cases of bowel cancer registered in the UK:

• 17,894 cases were diagnosed in women, making it the second most common cancer in women after breast cancer
• 22,097 cases were diagnosed in men, making it the third most common cancer after prostate and lung cancer

Approximately 80% of bowel cancer cases develop in people who are 60 or over. Two-thirds of bowel cancers develop in the colon, with the remaining third developing in the rectum.

In England, an estimated 16,000 people die from bowel cancer each year.

Factors that increase your risk of getting bowel cancer include:

• Age: around 80% of people diagnosed with bowel cancer are over 60.
• Diet: a diet high in fibre and low in saturated fat could reduce your bowel cancer risk. A diet high in red or processed meats can increase your risk.
• Healthy weight: leaner people are less likely to develop bowel cancer than obese people.
• Exercise: being inactive increases the risk of getting bowel cancer.
• Alcohol and smoking: high alcohol intake and smoking may increase your chances of getting bowel cancer.
• Family history and inherited conditions: having a close relative with bowel cancer puts you at much greater risk of developing the disease.
• Related conditions: having certain bowel conditions can put you more at risk of getting bowel cancer.

Bowel cancer screening

In 2006, the NHS launched a screening programme for bowel cancer. It is recommended that everyone between the ages of 60 and 69 is screened every two years.

Screening is carried out by taking a small stool sample and testing it for the presence of blood.

Screening plays an important part in the fight against bowel cancer because the earlier the cancer is diagnosed, the greater the chance that it can be cured completely.

For more information, see Bowel cancer - screening.

Outlook

Bowel cancer can be treated using a combination of surgery, chemotherapy, radiotherapy and, in some cases, biological therapy. As with most types of cancer, the outlook for an individual depends largely on how far the cancer has advanced by the time it is diagnosed.

If bowel cancer is diagnosed in its earliest stages, the chances of surviving for a further five years is 90%, and a complete cure is usually possible. However, bowel cancer that is diagnosed in its most advanced stage only has a five-year survival rate of 6% and a complete cure is unlikely.

Screening can diagnose cancer at its earliest stage and can increase the chance of successful treatment.

Want to know more?

• Beating Bowel Cancer: what is bowel cancer?
• Beating Bowel Cancer: nurse answers your frequently asked questions.

Blood

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Disease

A disease is an illness or condition that interferes with normal body functions.

Stools

Stool (also known as faeces) is the solid waste matter that is passed from the body as a bowel movement.

Tissue

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Early bowel cancer may have no symptoms. Some symptoms of later bowel cancer can also occur in people with less serious medical problems, such as haemorrhoids (piles). See your doctor if you notice any of the symptoms below.

The initial symptoms of bowel cancer include:

• blood in your stools (faeces) or bleeding from your rectum
• a change to your normal bowel habits that persists for more than six weeks, such as diarrhoea, constipation or passing stools more frequently than usual
• abdominal pain
• unexplained weight loss

As bowel cancer progresses, it can sometimes cause bleeding inside the bowel. Eventually, this can lead to your body not having enough red blood cells. This is known as anaemia.

Symptoms of anaemia include:

• fatigue
• breathlessness

In some cases, bowel cancer can cause an obstruction in the bowel. Symptoms of a bowel obstruction include:

• a feeling of bloating, usually around the belly button
• abdominal pain
• constipation
• vomiting

When to seek medical advice

See your GP if you have any of the symptoms above. While the symptoms are unlikely to be the result of bowel cancer, these types of symptoms always need to be investigated further.

Want to know more?

• Macmillan: Symptoms and diagnosis of colon and rectal cancer.
• Beating Bowel Cancer: Symptoms.
• Bowel Cancer UK: The signs and symptoms of bowel cancer.

How does cancer begin?

Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.

Most cases of bowel cancer first develop inside clumps of cells on the inner lining of the bowel. These clumps are known as polyps. However, if you develop polyps, it does not necessarily mean that you will get bowel cancer.

