As you may know (especially if you’ve seen the April 2016 edition of SLOAN! Magazine) April is Bowel Cancer Awareness Month so we asked Mr Lee Dvorkin MD FRCS (Gen Surg), Consultant General & Colorectal Surgeon at BMI The Cavell Hospital, to tell us the facts about bowel cancer, the symptoms, how it can be detected and the various treatments available.
What is bowel cancer?
Bowel cancer, also known as colorectal cancer, is a cancer situated anywhere in the large bowel (the colon or rectum). Bowel cancer is the 4th most common cancer in the UK and the second most common cause of cancer death with over 41,000 new cases diagnosed each year1. Bowel cancer is most common in the over 60’s and is rare in people younger than 40 years old. The majority of cases develop from pre-cancerous polyps (tiny growths in the bowel), which if left untreated can, over years, develop into cancer.
What are the symptoms?
The symptoms of bowel cancer are variable and can include:
- Diarrhoea or loose poo for over 3 weeks
- Blood in the poo
- Losing weight unintentionally
- Some cancers can bleed and cause anaemia which may lead to tiredness and weakness
- Sometimes cancer can block the bowel. If this happens symptoms include: cramps, vomiting and bloating
If you are suffering from any of these symptoms you should see a bowel specialist for investigation
Who is most at risk?
The biggest single risk factor is age. More than 8 out of 10 bowel cancers are diagnosed in people aged 60 or over. So the risk increases as you get older.
Other factors thought to increase the risk include smoking, obesity and eating excessive red meat, alcohol, animal fat and sugar. A reduced risk has been noted in those who exercise and eat more fibre and pulses
There are some other medical conditions that increase the risk of bowel cancer and these include; Ulcerative colitis, Crohns Disease and having lots of polyps (which are more common as you get older).
Should more care be taken if there is bowel cancer in the family?
Bowel cancer is very common so having a relative with bowel cancer is not unusual. The chance of getting bowel cancer goes up only if the family history is very strong. A strong family history means having several relatives with bowel cancer, especially if they are particularly young.
Examples of a strong family history might be; having a first degree relative diagnosed before the age of 45 or having two first degree relatives diagnosed at any age. To have a strong family history, the affected relatives must all come from the same side of the family.
If you have a strong family history of bowel cancer you may need to be referred to a genetics service. You will need to see a bowel specialist for regular colonoscopies to pick up any signs of cancer as early as possible.
How is it detected?
Usually patients develop symptoms and go to see their GP. The GP will do a rectal examination and some blood tests and then send the patient to see a specialist in the hospital. The two most common investigations to diagnose bowel cancer is a colonoscopy (a camera examination of the large bowel) and a CT colonogram (instead of having the camera put inside your bowel, the doctor looks at x ray pictures of the bowel).
Some patients without symptoms are diagnosed through the NHS Bowel Cancer Screening Programme. Screening is offered to everyone aged 60 to 69 years old (75 years in some areas). Every 2 years patients are asked to send a poo sample to the laboratory. If blood is detected in the poo a colonoscopy is offered to see if there are early signs of cancer.
What treatments are available?
The treatment depends on how advanced the cancer is when it is diagnosed. The mainstay of treatment for confirmed bowel cancer is an operation to remove the cancer and its surrounding lymph glands. The bowel ends are usually joined back together but sometimes a colostomy bag is required. Nowadays, these operations are performed by keyhole surgery and patients typically spend less than a week in hospital.
Often, surgery is all the treatment that is needed but If the cancer is advanced chemotherapy is offered and this can last for 6 months. Surgery can also be used to remove certain cancers that have spread to the liver or lungs but this is not always possible. For cancer in the rectum, radiotherapy is often used to shrink down the tumour before surgery
To find out more about bowel cancer and this year’s focus on screening, please click here to read the Bowel Cancer UK article in new edition of SLOAN! Magazine. Help support the cause at www.bowelcanceruk.org.uk
About Mr Lee Dvorkin MD FRCS (Gen Surg)
Mr Dvorkin graduated from Leeds University and completed his basic surgical training in Wessex. In 2002, he undertook a period of research at The Royal London Hospital, a renowned centre for colorectal research. This research focused on pelvic floor disorders and has been presented to many learned societies both nationally and internationally, and has been published as original papers, abstracts, posters and e-media. Mr Dvorkin was awarded an MD by the University of London for this work. He continues with surgical research and continues to publish original works.
Mr Dvorkin undertook higher surgical training in North East London which he completed in 2010. He then undertook an 18 month supra-specialist fellowship at St Marks Hospital, an internationally renowned centre for bowel diseases. This included a 6 month laparoscopic (keyhole surgery) colorectal fellowship.
Mr Dvorkin’s clinical practice encompasses all aspects of general & colorectal surgery with a special interest in colorectal cancer, inflammatory bowel disease and proctology. He also has extensive experience in laparoscopic colorectal surgery.
Mr Dvorkin sits on the faculty of various educational courses and is an examiner for trainee surgeons. He remains passionate about education and surgical training.
Lee is married with two daughters and enjoys outdoor pursuits and cycling.