Bowel Cancer

To get to the heart of the matter I recently interviewed a respected clinical specialist with many years' experience and expertise in the management of bowel cancer, Dr Alistair King. Dr King is a Hertfordshire-based Consultant Gastroenterologist, and is clinical lead and screening colonoscopist for the West Herts Bowel Cancer Screening Centre. He also has a specialist interest in the treatment of pancreatic & biliary disorders, viral hepatitis and other gastrointestinal cancers. Dr King knows first-hand the impact of bowel cancer on people's lives and he kindly took the time to provide us all with some key information and practical advice which I'll share here in Q & A format.

Q. Dr King, how common is bowel cancer (in the areas you work in, nationally and internationally)?

A. Bowel cancer is the UK's third most common cancer. 34,900 people are diagnosed with bowel cancer in the UK every year, ie one person is diagnosed every 15 minutes. One in 20 women and 1 in 18 men will be diagnosed with bowel cancer at some point in their lives.

Q. Are there certain people who are more likely to develop bowel cancer?

A. The biggest predictor of bowel cancer is advancing age, with 85% of cases occurring in those aged 60 or over. Individuals with one first degree relative (mother, father, son, daughter, brother, sister) diagnosed before the age of 45, or with two first degree relatives diagnosed at any age also have an increased risk, and should contact their doctor to talk about possible screening.

Q. What proportion of people with bowel cancer are likely to actually die from it?

A. 50% of people diagnosed with bowel cancer die of it, usually within 5 years of diagnosis. This works out as 16,100 deaths per year in the UK with one person dying of bowel cancer every 30 minutes.

Q. What causes bowel cancer and is there anything individuals can do to prevent or avoid developing it?

A. There is no one cause of bowel cancer, but probably a complex interaction of multiple factors. Genetics are likely to play an important role, hence the disease sometimes runs in families as described previously. There is also some evidence that lack of exercise, being overweight, and a diet high in red meat, low in fruit and vegetables, and low in fiber leads to an increased risk of bowel cancer. Hence efforts to improve diet and lifestyle are likely to be helpful, however are no guarantee against developing the condition.

Q. Is there anything you as a doctor can do to help prevent the disease?

A. The earlier a cancer is detected, the more likely the patient can be cured. Bowel cancer awareness campaigns encourage people with typical symptoms to seek medical help. This can be difficult as people are often reluctant to talk about bowel related issues, nonetheless it is very important. Typical symptoms of bowel cancer would be change in bowel habit to looser, blood in the stool, anemia (low blood count), and unexplained weight loss.

The National Bowel Cancer Screening Programme is now up and running across most of the country including Hertfordshire. This consists of a free stool testing kit sent through the post to all 60-69 year olds, and from April 2010 tests will also be sent to 70-75 year olds. 2% of individuals have an abnormal stool test and are referred to a screening center for further investigations. This program is already detecting many cancers at an early stage before the patient has any symptoms. At this stage curative treatment is much more likely to be successful.

Q. Briefly, how is bowel cancer treated?

A. Most bowel cancer is treated with surgery, where the section of the bowel affected by the cancer is removed. In most patients the remaining bowel is joined together again, and the patient's bowel continues to function as normal. Patients with more advanced cancers may also require chemotherapy (cancer drug treatment) in order to improve the chance of longterm cure. Sadly, if the tumor has spread beyond the bowel wall, or to other organs, the chance of cure is very small, but chemotherapy may be given to improve symptoms, and to improve survival.

Q. How effective/successful are the various treatments?

A. Treatments for colon cancer are very effective but are crucially dependent on how advanced the disease is at presentation. Early cancers confined to the inner lining of the bowel are cured in 85-95% of patients. However, if the tumor has spread to other organs, the chance of surviving the disease more than 5 years is less than 10%.