Exactly what causes cancer to develop inside the bowel is still unknown. However, research has shown that several factors may make you more likely to develop it. You cannot do anything about some of these factors, but others you can change.

Family history

There is evidence that bowel cancer can run in families. Around 20% of people who develop bowel cancer have a close relative (mother, father, brother or sister) or a second-degree relative (grandparent, uncle or aunt) who have also had bowel cancer.

It is estimated that if you have one close relative with a history of bowel cancer, your risk of getting bowel cancer is doubled. If you have two close relatives with a history of bowel cancer, your risk increases four-fold.

Diet

A large body of evidence suggests that a diet high in red and processed meat can increase your risk of developing bowel cancer. For this reason, the Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams. For more information, see Red meat and bowel cancer risk

There is also good evidence that a diet high in fibre and low in saturated fat could help reduce your bowel cancer risk. Cancer experts think this is because this type of diet encourages regular bowel movements.

Smoking

People who smoke cigarettes are 25% more likely to develop bowel cancer, other types of cancer and heart disease than people who do not smoke.

Find local stop-smoking clinics

Alcohol

A major study, called the EPIC study, showed that alcohol was associated with bowel cancer risk. Even small amounts of alcohol can put you at higher risk of getting bowel cancer. The EPIC study found that for every two units of alcohol a person drinks each day, their risk of bowel cancer goes up by 8%.

Obesity

Obesity is linked to an increased risk of bowel cancer. Obese men are 50% more likely to develop bowel cancer than people with a healthy weight. Morbidly obese men, who have a body mass index (BMI) of over 40, are twice as likely to develop bowel cancer.

Obese women have a very small increased risk of developing the condition, and morbidly obese women are 50% more likely to develop bowel cancer than women with a healthy weight.

Inactivity

People who are physically inactive have a higher risk of developing bowel cancer. You can help reduce your risk of bowel and other cancers by being physically active every day. Your risk could be cut by up to one-fifth if you do an hour of vigorous exercise every day or two hours of moderate exercise (such as vacuum cleaning or brisk walking).

Digestive disorders

Some conditions may put you at a higher risk of developing bowel cancer. People with Crohn’s disease are 2-3 times more likely to develop bowel cancer. The risk of developing bowel cancer is much higher in people with ulcerative colitis, and as many as 1 in 20 of these people will go on to develop it.

Genetic conditions

There are two rare inherited conditions that can cause bowel cancer. They are:

• familial adenomatous polyposis (FAP)
• hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome

FAP affects 1 in 10,000 people. The condition triggers the growth of non-cancerous polyps inside the bowel. Although the polyps are non-cancerous, there is a very high risk that, over time, at least one will turn cancerous. Almost all people with FAP will have bowel cancer by the time they are 50 years of age.

People with FAP have such a high risk of getting bowel cancer, they are often advised by their doctor to have their large bowel removed by surgery before they reach the age of 25. Families who are affected can find support and advice from the FAP registry at St Mark’s Hospital, London.

HNPCC is a type of bowel cancer caused by a mutated gene. An estimated 2-5% of all cases of bowel cancer are due to HNPCC. Around 90% of men and 70% of women with the HNPCC mutation will develop bowel cancer by the time they are 70 years of age.

As with FAP, removing the bowel as a precautionary measure is usually recommended in people with HNPCC.

Want to know more?

• Beating Bowel Cancer: Causes. 
• Bowel Cancer UK: Diet, nutrition and bowel cancer (PDF, 190Kb).
• Cancer Research UK: Food types and bowel cancer. 
• Cancer Research UK: Risk factors.
• Wellcome Trust: FAP, HNPCC and genetic testing.

Blood

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Chronic

Chronic usually means a condition that continues for a long time or keeps coming back.

Gene

Genes contain information that you inherit from your parents, such as eye or hair colour. They are carried by chromosomes.

Your GP will begin the diagnosis by asking you about your symptoms and whether you have a family history of bowel cancer.

They will then carry out a physical examination known as a digital rectal examination (DRE). A DRE involves your GP gently placing their finger into your anus, and then up into your rectum.

