Most people diagnosed with colonic cancer are over the age of 60.

Miss Boorman offers treatment and management for most colonic cancers.

Colorectal Cancer

Colonic cancer can occur anywhere in the colon. The cells that line the colon may become damaged such that they begin to divide in an uncontrolled way. This may lead to the formation of a polyp or eventually a cancer.

It is the third most common cancer in men and the second most common cancer in women in the UK with 40,000 cases diagnosed each year.

What are the symptoms?

Common symptoms include:

• Bleeding from the back passage
• A change in the frequency of bowel activity
• Abdominal pain
• Weight loss and poor appetite

However these symptoms are very common and are usually NOT due to colonic cancer.

How is the diagnosis made?

To make a diagnosis of colonic cancer it is essential to examine the colon either with a flexible telescope (flexible sigmoidoscope or colonoscope) or a special test called CT colonography. During colonoscopy if a cancer is seen a tiny portion of tissue (biopsy) is taken from the cancer for laboratory examination and a tattoo is often placed. In addition a CT scan will be arranged to examine the lungs and liver to check that the cancer has not spread.

How can it be treated?

The best chance of curing colonic cancer is with an operation which aims to remove the segment of colon with the cancer in it along with the blood supply and lymph nodes (glands) that supply it. The type of operation will depend on the location of the cancer.

• Right hemicolectomy involves removing the appendix and colon on the right side of the body and joining the small bowel back up to the colon so that the bowel functions normally.
  
• Left hemicolectomy or sigmoid colectomy involves removing the colon on the left side of the body and joining the bowel back up together so that the bowel functions normally.
  
• Subtotal colectomy involves removing the whole colon and usually joining the small bowel to the rectum.

These are the commonest types of operations but there are others which may be discussed and can be fully explained by your surgeon.

These operations can be done with a single large incision (open surgery) or multiple small incisions (‘key-hole’ or laparoscopic surgery). The way in which the operation is to be performed depends on a number of factors relating to you, the cancer and your surgeon.

Is a stoma necessary?

A colostomy , or artificial opening of the colon on to the abdominal wall is NOT usually necessary in these operations. The possibility of requiring a stoma will be discussed with you and if it is required then you will get all the support that you need.

Are there any other forms of treatment?

• Chemotherapy: Once you have recovered from your surgery and the cancer has been thoroughly examined by the pathologist it may be appropriate to recommend a course of chemotherapy. This will depend upon your general state of health and the stage of the cancer. The stage of cancer gives an indication as to whether the cancer has spread to other organs (usually the glands close to the bowel, the liver or lungs). The stage of cancer is assessed by a combination of the tests that you had before your operation (CT) and the pathologist’s opinion when the cancer is examined under the microscope. If chemotherapy is recommended then you will be able to discuss it further with a specialist in this field (oncologist).
  
• Liver surgery: If the cancer has spread to the liver it may still be possible to attempt to cure the cancer by removing a segment of the liver at an operation. If this is recommended then you will be able to discuss it further with a specialist in this field (hepatobiliary surgeon).
  
• Colostomy: Some cancers can cause a blockage to the bowel and it may be recommended that a colostomy be performed to prevent this. This is particularly the case if you are very frail or the cancer has spread to many other organs. All treatment options will be discussed fully with you and, with your permission the people important to you, before any decisions are made.

What are the chances of cure?

Appropriate surgery offers the best chance of cure possibly combined with chemotherapy. The earlier the cancer is detected and treated then the more likely the cure. In early cancers the cure rate is greater then 90%, in cancers at a more advanced stage then the chances of cure are less than 50%.

Will I need to be seen again?

You will be checked on a regular basis following your treatment. The frequency with which you will be seen will depend on the stage of cancer and will be tailored to your own particular circumstances. This will usually include visits to the clinic, CT scans and colonoscopy.

Further information

https://www.bowelcanceruk.org.uk/about-bowel- cancer/

https://www.cancerresearchuk.org/

https://www.nhs.uk/conditions/bowel-cancer/

Bowel Cancer Screening

This is a way to pick up bowel cancer when it is relatively easy to cure and before it gives rise to symptoms.

Is bowel cancer important?

YES. After lung cancer, bowel cancer kills more people in Britain each year than any other form of cancer. That is – it kills more people than breast cancer; it kills more people than cancer of the prostate; and it kills more people than cervix cancer. Yet it is often forgotten and rarely talked about.

What is screening and how does it work?

Screening aims to detect a disease before symptoms appear. For cancer, this might mean catching it at an earlier stage, when treatment offers a better chance of cure.

How can you screen for bowel cancer?

Most bowel cancers bleed to a greater or lesser extent. A special test (“faecal occult blood test”) that detects tiny amounts of blood in the bowel motion has been proven to detect cancers at an earlier stage.

We currently have two arms to screening in the UK. The first is a one-off test called bowel scope screening which is currently being offered in England to men and women aged 55 years. During this a thin telescope is passed into the left side of the bowel and it identifies any cancer and allows removal of any growths called polyps that may in the future become cancerous.

The second uses the faecal occult blood test (FOBt) and is offered to men and women aged 60-74 years (with the exception of Scotland where FOBt screening starts at 50). This test is very easy to perform. Every 2 years a kit is sent to your home in the post for you to perform and return. After the age of 74 you can request a kit if you wish every two years. If your test
is positive you may be called for a telescope test of the bowel called a colonoscopy. For every 1000 people screened only 16 need this procedure and only 2 will have a cancer.

