Bowel cancer


Overview

Bowel cancer is cancer in any part of the large bowel (colon or rectum). It is sometimes known as colorectal cancer and might also be called colon cancer or rectal cancer, depending on where it starts. Cancer of the small bowel is very rare – it is called small bowel cancer or small intestine cancer. For information on its treatment and management, call 13 11 20.

Bowel cancer grows from the inner lining of the bowel (mucosa). It usually develops from small growths on the bowel wall called polyps. Most polyps are harmless (benign), but some become cancerous (malignant) over time.

If untreated, bowel cancer can grow into the deeper layers of the bowel wall. It can spread from there to the lymph nodes. If the cancer advances further, it can spread (metastasise) to other organs, such as the liver or lungs.

In most cases, the cancer is confined to the bowel for months or years before spreading. The National Bowel Cancer Screening Program aims to improve early detection.

The bowel

The bowel is part of the lower gastrointestinal tract, which is part of the digestive system. The digestive system starts at the mouth and ends at the anus. It helps the body break down food and turn it into energy. It also gets rid of the parts of food the body does not use.

The small bowel (small intestine)

This is a long tube (4–6 m) that absorbs nutrients from food. It is longer but narrower than the large bowel. It has three parts:

  • duodenum – the first section of the small bowel; receives brokendown food from the stomach
  • jejunum – the middle section of the small bowel
  • ileum – the final and longest section of the small bowel; transfers waste matter to the large bowel.

The large bowel (large intestine) This tube is about 1.5 m long. It absorbs water and salts, and turns what is left over into solid waste matter (known as faeces, stools or poo when it leaves the body). The large bowel has three parts:

  • caecum – a pouch that receives waste from the small bowel; the appendix is a small tube hanging off the end of the caecum
  • colon – the main working area of the large bowel, the colon takes up most of the large bowel's length and has four parts: ascending colon, transverse colon, descending colon and sigmoid colon
  • rectum – the last 15–20 cm of the large bowel.

The anus This is the opening at the end of the bowel. During a bowel movement, the anal muscles relax to release faeces. Anal cancer is treated differently to bowel cancer: see Understanding Anal Cancer.

How common is bowel cancer?

Bowel cancer is the third most common cancer affecting people in Australia. It is estimated that about 15,250 people are diagnosed with bowel cancer every year. About one in 21 men and one in 31 women will develop bowel cancer before the age of 75. It is most common in people over 50, but it can occur at any age. 1

What are the symptoms?

In its early stages, bowel cancer may have no symptoms. This is why screening is important to increase the chance of an early diagnosis. However, many people with bowel cancer do experience symptoms. These can include:

  • blood in the stools or on the toilet paper
  • a change in bowel habit, such as diarrhoea, constipation or smaller, more frequent bowel movements
  • a change in appearance or consistency of bowel movements (e.g. narrower stools or mucus in stools)
  • a feeling of fullness or bloating in the abdomen or a strange sensation in the rectum, often during a bowel movement
  • feeling that the bowel hasn't emptied completely
  • unexplained weight loss
  • weakness or fatigue
  • rectal or anal pain
  • a lump in the rectum or anus
  • abdominal pain or swelling
  • a low red blood cell count (anaemia), which can cause tiredness and weakness
  • rarely, a blockage in the bowel.

Not everyone with these symptoms has bowel cancer. Other conditions, such as haemorrhoids, diverticulitis (inflammation of pouches in the bowel wall) or an anal fissure (cracks in the skin lining the anus), can also cause these changes. Changes in bowel function are common and often do not indicate a serious problem. However, any amount of bleeding is not normal and you should see your doctor for a check-up.

What are the risk factors?

The exact cause of bowel cancer is not known. However, research shows that people with certain risk factors are more likely to develop bowel cancer. Risk factors include:

  • older age – most people with bowel cancer are over 50, and the risk increases with age
  • polyps – having a large number of polyps in the bowel
  • bowel diseases – people who have an inflammatory bowel disease, such as Crohn's disease or ulcerative colitis, have a significantly increased risk, particularly if they have had it for more than eight years
  • lifestyle factors – being overweight, having a diet high in red meat or processed meats such as salami or ham, drinking alcohol and smoking
  • strong family history – a small number of bowel cancers run in families (see below)
  • other diseases – people who have had bowel cancer once are more likely to develop a second bowel cancer; some people who have had ovarian or endometrial (uterine) cancer may have an increased risk of bowel cancer
  • rare genetic disorders – a small number of bowel cancers are associated with an inherited gene (see below).