A DRE is a useful way of checking whether there is a noticeable lump inside your rectum. This is found in an estimated 40-80% of cases of rectal cancer.

A DRE is not painful, but some people may find it a little embarrassing.

If your symptoms suggest that you may have bowel cancer, or the diagnosis is uncertain, you will be referred to your local hospital for further examination. 

Further examination

Two tests are commonly used to confirm a diagnosis of bowel cancer:

• A sigmoidoscopy is an examination of your rectum and some of your large bowel.
• A colonoscopy is an examination of all of your large bowel.

Sigmoidoscopy

A sigmoidoscopy uses a device called a sigmoidoscope, which is a thin, flexible tube attached to a small camera and light.

The sigmoidoscope is inserted into your rectum and then up into your bowel. The camera relays images to a monitor. This allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer.

A sigmoidoscopy can also be used to remove small samples of suspected cancerous tissue so they can be tested in the lab. This is known as a biopsy.

A sigmoidoscopy is not usually painful, but it can feel slightly uncomfortable. Most people can go home after the examination has been completed.

Colonoscopy

A colonoscopy is similar to a sigmoidoscopy except a larger tube, called a colonoscope, is used to examine your entire bowel.

Your bowel needs to be empty when a colonoscopy is performed, so you will be given a special diet to eat for a few days before the examination and a laxative (medication to help empty your bowel) on the morning of the examination.

You will be given a sedative to help you relax, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. As with a sigmoidoscope, the colonoscope can be used to obtain a biopsy, as well as relaying images of any abnormal areas.

A colonoscopy usually takes about one hour to complete, and most people can go home once they have recovered from the effects of the sedative. After the procedure, you will probably feel a bit drowsy for a while, so arrange for someone to accompany you home.

Want to know more?

• Beating Bowel Cancer: Diagnosis.
• Bowel Cancer UK: Questions to ask about diagnosis and treatment (PDF, 610Kb).
• Cancer Research UK: Bowel cancer tests.
• Macmillan: Colonoscopy. 

Further testing

If a diagnosis of bowel cancer is confirmed, further testing is usually carried out for two reasons:

• to check if the cancer has spread from the bowel to other parts of the body
• to help decide what will be the most effective treatment for you

These tests can include:

• computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan to provide a detailed image of your colon
• ultrasound scans, which can be used to look inside other organs, such as your liver, to see if the cancer has spread there
• chest X-rays, which can be used to assess the state of your heart and lungs
• blood tests to detect a special protein, known as a tumour marker, which is released by the cancerous cells in some cases of bowel cancer 

Staging and grading

Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer. Staging refers to how far your cancer has advanced. Grading relates to how aggressive and likely to spread your cancer is.

• Stage 1: the cancer is still contained within the lining of the bowel or rectum.
• Stage 2: the cancer has spread into the layer of muscle surrounding the bowel.
• Stage 3: the cancer has spread into nearby lymph nodes.
• Stage 4: the cancer has spread into another part of the body, such as the liver.

This is a simplified guide. Stage 2 is divided into further categories called A and B and stage 3 is divided into A, B and C.

There are three grades of bowel cancer:

• Grade 1 is a cancer that grows slowly and has a low chance of spreading beyond the bowel.
• Grade 2 is a cancer that grows moderately and has a medium chance of spreading beyond the bowel.
• Grade 3 is a cancer that grows rapidly and has a high chance of spreading beyond the bowel.

If you are not sure what stage or grade of cancer you have, ask your doctor.

Want to know more?

• Macmillan: Staging and grading of colon and rectal cancer.

Biopsy

A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.

Blood test

During a blood test, a sample of blood is taken from a vein using a needle, so it can be examined in a laboratory.

Stools

Stool (also known as faeces) is the solid waste matter that is passed from the body as a bowel movement.

Ultrasound

Ultrasound scans are a way of producing pictures of inside the body using sound waves.

Tissue

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

X-ray

An X-ray is a painless way of producing pictures of inside the body using radiation.

