LIVING WITH CANCER

Bowel cancer, also known as colorectal cancer, develops in the large bowel, either in the colon or the rectum. It often begins as small growths called polyps. Most polyps are harmless, but some can slowly change into cancer over time.

If untreated, bowel cancer can grow through the bowel wall and spread to nearby lymph nodes or other parts of the body, most commonly the liver or lungs.

It affects both men and women and is more common in people over the age of 50.

Who’s most at risk and why

Age is the strongest risk factor. Most cases are diagnosed in people over 50. Some people have a higher risk because of family history or inherited genetic conditions such as Lynch syndrome. Lifestyle factors may also play a part. Diets low in fibre and high in red or processed meat have been linked to bowel cancer, as have smoking, excess alcohol, obesity, and low levels of physical activity.

Long-term inflammatory bowel conditions such as ulcerative colitis or Crohn’s disease can also increase risk.

Many people diagnosed with bowel cancer have no clear risk factors, which is why screening and awareness of symptoms remain important.

Knowing the signs

Bowel cancer does not always cause symptoms in its early stages. When symptoms do appear, they can be easy to dismiss at first.

One of the most common signs is blood in the stool. This may appear bright red or darker in colour. Some people notice a change in their usual bowel habits, such as going more often, looser stools, or a feeling that the bowel has not emptied fully.

Other symptoms may include ongoing tummy discomfort, bloating after meals, unexplained weight loss, or persistent tiredness caused by low iron levels.

These symptoms can have many causes, but if they continue or feel unusual for you, it is sensible to speak with a GP.

Diagnosis: Is it cancer?

People usually enter the diagnostic pathway in one of three ways. Some are referred by their GP after noticing symptoms. Others are identified through the national screening programme. Occasionally bowel cancer is discovered during tests carried out for another reason.

Screening is currently offered to people aged 50 to 74 in England, Scotland and Wales. In Northern Ireland, screening is offered between the ages of 60 and 74. The test involves using a simple home kit that checks for hidden blood in the stool.

If further investigation is needed, a colonoscopy may be arranged. This test uses a thin flexible tube with a camera to examine the bowel. If anything unusual is found, small tissue samples can be taken for closer examination. Imaging tests such as CT or MRI scans may also be used to determine the stage of the disease.

What’s going to happen

If bowel cancer is confirmed, your case will usually be reviewed by a multidisciplinary team. This group may include surgeons, oncologists, gastroenterologists, radiologists, and specialist nurses.

Together they look at the type and stage of the cancer, its location in the bowel, and your overall health before recommending the most appropriate treatment plan.

Treatment

Treatment depends on where the cancer is located, how far it has spread, and your general health.

Surgery is the most common treatment. For colon cancers, this often involves removing the affected section of bowel and reconnecting the healthy ends. For rectal cancers, surgery can be more complex and may sometimes involve creating a temporary or permanent stoma.

Radiotherapy is commonly used for rectal cancer, often before surgery to shrink the tumour or afterwards to reduce the risk of recurrence.

Chemotherapy may be offered after surgery to lower the risk of the cancer returning. In some situations it may be given before surgery to shrink the tumour, or used when the disease has spread to help control symptoms.

Targeted therapies and immunotherapy may be considered in certain advanced cases, particularly when specific genetic changes are identified.

Prognosis

Outcomes depend largely on how early the cancer is found.

When bowel cancer is detected at an early stage, treatment is often very successful and many people go on to live long and healthy lives. Screening programmes are helping more cases to be identified earlier.

When the disease has spread further, treatment becomes more complex, but many people still live well for years with the right care and support. Ongoing research continues to improve both treatments and outcomes.