FAQ's

What is bowel cancer?

Is there a cure?

What are the causes?

What are the symptoms?

Who is at risk?

Can diet and exercise help prevent bowel cancer?

Should I have a check-up?

What is Irritable Bowel Syndrome (IBS)?

What are Complementary therapies?

What is a Barium Enema?

What is a Colonoscopy?

What is a Digital Rectal Examination (DRE)?

What is Sigmoidoscopy?

What is Chemotherapy?

What is Radiation Therapy?

What is Surgery?

What is an FOBT?

What is bowel cancer?

The colon is the part of the digestive system where the waste material is stored. The rectum is the end of the colon adjacent to the anus. Together, they form a long, muscular tube called the large intestine (also known as the large bowel). Tumours of the colon and rectum are growths arising from the inner wall of the large intestine.

Benign tumours of the large intestine are called polyps. Malignant tumours of the large intestine are called cancers. Benign polyps do not invade nearby tissue or spread to other parts of the body. Benign polyps can be easily removed during colonoscopy, and are not life threatening.

If benign polyps are not removed from the large intestine, they can become malignant (cancerous) over time. Most of the cancers of the large intestine are believed to have developed from polyps. Cancer of the colon and rectum (also referred to as colorectal cancer) can invade and damage adjacent tissues and organs. Cancer cells can also break away and spread to other parts of the body (such as liver and lung) where new tumours form.

The spread of colon cancer to distant organs is called metastasis of the colon cancer. Once metastasis has occurred in colorectal cancer, a complete cure of the cancer is unlikely.

Is there a cure?

Surgery is the most common treatment for colorectal cancer. During surgery, the tumour, a small margin of the surrounding healthy bowel, and adjacent lymph nodes are removed. The surgeon then reconnects the healthy sections of the bowel. In patients with rectal cancer, the rectum is permanently removed. The surgeon then creates an opening (colostomy) on the abdomen wall through which solid waste in the colon is excreted. Specially trained nurses (enterostomal therapists) can help patients adjust to colostomies, and most patients with colostomies return to a normal lifestyle.

The long term prognosis after surgery depends on whether the cancer has spread to other organs (metastasis). The risk of metastasis is proportional to the depth of penetration of the cancer into the bowel wall. In patients with early colon cancer which is limited to the superficial layer of the bowel wall, surgery is often the only treatment needed. These patients can experience long term survival in excess of eighty percent. In patients with advanced colon cancer, wherein the tumour has penetrated beyond the bowel wall and there is evidence of metastasis to distant organs, the five year survival rate is less than ten percent.

What are the causes?

The exact causes of bowel cancer are not certain, but it is believed that lifestyle and environmental factors, such as a high-fat, low-fibre diet and a lack of physical activity can contribute to the disease. Polyps on the bowel, even if initially benign, can become malignant and lead to cancer.

What are the symptoms?

Any unexplained changes in bowel habits could be symptoms of bowel cancer including:

• constipation or diarrhoea
• blood in faeces (stools)
• rectal bleeding
• persistent colicky pain in the abdomen
• chronic tiredness
• bloating or frequent gas pains
• feeling of fullness and/or cramps
• a feeling that the bowel is not empty after passing a stool
• anaemia
• lumps or masses in the abdomen
• unaccountable weight loss
• constant tiredness or sense of malaise

These symptoms are also indicators of other diseases and conditions. Rectal bleeding, for example, is often a sign of haemorrhoids, a relatively harmless condition. However, if you are uncertain about any bleeding you should check with your doctor, particularly if you are over 50, as the incidence of bowel cancer increases with age.

Who is at risk?

Cancer is a disease that affects mainly older people, with 65% of cases occurring in those over 65. As the average life expectancy in Australia has almost doubled since the mid nineteenth century the population at risk of cancer has grown. Death rates from other causes of death, such as heart disease, have fallen in recent years while deaths from cancer have remained relatively stable.

The result is that 1 in 2 people will be diagnosed with cancer during their lifetime and 1 in 4 people will die from cancer.

There are over 200 different types of cancer but the four major types, lung, breast, prostate and colorectal, account for over half of all cases diagnosed.