Surgery - colon cancer

If the cancer is at a very early stage, it may be possible to remove just a small piece of the lining of the colon wall. This is known as local excision.

If the cancer has begun to spread into the muscles surrounding the colon, it will usually be necessary to remove an entire section of your colon. Removing some of the colon is known as a colectomy.

Depending on the location of the cancer, possible surgical procedures include:

• left-hemi colectomy, where the left half of your colon is removed
• transverse colectomy, where the middle section of your colon is removed
• right-hemi colectomy, where the right half of your colon is removed
• sigmoid colectomy, where the lower section of your colon is removed

There are two ways that a colectomy can be performed:

• In an open colectomy, the surgeon makes a large incision in your abdomen and removes a section of your colon.
• A laparoscopic colectomy is a type of ‘keyhole surgery’, where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of colon.

Both techniques are thought to be equally effective in removing cancer and have similar risks of complications. Laparoscopic colectomies have the advantage of a faster recovery time and less post-operative pain.

Laparoscopic colectomies should now be available in all hospitals carrying out bowel cancer surgery, although not all surgeons perform this type of surgery. If you are considering having your bowel cancer surgery done using keyhole surgery, discuss this with your surgeon.

During surgery, nearby lymph nodes may also be removed. It is usual to join the ends of the bowel together after bowel cancer surgery, but very occasionally this is not possible and a stoma is needed. 

Enhanced recovery programmes

Enhanced recovery surgical programmes may be available for colon, rectal and bowel cancer patients. These programmes differ from traditional surgery by:

• ensuring patients are in the best possible physical condition before surgery
• minimising the trauma patients go through during surgery - for example, minimally invasive surgery when possible and better pain control
• ensuring patients experience the best possible rehabilitation after surgery

Want to know more?

• Cancer Research UK: Which surgery for bowel cancer.
• Beating Bowel Cancer: Surgery.

Stoma surgery

In some cases, the surgeon may decide that the colon needs to heal before it can be reattached, or that too much of the colon has been removed to make reattachment possible.

In this case, it will be necessary to find a way of removing waste materials from your body without stools passing through your anus. This is done using stoma surgery.

Stoma surgery involves the surgeon making a small hole in your abdomen, which is known as a stoma. There are two ways that stoma surgery can be carried out.

• An ileostomy is where a stoma is made in the right-hand side of your abdomen. Your small intestine is separated from your colon and connected to the stoma, and the rest of the colon is sealed. You will need to wear a pouch that is connected to the stoma to collect waste material.
• A colostomy is where a stoma is made in your lower abdomen and a section of the colon is removed and connected to the stoma. As with an ileostomy, you will need to wear a pouch to collect waste material.

In most cases, the stoma will be temporary and can be removed once your colon has recovered from the effects of the surgery. This will usually take at least nine weeks. Specialist stoma nurses are available to advise you on the best site for a stoma, and about the best sort of pouch to cover the stoma and collect the waste material.

Before you have a colectomy, your care team will be able to tell you whether they think stoma surgery will be necessary and the likelihood that you will need to have a temporary or permanent ileostomy or colostomy.

Want to know more?

• Bowel Cancer UK: Information on stomas (PDF, 238Kb)

Surgery - rectal cancer

Two common surgical procedures can be used to treat rectal cancers:

• low anterior resection
• abdominoperineal resection

Low anterior resection

Low anterior resection is a procedure that is used to treat cases where the cancer is in the upper section of your rectum. The surgeon will make an incision in your abdomen and remove the upper section of your rectum, as well as some surrounding tissue to make sure that any lymph glands containing cancer cells are also removed. They will then attach your colon to the lowest part of your rectum or upper part of the anal canal. Sometimes, they turn the end of the colon into an internal pouch to replace the rectum. You will probably require a temporary stoma to give the join-up time to heal.

