Bowel cancer is a malignant growth that develops most commonly inside the large bowel. It often develops from tiny growths called “polyps”. The majority of polyps are benign or non-cancerous but because they could be early warning sign for bowel cancer, they should be removed. Some of the polyps may enlarge and become malignant. A cancer can remain then localised in the bowel for some time before spreading outside the bowel. That is why early detection provides a better chance of cure.

The clinical signs of bowel cancer include 1/ blood (either bright or dark red) combined with the bowel motion (faeces) 2/ unexplained loss of weight 3/ recent changes in normal bowel habits (for example, increasing constipation or persistent diarrhoea) 4/ abdominal pain or persistent cramping 5/ feeling of incomplete emptying of the bowel 6/ general tiredness, weakness and breathlessness as symptoms of anaemia secondary to bowel cancer.

Bowel cancer is a preventable disease. Smoking and alcohol use have been shown to be associated with bowel cancer. A diet high in fibre and low in fat (less then 25 percent of total energy intake) is recommended. Daily energy intake has to be restricted (for men less than 2500 calories and for women less then 2000 calories per day). It is also advised that vegetables (5 or more serves), fruits (2 serves) and dietary calcium (1 – 1.2 gm) be consumed each day. Charring of red meat and consumption of processed meats should be limited.

It is important to maintain a healthy body weight. Moderate to vigorous levels of physical activity for 30 to 60 min per day are recommended.

The role of folates, phytonutrients, antioxidant vitamins and selenium supplements is under investigation.
Tests for the detection of bowel cancer include:

Faecal Occult Blood Test (FOBT), which is used to detect blood in bowel motions and requires only the collection of tiny amount of faeces. You can do it in the privacy of your own home and send it then to laboratory for analysis.

Positive FOBT does not necessary indicate bowel cancer (could be other reasons for it) but warrants further investigations. FOBT may detect 60-90% of cancers.

Sigmoidoscopy, when a lighted tube is inserted by the doctor into the lower part of bowel, which allows the rectum and the lower part of the colon to be viewed.

Colonoscopy involves an insertion through the anus a long, thin, flexible tube with a video camera lens on the end, so the doctor can directly examine the surface of the colon and remove any small polyps (and send them to a laboratory for further morphological tests). The procedure is performed under the sedation. Prior to the procedure you will need to have a bowel preparation to clean out the bowel.

Virtual colonoscopy means a CT scan of the bowel.

The National Health and Medical Research Council recommend everyone over 50 years of age should have a FOBT at least every two years. In addition, they are advised to consider having a flexible sigmoidoscopy every five years.

The usual treatment for bowel cancer is surgery. It involves removing the cancer, as well as nearby lymph glands to check if the cancer has spread outside the bowel. Radiation therapy and chemotherapy may be offered to patients with locally advanced or recurrent disease.

Eligible people will be sent a bowel cancer screening kit by mail containing a FOBT and will be asked to take samples from two separate bowel motions before sending the completed test back to a laboratory for analysis. All participants will receive their results in the mail. Those with a positive test will be advised to contact their general practitioner for referral for appropriate follow up, such as assessment colonoscopy (through public or private medical system).

For further information you can contact QBCSP State Coordination Unit on 07 3234 1990 or visit the website www.health.qld.au/bowelcancer