Together, cancers of the colon and rectum are among the most common cancers. They occur in both men and women and are most often found among people who are over the age of 50.

"Colorectal cancer - afflicts one in 20 Australians during their lifetime and kills almost half of those with the disease."

(Professor Robert Thomas, of the National Health & Medical Research Council, 1998)

The incidence of Bowel Cancer is alarming, as the following statistics will verify:

• World-wide about 1,023,000 (Globocan 2002) people are diagnosed with colorectal cancer each year - 9% of all cancers
• Of those diagnosed, about 528,978 (Globocan 2002) people die each year
• Australia, North America, Japan and Western Europe have the highest incidences and deaths in the world
• In Australia doctors diagnose about 13,076 (AIHW 2005) new cases of colorectal cancer every year - 13% of all cancers
• Of those diagnosed, about 4,165 (AIHW 2005) people die each year
• More than 20,000 (AIHW 2005) Australians are diagnosed with cancer of the digestive system every year
• Mortality rates are still in excess of 35%
• Bowel cancers comprise approximately two thirds (2/3) of all digestive tract cancers
• Cancers of the digestive system account for one third (1/3) of all deaths from cancer
• The incidence of bowel cancer in Australia is among the highest in the world
• The incidence of bowel cancer has increased by 20% in the last twenty (20) years

Can diet and exercise help prevent bowel cancer?

Eating five or more portions a day of fruit and vegetables as well as regular servings of wholegrain cereal fibres and wheat bran are recommended as part of a healthy diet which may help prevent bowel cancer. Drinking two litres (about 8 glasses) of water also helps retain an active bowel that can effectively eliminate waste.

A "healthy bowel" diet should include a range of low-fat, high fibre whole foods diet such as the cruciferous (leafy green) vegetables, cabbage and broccoli, wholemeal and wholegrain products and pulses. Calcium intake should be around 1000 to 1200 mg per day for adults aged 30 and older. As a guide, one cup of skim milk provides just over 300mg of calcium. Reducing red meat, full-fat dairy products, sugar, salt and spicy foods, controlling alcohol consumption and avoiding becoming overweight are also recommended.

Studies have linked the consumption of charred meats with bowel cancer. Meats cooked at high temperatures undergo a chemical transformation which can create carcinogenic (cancer causing) compounds in the food.

Red meats, poultry, and fish that are grilled/barbecued, broiled, or pan-fried for extended periods are the main contributors to this so it is recommended that eating charred meats be avoided.

Exercise is also considered a preventative measure that maintains a healthy bowel. A minimum of 30 minutes aerobic exercise three times a week is advised.

Should I have a check-up?

Authorities recommend a digital rectal examination as part of a regular physical check-up regardless of whether or not symptoms are present, particularly if there is a family history of the disease. From age 40, a yearly faecal occult blood test is recommended. Bowel cancer-related bleeding may not be visible and this test enables doctors to determine conclusively if there is blood in the stool. From age 50, a sigmoidoscopy is recommended every 3 to 5 years.

National bowel cancer screening program click here

What is Irritable Bowel Syndrome (IBS)?

Irritable Bowel Syndrome is known as a functional disorder commonly characterized by abdominal pain or frequent bowel movements, diarrheadiarrhoea, or constipation.

Irritable Bowel Syndrome affects up to 20% of the general population. To find out more information about IBS link to the relevant websites or see your local general practitioner who may refer to a gastroenterologist.

What are Complementary therapies?

Complementary therapies are those used alongside medical treatments such as after Surgery, Chemotherapy and Radiation therapy. A number have shown to be beneficial and improve the quality of life and reduce pain. Unfortunately, each person may react differently to the diverse types available. They have not been proven to cure or prevent cancer and some types may even have adverse side effects or negate medical treatments. It is important to consult with your medical staff before making a decision to use complementary therapies.

What is a Barium Enema?

A Barium Enema is a procedure used to examine the lining of the colon and rectum. Barium refers to the barium sulphate, a chalky chemical that appears white on X-ray film. Enema refers to any fluid pumped into the rectum through the anus. After the barium sulphate liquid makes its way to your intestines, a series of X-ray pictures are taken. In these X-rays, the white barium fluid allows some abnormalities in the lining of the intestines to appear dark. The procedure is done as an outpatient at a hospital and takes less than an hour.