Abdominoperineal resection

Abdominoperineal resection is used to treat cases where the cancer is in the lowest section of your rectum. In this case, it will be necessary to remove a large section of your rectum and surrounding muscles to reduce the risk of the cancer regrowing in the same area. This involves removing the anus and its sphincter muscles too, so there is no option except to have a permanent stoma after the operation. Bowel cancer surgeons always do their best to avoid giving people permanent stomas wherever possible.

Side effects of surgery

Bowel cancer operations carry the same risks as other major operations, including the risks of bleeding, infection, developing blood clots or heart or breathing problems. 

One risk is that the join-up in the bowel may not heal properly and may leak inside your abdomen. This is usually only a risk in the first few days after the operation. 

Another risk is for patients having rectal cancer surgery. The nerves controlling passing urine and sexual function are very close to the rectum, and sometimes an operation to remove a rectal cancer can damage these nerves. 

After bowel cancer surgery, the bowel is shorter than it used to be. This results in some patients needing to go to the toilet to open their bowels more often than before. This usually settles down within three to six months of the operation.

Radiotherapy

There are two main ways that radiotherapy can be used to treat bowel cancer. It can be:

• given before surgery, in cases of rectal cancer
• used to control symptoms and slow the spread of cancer, in cases of advanced bowel cancer (called palliative radiotherapy)

Radiotherapy given before surgery for rectal cancer can be performed in two ways:

• external radiotherapy, where a machine is used to beam high-energy waves at your rectum to kill cancerous cells
• internal radiotherapy (also known as brachytherapy), where a radioactive tube is inserted into your anus and placed next to the tumour to shrink it

External radiotherapy is usually given daily, five days a week, with a break at the weekend. Depending on the size of your tumour, you may need one to five weeks of treatment. Each session of radiotherapy is short and will only last for 10-15 minutes.

Internal radiotherapy can usually be performed in one session before surgery is carried out a few weeks later.

Palliative radiotherapy is usually given in short, daily sessions, with a course ranging from 2-3 days to 10 days.

Short-term side effects of radiotherapy include:

• nausea
• fatigue
• diarrhoea
• burning and irritation of the skin around the rectum and pelvis (this looks and feels like sunburn)
• a frequent need to urinate
• a burning sensation when passing urine

These side effects should pass once the course of radiotherapy has finished. Tell your care team if the side effects of treatment become particularly troublesome. Additional treatments are often available to help you cope better with the side effects.

Long-term side effects of radiotherapy include:

• a more frequent need to pass urine or stools
• blood in your urine and stools
• infertility
• impotence in men

If you want to have children, it may be possible to store a sample of your sperm or eggs before treatment begins so that they can be used in fertility treatments in the future.

Want to know more?

• Bowel Cancer UK: Radiotherapy for bowel cancer (PDF, 240Kb). 
• Cancer Research UK: Radiotherapy for bowel cancer. 
• Macmillan: Radiotherapy for colon cancer. 
• NICE: Treatment of rectal cancer with preoperative high dose rate brachytherapy (PDF, 56Kb).
• Macmillan: Brachytherapy.

Chemotherapy

There are three ways that chemotherapy can be used to treat bowel cancer. It can be:

• given before surgery for rectal cancer in combination with radiotherapy
• given after surgery to prevent the return of cancer
• given to slow the spread of advanced bowel cancer and to help control symptoms (palliative chemotherapy)

Chemotherapy for bowel cancer usually involves taking a combination of medications that kill cancer cells. They can be given as a tablet (oral chemotherapy), through a drip in your arm or chest (intravenous chemotherapy), or as a combination of both.

Depending on the stage and grade of your cancer, a single session of intravenous chemotherapy can last from several hours to several days.

Most people have regular daily sessions of chemotherapy over the course of one or two weeks before having a break from treatment for another week.

A course of chemotherapy can last up to six months depending on how well you respond to the treatment.