Some things reduce your risk of developing bowel cancer, including being physically active, maintaining a healthy weight, cutting out processed meat, cutting down on red meat, drinking less alcohol, not smoking, and eating wholegrains, dietary fibre and dairy foods. Talk to your doctor about whether you should take aspirin, which has been shown to reduce the risk of developing bowel cancer.

Can bowel cancer run in families?

Sometimes bowel cancer runs in families. If one or more of your close family members (such as a parent or sibling) have had bowel cancer, it may increase your risk. This is especially the case if they were diagnosed before the age of 55, or if there are two or more close relatives on the same side of your family with bowel cancer. A family history of other cancers, such as endometrial (uterine) cancer, may also increase your risk of developing bowel cancer.

Some people have an inherited faulty gene that increases their risk of developing bowel cancer. These faulty genes cause a small number (about 5–6%) of bowel cancers. There are two main genetic conditions that occur in some families:

  • Familial adenomatous polyposis (FAP) – This condition causes hundreds of polyps to form in the bowel. If these polyps are not removed, they may become cancerous.
  • Lynch syndrome – This syndrome is characterised by a fault in the gene that helps the cell's DNA repair itself.

If you are concerned about your family history, talk to your doctor about having regular check-ups or ask for a referral to a family cancer clinic. To find out more, call Cancer Council 13 11 20.

For an overview of what to expect during your cancer care, visit What to expect - Bowel cancer. This is a short guide to what is recommended from diagnosis to treatment and beyond.

Which health professionals will I see?

Your general practitioner (GP) will arrange the first tests to assess your symptoms, or further tests if you have had a positive screening test. If these tests do not rule out cancer, you will usually be referred to a specialist, such as a colorectal surgeon or a gastroenterologist. The specialist will arrange further tests. If bowel cancer is diagnosed, the specialist will consider treatment options. Often these will be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting. During and after treatment, you may see a range of health professionals who specialise in different aspects of your care.

Health professionals you may see
Role
GP assists with treatment decisions; provides ongoing care in partnership with specialists
colorectal surgeon* diagnoses bowel cancer and performs bowel surgery
gastroenterologist* diagnoses and treats disorders of the digestive system, including bowel cancer; may perform endoscopy
medical oncologist* treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy (systemic treatment)
radiation oncologist* treats cancer by prescribing and overseeing a course of radiation therapy
cancer care coordinator coordinates your care, liaises with MDT members, and supports you and your family throughout treatment; may be a clinical nurse consultant (CNC) or colorectal cancer nurse
operating room staff include anaesthetists, technicians and nurses who prepare you for surgery and care for you during the operation and recovery
nurse administers drugs and provides care, information and support throughout treatment
stomal therapy nurses provides information about surgery and can support you to adjust to life with a temporary or permanent stoma
dietitian recommends an eating plan to follow while you are in treatment and recovery
genetic counsellor provides advice for people with a strong family history of bowel cancer or with a genetic condition linked to bowel cancer
social worker links you to support services and helps you with emotional, practical or financial issues
physiotherapist, occupational therapist assist with physical and practical problems, including restoring movement and mobility after treatment, and recommending aids and equipment
counsellor, psychologist help you manage your emotional response to diagnosis and treatment

*specialist doctor

Expert content reviewers:

A/Prof Craig Lynch, Colorectal Surgeon, Peter MacCallum Cancer Centre, VIC; Prof Tim Price, Medical Oncologist, The Queen Elizabeth Hospital, Adelaide, and Clinical Professor, Faculty of Medicine, The University of Adelaide, SA; Department of Dietetics, Liverpool Hospital, NSW; Dr Hooi Ee, Gastroenterologist, Sir Charles Gairdner Hospital, WA; Dr Debra Furniss, Radiation Oncologist, Genesis CancerCare, QLD; Jocelyn Head, Consumer; Jackie Johnston, Palliative Care and Stomal Therapy Clinical Nurse Consultant, St Vincent's Private Hospital, NSW; Zeinah Keen, 13 11 20 Consultant, Cancer Council NSW; Dr Elizabeth Murphy, Head, Colorectal Surgical Unit, Lyell McEwin Hospital, SA.

1. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: colorectal (bowel) cancer, AIHW, Canberra, December 2017.

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