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Colorectal cancer (cancer of the colon or rectum) is an important public health problem. In the UK approximately 30,000 new cases of colorectal cancer are diagnosed each year and the disease represents the third most common cause of cancer death after lung and breast cancer. The recent bowel cancer awareness campaign by the government has made many people concerned. Mr Rai answers some of the most common concerns that you may have:

Q. What are the symptoms of Bowel cancer?

The symptoms of bowel cancer are a matter of much debate and form the basis of the current ‘two-week-wait’ fast-track referral system used by GPs to refer patients suspected to have colorectal cancer. The most widely accepted ‘high-risk’ symptoms are (i) change in bowel habit to loose and more frequent stools, (ii) bleeding from the back passage (rectal bleeding) without anal symptoms (iii) blood mixed with stools. These symptoms become more important if you are over 60 years of age and have had these symptoms for 6 or more weeks, or are associated with an important ‘sign’ picked up by your GP when you visit them like an abdominal lump, a lump or mass in your back passage (rectal mass) or unexplained iron deficiency anaemia. However it is important to bear in mind that while it is important you visit your GP if you have these symptoms, it does not necessarily mean that you have bowel cancer. Of every 100 patients referred on the fast-track suspected cancer pathway by the GPs, less than 10 will be diagnosed with bowel cancer.

Q. I have someone in my family diagnosed with bowel cancer, should I be worried?

Yes, but not unduly so. Try to find out who and how many of your relatives were diagnosed and most importantly at what age the diagnosis was made. The vast majority of colorectal cancers happen in older individuals and are not inherited. However inherited factors do play a role in two ways: (i) Inherited syndromes that run in families caused by specific gene abnormalities that predispose to developing colorectal cancer. These contribute to less than 5% of all colorectal cancers and usually require intensive surveillance from a young age and sometimes preventive surgery. (ii) the more common ‘clustering’ or grouping of bowel cancer cases in a family due to inherited and other factors. If you fall in this second category and have one (or more) first degree relatives (sibling or parent) diagnosed with bowel cancer at a young age (less than 50yrs), you may require surveillance with colonoscopy as you would have a higher risk of having colorectal cancer than the general population.

Q. I have inflammatory bowel disease (Ulcerative colitis or Crohn’s disease), does it increase my risk of developing colorectal cancer?

Yes. If you suffer from Ulcerative colitis or Crohn’s disease of the colon, then your risk of developing colorectal cancer increases with each passing decade of having the disease. The risk is more if the disease affects your entire colon and if it was diagnosed at a young age. Regular surveillance colonoscopies with biopsy are therefore a must to pick up any changes developing in the lining of your colon. On average this should happen every two years.

Q. What is bowel cancer screening and should I take part?

Bowel cancer screening is an attempt to detect bowel cancer in individuals who do not have any bowel symptoms but may still be harbouring bowel cancer. Studies have shown that this program helps to detect bowel cancer at an early stage and improves cancer survival rates. In England all men and women aged 60 to 69 years are automatically offered screening through their GP in the form of a stool test kit sent in the post. This aims to pick up any occult (or unseen) blood in your stools and if positive is followed up by an offer of colonoscopy (camera test of the large bowel). If you fall in this age bracket, you must avail of this opportunity.