It is important to note that even if your bowel scope test is normal you must still participate in FOBt screening to ensure you get the most benefit out of screening. If following a screen test you notice new symptoms such as change in bowel habit or bleeding you should still see your doctor.

Does screening for bowel cancer work?

YES. Many studies have proved that people with bowel cancer detected by screening using “faecal occult blood tests” and bowel scope screening are more likely to be cured than those who wait for symptoms to develop.

What are the benefits of screening?

You may be one of those who has a bowel cancer growing that has not yet produced symptoms. In general, bowel cancers detected by screening have a better outlook than cancers found in people with symptoms.

What are the disadvantages?

It is important to know that the majority of people with a positive bowel motion test have nothing seriously wrong with their bowel. However, once the bowel has been checked out they can have peace of mind.

Although the bowel motion tests are better at predicting cancer than any symptom, sometimes patients with cancer can return a negative test. Therefore, you should always report any worrying bowel symptoms to your doctor.

The most important are: bleeding from the back passage and change in the normal bowel pattern, particularly when these have continued over a six week period or more.

Further information

https://www.bowelcanceruk.org.uk

https://www.cancerresearchuk.org

https://www.nhs.uk/conditions/bowel-cancer- screening/pages/introduction.aspx

Rectal cancer

Rectal cancer is the third most common cancer in men and the second most common cancer in women in the UK with 40,000 new diagnoses being made each year. The cells that line the rectum may become damaged such that they begin to divide in an uncontrolled way. This may lead to the formation of a polyp or eventually a cancer.

What are the symptoms?

Common symptoms include:

• Bleeding from the back passage
• A change in the frequency of bowel activity
• The passage of mucous or slime
• Weight loss and poor appetite

However, these symptoms are very common and are usually not due to rectal cancer.

How is the diagnosis made?

To make a diagnosis of rectal cancer it is essential to examine the colon and rectum either with a flexible telescope (flexible sigmoidoscope or colonoscope) or a special test called a CT colonography. During colonoscopy a tiny portion of tissue (biopsy) is taken from the cancer for laboratory examination. In addition a CT scan will be arranged to examine the lungs and liver to check that the cancer has not spread. A MRI scan will also be required to help plan the most appropriate course of treatment.

How can it be treated?

The best chance of curing rectal cancer is with an operation which aims to remove the segment of rectum with the cancer in it along with the blood supply and lymph nodes (glands) that supply it. These operations can be done with single large incision (open surgery) or multiple small incisions (‘key-hole’ or laparoscopic surgery). The exact type of operation will depend on the location of the cancer.

• Anterior resection: Involves removing the upper rectum and some of the colon on the left of the body and joining the colon back up to the rectum so that the bowel functions normally.
  
• Abdominoperineal resection (APR): If the cancer is very low in the rectum then it is not possible to remove the cancer without damaging the muscles which control the bowel (sphincters). This would lead to faecal incontinence. In such circumstances it is better to remove a rectum and anus and form a colostomy, or artificial opening of the colon on to the abdominal wall.
  
• Transanal Endoscopic MicroSurgery (TEMS): TEMS is an operation, using a specially designed microscope and instruments, to allow surgery to be performed through the anus (back passage) inside the rectum. It requires no cuts on the outside of the anus or abdomen (tummy). Sometimes, TEMS is used to remove small early cancers from the rectum and so avoid major surgery or when the TEMS operation is considered safer than major surgery. Where necessary, your surgeon will explain these choices to you.

These are the commonest types of operations but there are others which may be discussed and can be fully explained by your surgeon.

Is a stoma necessary?

A stoma (colostomy, ileostomy), or artificial opening of the colon/small bowel on to the abdominal wall is NOT always necessary in these operations. Sometimes it is necessary to have a temporary stoma (for 3 months or so) to allow the bowel join to heal. The possibility of requiring a stoma will be discussed with you and if it is required then you will get all the support that you need.

Are there any other forms of treatment?

• Radiotherapy: Some rectal cancers respond to a course of radiotherapy before surgery. This may make surgery easier and possibly prevent the cancer coming back at the same place. If radiotherapy is recommended then you will be able to discuss it further with a specialist in this field (oncologist).
  
• Chemotherapy: This can be given together with radiotherapy before surgery or on its own. Once you have recovered from your surgery and the cancer has been thoroughly examined by the pathologist it may be appropriate to recommend a course of chemotherapy. This will depend upon your general state of health and the stage of the disease. The stage of disease gives an indication as to whether the cancer has spread to other organs (usually the glands close to the bowel, the liver or lungs). The stage of disease is assessed by a combination of the tests that you had before your operation (CT, MRI) and the pathologist’s opinion when the cancer is examined under the microscope. If chemotherapy is recommended then you will be able to discuss it further with a specialist in this field (oncologist).
  
• Liver surgery: If the cancer has spread to the liver it may still be possible to attempt to cure the cancer by removing a segment of the liver at an operation. If this is recommended then you will be able to discuss it further with a specialist in this field (hepatobiliary surgeon).

All treatment options will be discussed fully with you and, with your permission the people important to you, before any decisions are made.

What are the chances of cure?

Appropriate surgery offers the best chance of cure possibly combined with chemotherapy and radiotherapy. The earlier the cancer is detected and treated then the more likely the cure. In early cancers the cure rate is greater then 90%, in cancers at a more advanced stage then the chances of cure are less than 50%.

Will I need to be seen again?

You will be checked on a regular basis following your treatment. The frequency with which you will be seen will depend on the stage of cancer and will be tailored to your own particular circumstances. This will usually include visits to the clinic, a CT scans and colonoscopy.