Bowel Cancer – What you need to know

April is Bowel Cancer Awareness Month. At a time when there are still uncertainties about seeking medical help, what should you look out for, what should you do if you find something, and what happens next?

The past year has been a troubling time for just about everyone, but especially those who are experiencing the onset of new potential symptoms and are uncertain whether or not these might represent something more serious, such as bowel cancer. There are ongoing concerns about access to GPs, waiting lists for hospital appointments and postponement of operations and treatment. However the NHS is at pains to point out that they are still ‘open for business’ and able to treat patients in need, especially those who may have cancer. Nobody wants one of the legacies of Covid 19 to be yet further deaths that could have been prevented if patients had been treated sooner.

Bowel cancer (also referred to as colorectal cancer) is the fourth most commonly diagnosed cancer in the UK and leads to the second highest number of deaths. Over 40,000 people per year are diagnosed with bowel cancer and it leads to around £16,000 deaths each year. However, the prospects of undergoing successful treatment and surviving bowel cancer in the long term improve very considerably with early diagnosis. If diagnosed when the cancer is in its earliest stages, the vast majority of people will survive. Early diagnosis and treatment is therefore key.

Bowel Cancer – What are the warning signs?

Bowel cancer affects slightly more men than women, but the difference is not significant. It can affect people of any age, although is far more commonly diagnosed in those over the age of 50. If you have a strong family history of bowel cancer, you may be at increased risk, and there are some medical conditions that also place you at higher risk of being diagnosed with bowel cancer, including Crohn’s disease, ulcerative colitis, colonic polyps and type 2 diabetes.

What are the symptoms of bowel cancer?

Firstly, it is important to note that having one or more of these symptoms does not mean that you necessarily have bowel cancer. There are other, often much less serious conditions that can produce these symptoms.

• Bleeding from the anus or blood in your faeces
• Persistent change in bowel habit that has continued for a number of weeks
• Unexplained weight loss
• Extreme tiredness – this can be caused by anaemia due to hidden bleeding within the bowel
• Pain or a lump in your abdomen

What to do if you think you might have bowel cancer

Remember, early diagnosis and treatment of bowel cancer has been shown to have a very significant impact upon the chances of survival. If you have experienced these symptoms it is worth seeking further medical advice from your GP in the first instance. There are a number of other conditions that may cause these symptoms that can also benefit from medical intervention, but ruling out bowel cancer is a key step.

What can you expect of your GP?

GPs are expected to follow Guidelines provided by the National Institute of Clinical Excellence (NICE). NICE have created Guidelines for GPs to follow in cases of suspected or potential cancer, depending upon the type of cancer concerned. In terms of bowel cancer, the Guidelines state the following:

Adults should be referred using the suspected cancer pathway for colorectal cancer, for an appointment within 2 weeks if they are:

Age 40 and over with unexplained weight loss and abdominal pain

Age 50 and over with unexplained rectal bleeding

Age 60 and over with:
• iron‑deficiency anaemia or
• changes in their bowel habit, or
• tests show occult blood in their faeces.

GPs should consider making a referral for suspected colorectal cancer for an appointment within 2 weeks in adults with a rectal or abdominal mass.

GPs should consider making a referral for suspected colorectal cancer for an appointment within 2 weeks for:

Adults aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:
• abdominal pain
• change in bowel habit
• weight loss
• iron‑deficiency anaemia

Where symptoms are more borderline but there is a suspicion of possible cancer, GPs are able to offer faecal immunochemical testing (FIT). This specifically tests for human blood products in your faeces, that if present, may well have come from bleeding in the bowel.

Under NICE guidelines, your GP should offer FIT to assess for colorectal cancer in adults without rectal bleeding who are:

Age 50 and over with unexplained:
• abdominal pain or
• weight loss, or

Age under 60 with:
• changes in their bowel habit, or
• iron-deficiency anaemia, or

Aged 60 and over and have anaemia even in the absence of iron deficiency.

If the FIT comes back positive, there is an expectation that the patient will be referred for further investigation and I would argue that whatever your age, in the absence of an alternative explanation (such as haemorrhoids), this should be on the basis of a 2-week suspected colorectal cancer referral.

Even if you don’t meet the criteria for referral under the 2-week cancer referral scheme when you first attend your GP, if your symptoms persist and/or you are concerned about possible bowel cancer, it is important that you go back to your GP to make them aware of this fact.

