Bowel Cancer

About bowel cancer

Bowel cancer (also known as colon, rectal or colorectal cancer,) is one of the most common forms of cancer in men and women worldwide. In Australia about 1 in 13 people will develop bowel cancer at some stage in their lifetime.

Why did I get bowel cancer?

This is a question that our brightest doctors and scientists are forever trying to answer. Up to about 30% of people who are diagnosed with bowel cancer have a family history of bowel cancer or a hereditary condition. For the other 70% no genetic or hereditary factor can be found.

What we do know is that almost all bowel cancers develop from polyps. This however is not true in converse, where only a small proportion of polyps will ever develop in to cancers.

What is the stage of my cancer?

Often at the time of diagnosis we can not tell you the exact stage of the cancer. The stage of a cancer is assessed through a combination of scans and pathology. For most people we can not tell you the stage of cancer until after you have undergone surgery.

What investigations will I require?

This will depend on the type and location of the cancer itself. You may require some or all of the following:

Colonoscopy

Most bowel cancers are initially diagnosed with a colonoscopy. Some however may be first seen on a scan. If you haven’t had a colonoscopy you will most likely require one.

CT Scan

A CT is commonly performed of the chest, abdomen and pelvis. This is to both look at the bowel cancer itself and to see if there is any evidence it has spread to other parts of the body.

MRI Scan

Most people who are diagnosed with a rectal cancer (the lower most part of the bowel) will require an MRI scan. This scan is vital for deciding if someone with rectal cancer needs chemotherapy and radiotherapy before surgery (see later).

An MRI scan may also be performed of the liver if the CT scan has detected any abnormalities.

PET scan

This is a special whole body scan and is usually only used  if the other scans (CT and MRI) have detected uncertain abnormalities.

Blood Tests

Everyone will need some blood tests.

Full blood count and Iron studies

This is to check for anaemia and iron deficiency. You may need an iron infusion if it is abnormal.

Electrolyte and kidney function

Prior to any surgery it is important to make sure that your kidneys are functioning properly.

CEA Tumour Marker

Some, not all, bowel cancers produce a marker that can be checked in the blood.  This is important also for follow up surveillance after surgery.

Will I need a stoma bag?

This is one of the most common questions that we get asked.  Most people who undergo surgery for bowel cancer do not need a stoma. For some during surgery it may be necessary to bring a section of bowel through a hole in the abdominal wall to collect waste. A disposable bag is then attached to the skin. This is what is referred to as a stoma (ileostomy or colostomy). This may be temporary or permanent.

For an elective bowel cancer operation, usually only those with a low rectal cancer would require a stoma. It is uncommon for those with a right colon, left colon or high rectal cancer to require a stoma.

If you do require a stoma you will usually be seen before and after the operation by expertly trained stoma nurses. They will provide you with the education and support required.

For those who require a temporary stoma you will usually undergo a second operation to remove the stoma after at least 3 months. This may be longer if you require chemotherapy after surgery.

Will I need chemotherapy or radiotherapy?

Chemotherapy or radiotherapy may be given either before or after surgery. This is different for colon and rectal cancer.

Colon Cancer

Chemotherapy will usually be offered to people with Stage 3 or Stage 4 cancers (see staging above). Occasionally those with Stage 2 cancers will be offered chemotherapy, particular in younger people. Those with Stage 1 cancer do not require chemotherapy. Radiotherapy is rarely given to treat colon cancer.

Rectal cancer

You may require chemotherapy and radiotherapy prior to your surgery if the MRI scan has shown that the cancer has invaded through the full thickness of the bowel wall or the lymph nodes are involved. The radiotherapy is given in conjunction with chemotherapy over a 5 week period. The chemotherapy will usually be recommenced for several months after your surgery.

How will my surgery be performed?

The aim of cancer surgery will always be to remove the cancer in the bowel with the surrounding lymph nodes in the safest way and with the fastest recovery. For many people we can offer keyhole (laparoscopic) surgery which can speed up recovery. Others may require an open approach meaning a longer incision down the middle of the abdomen.

There are many factors which contribute to the decision on surgical technique including location and size of the cancer, obesity, previous surgery and other medical problems.

Multidisciplinary Team Meeting

There are more people involved in your care than you probably realise. Everyone who has a diagnosis of bowel cancer has their case discussed at a multidisciplinary team meeting. At this meeting we look over all the scans and pathology in detail to ensure your care is kept to the highest standard.

Included in the team are colorectal surgeons, medical and radiation oncologists, radiologists, pathologists, gastroenterologists and nurses.

What Happens Now?

Your first appointment after a bowel cancer diagnosis will usually be with a Colorectal Surgeon. At this appointment a thorough history will be taken and an examination will be performed. You may have already undergone the required investigations but if not they will be ordered. Your treatment plan will be discussed with you. If further investigations are needed you will likely need to return for a second consultation after they are performed. If no further investigations are required you will likely be given a date for your surgery.

What surgery is required?

This will depend on many factors, the most important of which is the location of the cancer. The section of bowel involved as well as the draining lymph nodes will need to be removed.

Click on the more common operations below to learn more:

• Right hemicolectomy

• High anterior resection

• Ultra low anterior resection