A Barium Enema is used to check for tumours of the colon and rectum. It also can also be used to check for polyps.

What is a Colonoscopy?

A Colonoscopy is a common procedure that allows examination of the large bowel (colon) by the means of a colonoscope. It is possible to investigate the whole colon up to and including the caecum and even the ileum (at the end of the small intestine). Colonoscopy is important in surveillance of possible colorectal cancers.

Colonoscopy uses a flexible, tubular instrument that has a special light at its end and equipment channel in the centre. The colonoscope is inserted via the rectum after the patient is given a sedative injection or a light anaesthetic.

Colonoscopy is commonly used for the removal of polyps to prevent the development of malignancy. Most polyps can be burnt off by placing a wire snare around the base and applying an electric current. If necessary, small samples, or biopsies, of the bowel can be taken for examination.

The outpatient is given a special diet and laxatives two days prior and may eat nothing six hours prior to the procedure. The procedure takes around one hour to complete. The outpatient is kept in for a further two hours for observation.

What is a Digital Rectal Examination (DRE)?

A DRE is conducted to check for problems with organs or other structures in the pelvis and lower stomach. During the examination, a health professional gently puts a lubricated, gloved finger of one hand in the rectum. The other hand may be used to apply pressure to the lower stomach or pelvic area.

The DRE is done to help find the cause of symptoms such as rectal bleeding (blood in stool), stomach or pelvic pain, or a change in bowel habits. It is used to collect a stool sample to test for blood in the stool. It is also done to check for growths, such as cancer, in the rectum.

DRE alone is not used to diagnose colorectal cancer.

What is Sigmoidoscopy?

A sigmoidoscopy is a technique of directly visualizing the lower part of the bowel, rectum and the sigmoid colon in order to see abnormalities.

Sigmoidoscopy is performed without an anaesthetic and whilst the patient is awake. The rigid sigmoidoscope is a narrow, straight metal or plastic tube with a light source attached, which enables the examining doctor to look inside the bowel at its inside surface. The flexible sigmoidoscope allows the same examination, but uses fibre-optic technology in a device that can be manipulated to look in different directions. In both cases air is gently pumped into the rectum.

A sigmoidoscopy is performed for rectal bleeding, chronic diarrhoea - especially with blood and mucus, weight loss, or a feeling of incomplete evacuation of the bowels. These symptoms may indicate an infection or inflammation of the colon, or even a tumour of the rectum or sigmoid colon. Bleeding may also be from a less serious cause such as a polyp, or from dilated fragile blood vessels.

What is Chemotherapy?

Chemotherapy is the term used for any treatment involving the use of chemical anti-cancer drugs to stop cancer cells from growing. In most treatments a number of drugs may be given at the same time. Chemotherapy can eliminate cancer cells at sites great distances from the original cancer.

Chemotherapy may be used before or after surgery or radiation therapy or together with radiation therapy. Chemotherapy can be administered through a vein, injected into a body cavity, or orally (mouth) in the form of a pill. Chemotherapy can be given for a few days or a few weeks, for a period of months or a long term basis depending on the nature of diagnosis and the person's ability to respond to treatment.

In most circumstances chemotherapy should not cause any discomfort, however some medications can cause a burning sensation in the veins. It is important to keep in immediate contact with the chemotherapy staff if there is any pain, burning, redness or tenderness in the body or over the injection site.

Chemotherapy is given to cure cancer, reduce the chance of cancer returning or to shrink a cancer prior to primary treatment, such as surgery or radiation therapy. If a cure is not possible, it can also be used to shrink cancer to reduce the symptoms and ultimately prolong the quality of life.

Chemotherapy can cause a number of different side effects which are often temporary and can usually be treated by other medications. These include; fatigue, nausea, vomiting, hair loss, diarrhoea, constipation, mouth sores or ulcers, muscle weakness, loss of appetite, increased risk of infection, increased risk of bruising, dry or tired eyes, skin sensitivity to sunlight.