If you continue to have troublesome bowel habits such as persistent diarrhoea for weeks at a time, or rectal bleeding without explanation, then regardless of your age, this is not normal and you should be referred for further investigation. The NICE Guidelines for 2 week suspected cancer referral are not the only pathway to further investigations and all competent GPs should consider onward referral if a patient presents with persistent disordered bowel habit, especially if in combination with other symptoms.

However, your GP won’t know that your symptoms are continuing unless you make a further appointment and tell them.

Bowel Cancer Screening

Faecal immunochemical testing (FIT) should currently be offered to all adults over 60 up to the age of 74, every 2 years to try to identify otherwise hidden cases of colorectal cancer. From 2021, this is expected to be extended to cover adults from the age of 50 to age 74. Adults over the age of 74 can specifically request a test if they wish.

How has Covid affected bowel cancer screening?

Each GP practice seems to have adopted their own system and criteria for assessing patients. All patients should be able to see a GP in person if their symptoms warrant a face-to-face consultation. However, it can be seen from the information above, that in some cases it may not be necessary for you to see your GP in person to obtain a referral, even an urgent referral, for further investigation of the cause of your symptoms. The important thing is to seek expert advice and not wait until all appointments are on a face-to-face basis again. We have no way of knowing when that might be and time is critical when looking to treat bowel cancer.

What happens next?

Having been referred to the colorectal clinic at your local hospital, it is likely that you will need to have either a sigmoidoscopy or a colonoscopy, where a camera is placed into your colon using a flexible tube, to allow doctors to examine the colon and check for any abnormalities. Research has shown that many bowel cancers develop over time from non-cancerous polyps in the bowel, and if these are identified during the procedure, they can be removed.

New methods of examining the bowel are being developed and may be more suitable if a colonoscopy is particularly difficult for you because of some other physical disability for example. These include a capsule camera, which you swallow and pass in your stool at a later date, and CT colonography. Neither of these methods however allows biopsies to be taken to confirm a diagnosis, or polyps to be removed.

In the event that a bowel cancer is discovered, the doctors will need to find out what stage your cancer is at, to decide what is the best treatment plan for you. This usually involves taking some form of full body imaging to see whether the cancer has spread to other parts of your body or not.

Once the stage of the cancer is known, the colorectal oncology team will advise on the best course of treatment available for you. This will likely involve one or more of the following:
• Surgery
• Radiotherapy
• Chemotherapy

Patients remain under the care of the colorectal oncology team for years, even if the cancer can be surgically removed. This is to monitor your progress with treatment and to address any particular problems that you are having.

Some people suffer more from side effects of treatment than others and how you cope with this will be a very personal matter for each individual. There are many organisations that are available to provide help and support and even if you feel that this is a battle you would rather deal with on your own, it is important to know where you can find help should you need it.

How has Covid affected Bowel Cancer treatment?

Certainly during the first lockdown in 2020, there were many patients whose cancer treatment was delayed. This will have had a devastating impact on some people and whether or not these delays are considered ‘reasonable’ in all of the circumstances by the courts, remains to be seen.

Since the first lockdown however, the government and the NHS have been keen to emphasise that cancer patients remain a top priority and steps have been taken to try to ensure that treatments can go ahead. This may mean having to have telephone or video consultations and may mean that an alternative form of chemotherapy, that can be taken in tablet form, is prescribed, but treatment, advice and support should be available.

Bowel cancer is a frightening and all too common condition that can affect just about anyone. Being aware of the symptoms of potential bowel cancer and not being embarrassed to seek medical help from your GP is critical. In addition, an awareness of the steps that a GP should take and having the confidence to return to ask for further help if symptoms don’t improve, can help to ensure that the cancer is diagnosed and treated at the earliest possible opportunity, giving you the best chance of long term survival.

As we can see, early recognition of symptoms combined with early diagnosis and treatment is key to beating bowel cancer. Sadly not all GPs or treating hospitals get it right. Here at Enable Law we have acted for many individuals whose treatment options or even life expectancy, have been adversely affected because of a delay in diagnosis and treatment of bowel cancer. If you have any concerns about the treatment that you or a loved one have received in the last 3 years, and want to discuss the possibility of bringing a claim for compensation, we are happy to have a no obligation chat with you about your particular circumstances.