Side effects of chemotherapy include:

• fatigue
• nausea
• vomiting
• diarrhoea
• mouth ulcers
• hair loss
• redness and soreness on the palms of your hands and the soles of your feet
• a sensation of numbness, tingling or burning in your hands, feet and neck

These side effects should gradually pass once your treatment has finished. It usually takes three to six months for your hair to grow back.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Inform your care team or GP as soon as possible if you experience possible signs of an infection, including:

• a high temperature (fever) of 38C (100.4F) or above
• a sudden feeling of being generally unwell

The medications that are used in chemotherapy can cause temporary damage to men's sperm and women's eggs. This means that for women who become pregnant or for men who father a child, there is a risk to the unborn baby’s health. Therefore, it is recommended that you use a reliable method of contraception while having chemotherapy treatment and for a further year after your treatment has finished.

Want to know more?

• Beating Bowel Cancer: Chemotherapy. 

Biological treatments

Biological treatments, including cetuximab, bevacizumab and panitumumab, are a newer type of medication known as monoclonal antibodies. Monoclonal antibodies are antibodies that have been genetically engineered in a laboratory. They target special proteins that are found on the surface of cancer cells, known as epidermal growth factor receptors (EGFR). As EGFRs help the cancer to grow, by targeting these proteins, biological treatments can help prevent the cancer spreading.

Biological treatments are usually used in combination with chemotherapy and radiotherapy.

These treatments are not available to everyone with bowel cancer. The National Institute for Health and Clinical Excellence (NICE) has determined that specific criteria need to be met before they can be prescribed.

Cetuximab is only available on the NHS when:

• bowel cancer has spread to the liver and cannot be removed using surgery
• surgery to remove the cancer in the colon or rectum has been carried out or is possible
• a person is fit enough to undergo surgery to remove the cancer from the liver if this becomes possible after treatment with cetuximab

Bevacizumab and panitumumab are not available on the NHS. All these medications are are available privately but are very expensive. The medication is usually given in combination with chemotherapy.

Want to know more?

• Macmillan: Biological therapies (targeted therapies) for colon cancer.
• Beating Bowel Cancer: Accessing treatments not available on the NHS.

There are several ways to reduce your risk of developing bowel cancer.

Diet

Research suggests that a low-fat, high-fibre diet that includes plenty of fresh fruit and vegetables (at least five portions a day) and wholegrains can help reduce your risk of getting bowel cancer. It can also reduce your risk of other types of cancer and heart disease.

It is recommended that you do not eat a lot of processed meat and red meat. The Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams. For more information, see Red meat and bowel cancer risk

Exercise

There is a strong body of evidence to suggest that regular exercise can lower the risk of developing bowel cancer, as well as other types of cancer.

It is recommended that adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week..

Healthy weight

Try to maintain a healthy weight. Changes to your diet and an increase in your physical activities will help to keep your weight under control. Find out if you are a healthy weight with the Healthy weight calculator.

Smoking

If you smoke, giving up will reduce your risk of developing bowel cancer, as well as many other types of cancer.

The free NHS Smoking Helpline can offer advice and encouragement to help you quit smoking. Call 0800 022 4 332 or visit the NHS Smokefree website.

Your GP or pharmacist can also give you help, support and advice if you want to give up smoking.

Bowel cancer can be present for a long time before any symptoms appear. If bowel cancer is detected before symptoms appear, it is easier to treat and there is a better chance of surviving the disease.

The NHS Bowel Cancer Screening Programme in England started in July 2006. Men and women aged 60-69 who are registered with a GP will automatically be sent an invitation for screening through the post. The screening programme will be extended in England to those aged 70 to 75 from 2010. At the moment, if you are aged 70 or over, you can choose to participate by requesting a screening kit.

Screening consists of a home testing kit, called an FOBt (faecal occult blood test) kit. The kit arrives through the post when screening is due. The kit is used to collect tiny stool samples on a special card. The card is then sealed in a special hygienic freepost envelope and sent to a laboratory where it will be checked for traces of blood, which may indicate a problem.