Chemotherapy may include time away from family and friends, uncomfortable side effects or long-term complications. Chemotherapy may be inconvenient, prolonged, or unavailable close to home. These are important considerations when evaluating treatment options.

Cancer & Bowel Research Trust provides private and dignified Patient Accommodation for persons living outside 100km from the metropolitan hospital they must travel to.

What is Radiation Therapy?

Radiation therapy, also commonly known as radiotherapy, uses x-rays to destroy or injure cancer cells so they cannot multiply. Radiation therapy can be used to treat the primary cancer or advanced cancer. It may be the only treatment used or in combination with chemotherapy and/or surgery.

Radiation therapy is used to cure, maintain the cancer or bring relief of the symptoms.

Radiation therapy is given by a radiation oncologist who is a specialist treating cancer with radiation therapy. The oncologist will supervise the treatment via radiation therapy machines operated by a trained therapist.

Radiation therapy is given internally (bracytherapy) or externally (beam). In internal radiation therapy, thin tubes are filled with radioactive material and placed in your body or close to the cancer. In external radiation therapy, radiation is directed by a machine towards the cancer and surrounding tissue.

External radiation therapy can last anywhere from one day to five days a week for a number of weeks. In most circumstances external radiation therapy will not hurt, you will only here a buzzing sound when the machine is on. You will not become radioactive.

Internal radiation therapy can last anywhere from a number of minutes, one to five days or permanently. In most circumstances internal radiation therapy you will not feel ill or have any major pain, just mild discomfort from the implant. It may send radiation outside your body and there will be limits to visits during this therapy.

Radiation therapy can cause a number of different side effects which are often temporary and can gradually disappear once treatment has been completed. These include; fatigue, nausea, dry red or itchy skin, digestive problems, dry or sore throat or mouth, swelling, coughing or shortness of breath.

Radiation therapy may include time away from family and friends, uncomfortable side effects or long-term complications. Radiation therapy may be inconvenient, prolonged, or unavailable close to home. These are important considerations when evaluating treatment options.

Cancer & Bowel Research Trust provides private and dignified Patient Accommodation for persons living outside 100km from the metropolitan hospital they must travel to.

What is Surgery?

Surgery is performed on bowel cancer after diagnosis has been made conclusively. It is the most common treatment which can completely cure the person of bowel cancer if detected early. In some instances there is no need for additional radiation therapy or chemotherapy.

Surgery involves removing the cancer and any surrounding tissue that may be affected by it to ensure no cancer is left behind. It is most common that after treatment the bowel can be joined together again to restore normal function. In some instances the bowel cannot be rejoined, hence an artificial opening (colostomy) is made in the wall of the abdomen to allow faecal waste to pass through it. After surgery and sufficient time a temporary colostomy can be reversed and normal function is regained. Only a small percentage of persons may need a permanent colostomy for the future.

Surgery to the bowel will require a stay of anywhere up to 10 days in hospital. This will then follow by a recovery of up to 6 weeks at home. If the tumour is large and has spread to lymph nodes the hospital may recommend further treatment. A combination of radiation therapy and chemotherapy will help maintain the cancer or achieve full recovery.

What is an FOBT?

An FOBT (faecal occult blood test) is a simple, do it yourself, test kit. It involves taking 2 or 3 separate bowel motions (faeces) in the comfort of your home. Once these samples have been taken they are then sent to a laboratory for testing.

The FOBT analyst is looking for small traces of blood in the bowel motion. Blood can be an early sign of bowel cancer or a polyp, which is a growth on the inside of the bowel which can develop into cancer. If blood is found, further tests will be ordered to investigate the nature of the bleeding.

Persons who are over the age of 40 with a family history or people over the age of 50 without symptoms and with a family history of bowel cancer are encouraged to do an FOBT every 2 years.

If you are turning 50, 55 or 65 between 1 January 2008 and 31 December 2010, the Australian Government will send you a free FOBT as part of the National Bowel Cancer Screening Program.

General Practitioners can provide FOBTs with payment, pharmacies sell FOBTs and some health insurance funds provide FOBTs to their clients.