Bowel cancer - the facts

• Australia has one of the highest rates of bowel cancer in the world
• It accounts for 13% of all invasive cancers diagnosed in Australia, second only to prostate cancer
• There were approximately 17000 new cases and more than 4000 deaths each year
• 1 in 12 Australians will develop bowel cancer before the age of 85
• 90% of bowel cancers can be successfully treated if detected early 
   

What is bowel cancer?

• Colorectal cancer (CRC), or bowel cancer, develops when cells in the bowel lining grow too quickly, forming a clump known as a polyp or an adenoma
• Polyps are usually benign. Polyps can grow for several years before undergoing additional changes and becoming cancerous and spreading to other parts of the body
   

Bowel cancer risk factors

• Are 50 and over
• Are overweight
• Have a poor diet, such as a diet high in red meats, processed meats (e.g. bacon, sausages), fried foods, alcohol, or low in vegetables, fruit and whole grains (e.g. wholemeal bread, brown rice)
• Have had an inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
• Have previously had non-cancerous tumours in the bowel
• Have a strong family history of bowel cancer or polyps
  • More than 80 per cent of people who develop bowel cancer do not have a family history of bowel cancer
  • The risk of bowel cancer is twice as high if a patient has a first degree relative with bowel cancer
  • The risk is four times as high if a patient has two first degree relatives with the disease
     

What are the symptoms?

• Bowel cancer can develop with few, if any, early warning symptoms. Symptoms of bowel cancer include:
  • bleeding from the rectum, or any sign of blood after a bowel motion
  • a recent and persistent change in bowel habit, for example looser bowel motions, severe constipation and/or needing to go to the toilet more than usual
  • unexplained tiredness (a symptom of anaemia)
  • abdominal pain

What you can do

• Lower your risk of developing bowel cancer by
  • having a healthy diet
  • exercising regularly
  • reducing your alcohol consumption
  • not smoking
• There has been additional evidence that low-dose aspirin may reduce the risk of adenoma formation and bowel cancer
  • Aspirin consumed for >5 yr period showed a reduction in incidence of CRC by 25% and mortality by 33%
  • It is now recommended that patients >50 yrs of age and particularly those at an above average risk (FHx, Lynch syndrome, history of adenomas) should be offered low-dose aspirin for chemopreventative effects
• Participate in a screening program
   

Screening

• Colorectal cancer is one of the few cancers for which screening has reduced the incidence
• National Bowel Cancer Screening Program (NBCSP) Facts 
  • Only 36% of those receiving the Faecal Occult Blood Test (FOBT) participated
  • 7.5% of the participants had a positive FOBT
  • Only 68% of those went on to have a documented colonoscopy
  • 9% had advanced adenomas
  • 4% had a colorectal cancer
  • Women participated more than men
  • More men had cancers
• Current eligible ages receiving the NBCSP begin at age 50 and by 2020 second yearly NBCSP invites will be made to 50 to 74 year olds
• The program has proved unequivocally effective, reducing predicted CRC mortality by up to 15-25%. Earlier diagnostic staging has also reduced morbidity. There is however much room for improvement with participation and appropriate follow-up.
• Treating bowel cancer
• You will usually require surgery if bowel cancer is found. If the cancer is found at an early stage, the chance of a full recovery is high. Most people will be able to return to their current lifestyle and activities.
   

What can we do as GPs?

• Discuss these facts with our patients & explain the importance of participating in the NBCSP
• If your patient hasn’t been invited, then FOBT testing can be offered every 1-2 years
• Remember, a negative test does not mean your patient doesn’t have CRC or other gastrointestinal pathology. So, if you’re worried, please refer!
   

This fact sheet is courtesy of Dr Griff Walker, Gastroenterologist & Interventional Endoscopist for Coast Gastroenterology at Gold Coast Private Hospital. 

Call 07 55 746 133 or email admin@coastgastro.com.au for more information.