Results

Results are received in writing within two weeks of sending in the test kit. There are three types of result:

• Normal: no blood was found in the samples. Screening will be offered again in two years’ time.
• Unclear: there were possible traces of blood that could be caused by factors other than cancer, such as haemorrhoids (piles) or stomach ulcers. If you have an unclear result, you will be asked to repeat the test kit up to twice more.
• Abnormal: blood was definitely found in the samples. Again, this could be from piles or bowel polyps (small growths which are usually not cancerous). If you have an abnormal result, you will be offered an appointment with a specialist nurse to discuss having an examination of the bowel, called a colonoscopy.

Colonoscopy

A colonoscopy is an investigation of the lining of the large bowel (colon). A thin flexible tube with a tiny camera on the end is passed into your bottom and guided around the bowel. Only around 2 in every 100 people completing the FOBt kit will have an abnormal result and will be offered a colonoscopy. Of those who have a colonoscopy, only about 1 in 10 will have cancer.

Want to know more?

• Bowel cancer screening and why it is necessary (PDF, 174Kb).
• The bowel cancer screening helpline: 0800 707 6060. You’ll need your NHS number to hand. 
• Beating Bowel Cancer: Screening. 
• Bowel Cancer UK: Bowel cancer screening programmes.
• News: Boost for bowel cancer screening.

Talk to others

Your GP or nurse may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP surgery will have information on these. Some people find it helpful to talk to other people with bowel cancer at a local support group or through an internet chat room.

Want to know more?

• Bowel Cancer UK: Patient to patient support.
• Beating Bowel Cancer: Patient Voices group. 

Emotional effects

Having cancer can cause a range of emotions. These may include shock, anxiety, relief, sadness and depression. Different people deal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you. However, you and your loved ones may find it helpful to know about the feelings that people diagnosed with cancer have reported.

Want to know more?

• Macmillan: The emotional effects of cancer.

Recovering from colon or rectal surgery

Surgeons and anaesthetists have found that using an “enhanced recovery programme” after bowel cancer surgery helps patients recover more quickly.

Many hospitals now use this programme. It involves giving you more information before the operation about what to expect, avoiding giving you strong laxatives to clean the bowel before surgery, and in some cases giving you a sugary drink two hours before the operation to give you energy. 

During and after the operation, the anaesthetist controls the amount of IV fluid you need very carefully, and after the operation you will be given painkillers that allow you to get up and out of bed by the next day.

Most people will be able to start to eat a light diet the day after their operation.

To reduce the risk of deep vein thrombosis (blood clots in the legs), you may be given special compression stockings that help prevent blood clots, or a regular injection with heparin until you are fully mobile.

A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home again within a few days.

With the enhanced recovery programme, most people are well enough to go home within five to six days of their operation. The timing depends on when you and the doctors and nurses looking after you agree that you are well enough to go home.

Want to know more?

• Beating Bowel Cancer: Returning home after surgery (PDF, 44Kb).
• Cancer Research UK: After your operation for bowel cancer.

Coping with a colostomy

If you need a colostomy, you may feel worried about how you look and how others will react to you. Information and advice about living with a stoma - including stoma care, stoma products and ‘stoma-friendly’ diets - is available via the ileostomy and colostomy topics.

Want to know more?

• Cancer Research UK: Coping with a stoma after bowel cancer.
• Colostomy Association.

Diet after bowel surgery

If you have had part of your colon removed, it is likely that your stools (faeces) will be looser because one of the functions of the colon is to absorb water from the stools. This may mean that you experience repeated episodes of diarrhoea.

You should inform your care team if diarrhoea becomes particularly troublesome because medication is available to help control symptoms.

You may find that some foods upset your bowels, particularly during the first few months after your operation.

Different foods can upset different people, but food and drink that is commonly known to cause problems include:

• rich and fatty food,
• fruit and vegetables that are high in fibre, such as beans, cabbages, apples and bananas, and 
• fizzy drinks, such as cola and beer.

You may find it useful to keep a food diary to record the effects of different foods on your bowel.

If you find that you are having continual problems with your bowels as a result of your diet, and/or you are finding it difficult to maintain a healthy diet, you should contact your care team. You may need to be referred to a dietitian for further advice.

Want to know more?

• Cancer Research UK: Diet after bowel cancer.
• Beating Bowel Cancer: Diet and bowel cancer. 
• Bowel Cancer UK: Eating after bowel surgery (PDF, 184kb).

Sex and bowel cancer

Having cancer and its treatment may affect how you feel about relationships and sex. Although most people are able to enjoy a normal sex life after bowel cancer treatment, if you have had a colostomy you may feel self-conscious or uncomfortable.

Talking about how you feel with your partner may help you both to support each other. Or you may feel that you’d like to talk to someone else about your feelings, your doctor or nurse will be able to help.

Want to know more?

• Cancer Research UK: Sex and bowel cancer.
• Beating Bowel Cancer: Body image/sexual health.

Financial concerns

A diagnosis of cancer can cause money problems because you are unable to work or someone you are close to has to stop working to look after you. There is financial support available for carers and for you if you have to stay off work for a while or have to stop work because of your sickness. 

Free prescriptions

People being treated for cancer are entitled to apply an exemption certificate giving free prescriptions for all medication, including that which treats unrelated conditions.

The certificate is valid for five years and you can apply for a certificate by speaking to your GP or cancer specialist.

Want to know more?

• Directgov: Incapacity and other benefits.
• Carers Direct.
• Macmillan: Financial issues.
• Cancer Research UK: Free prescriptions for people with cancer.
• Money Advice Service.

Dealing with dying

If you are told that there is nothing more that can be done to treat your bowel cancer, your GP will still provide you with support and pain relief. This is called palliative care. Support is also available for your family and friends.

Want to know more?

• Macmillan: Caring for someone with cancer.
• Marie Curie Cancer Care.
• Live Well: End of life care.

Anne Messenger, 65, from London was diagnosed with bowel cancer in 2005. After keyhole surgery, she is now in the clear and focused on helping others.

“For years I’d suffered from indigestion and I thought I had irritable bowel syndrome, but when I noticed I had passed a little bit of blood, I went to the doctor. I was referred to St George's Hospital for tests and, following a stool sample, I was told I had a peptic ulcer. However, when I had a routine colonoscopy, doctors discovered that it was bowel cancer.

"It turned out that the initial bleeding had nothing to do with the cancer, so I’m fortunate that whatever caused it put me in a position where the doctors could pick up on the cancer. 

"Not long after my diagnosis, I was given a date for an operation to remove the cancer. I had a full body scan and the consultant told me that everything looked straightforward. They would perform keyhole surgery and I wouldn’t need a colostomy.

"Leading up to the surgery, I had another colonoscopy, in which purple dye was used to pinpoint where doctors needed to operate. I never thought I’d have any problems, as I was naturally upbeat.

"The operation went well and they removed an 8cm (3 inch) growth. Doctors told me there was a 20% chance of recurrence, which would be halved if I had a course of chemotherapy. I began chemotherapy two weeks after my operation, but I had a bad reaction to it and had to stop. 

"For the two years after my operation, I had a check-up every three months. I now have one every six months. I had my last cigarette on the morning of my operation and I have become more aware of what I eat. My diet includes lots more fruit and veg.

"My advice is to try to take a bit of control and understand what is happening to you. Pay attention and always make a note of things to ask the consultant. You don’t want to fuss, but you also don’t want the consultant to say, ‘You should have come to see me about this two months ago.' People can find doctors intimidating, but they’re nice to everyone, so if something is worrying you, just ask. I used to call up or write to my doctor if I had any worries, and I'd take my husband with me if I was going to an appointment where I needed to take in information or make decisions about my treatment.

"Also, try to carry on as if you’re going to be fine. I did, and because of that, my family coped well.

"I am now on the cancer committee at St George's. I think it's best to face cancer head on, and people who survive have a better view of life than most."

Lester and his wife Carolyn talk about his experience of bowel cancer, and offer their advice to others.

Linda recalls the day she first noticed her bowel cancer warning symptoms, and regrets not seeing her doctor straight away.

People who have been through cancer treatment talk about what kept them going and the practicalities of treatment.