- Bowel Cancer (colorectal cancer): This cancer starts within the lining of the large bowel (colon) or the last part of large bowel before reaching the back passage (rectum).
Symptoms to look out for include:
– Persistent change in normal bowel habit for more than 2-3 weeks such as looser motions, passing more frequent motions, or getting constipation
– Bleeding from the back passage, or blood that is mixed with stool
– Pain or lump in your tummy
– Unexplained weight loss, and / or loss of appetite
-Tiredness caused by lower than normal level of red blood cells (anaemia)Treatment depends on which part of the colon the cancer starts.
– Right colon cancer: Surgery includes removal of the right colon and associated blood vessels and lymph glands. The bowel ends are then joined (anastomosis) with low chances to have a stoma (Right Hemicolectomy)
– Transverse colon cancer: Surgery includes removal of the right colon, transverse colon and associated blood vessels and lymph glands. The bowel ends are then joined (anastomosis) with low chances to have a stoma (Extended Right Hemicolectomy)
– Left colon cancer: Surgery includes removal of the left colon and associated blood vessels and lymph glands. The bowel ends are then joined (anastomosis) with low chances to have a stoma (Left Hemicolectomy)
– Sigmoid / upper rectal cancer: Surgery includes removal of part of the left colon, upper part of the rectum and associated blood vessels and lymph glands. The bowel ends are then joined (anastomosis) with a possibility to have a stoma (High Anterior Resection)
– Mid rectal cancer: Surgery includes removal of lower part of the left colon, the whole rectum and associated blood vessels and lymph glands. The bowel ends are then joined (anastomosis) with most likely creating a diverting temporary stoma that can be reversed by another smaller surgery (Low Anterior Resection)
– Low rectal cancer: Surgery includes removal of the whole rectum, anus and all associated muscle, and associated blood vessels and lymph glands resulting in permanent stoma (Abdominoperineal Excision of the Anus and Rectum – APER) - Anal Cancer: This rare cancer starts in the lining of the back passage (anus). Symptoms include bleeding, bowel changes, pain around the back passage, and severe itching (pruritis). These symptoms could be caused by other conditions, therefore it’s important to seek medical advice if you have any of these symptoms. Examination by specialist is essential to decide if further diagnostic tests are required. This includes Examination Under Anaesthesia (EUA) of the back passage and taking samples (biopsies). The mainstay of treatment of anal cancer is combined chemotherapy and radiotherapy (chemoradiotherapy). Surgery might be required for very early stages of anal cancer, or if the cancer comes back or hasn’t gone completely after chemoradiotherapy.
- Small bowel cancer: This cancer starts in the small bowel which makes up most of the digestive system and helps the body to digest food and take in vitamins.
The symptoms of small bowel cancer can be vague and other conditions could have similar symptoms like irritable bowel syndrome or inflammatory bowel disease. Symptoms include tummy pain or lump, weight loss, feeling or becoming sick, diarrhoea, tiredness, dark black stool due to bleeding in the small bowel, blockage in the bowel, and a low number of red blood cells (anaemia) due to bleeding. It’s important to see your doctor if you have any of these symptoms to arrange for the required tests.
Treatment will depend on many factors that include where the cancer is, how big it is and whether it has spread (the stage), type of cancer, general health and level of fitness. Treatment includes surgery to remove the cancer along with clear border if the cancer hasn’t spread to other parts of the body, or in emergency situations where the cancer has blocked the bowel. Treatment also includes chemotherapy either after surgery to reduce the risk of cancer coming back, or to reduce or control symptoms in advanced cancer that has spread to other parts of the body. - Colorectal Polyps: These are small growth on the inner lining of the colon or rectum. They are common affecting around 1 in 4 people at some point in their lives. They don’t normally have any symptoms; however, some people might get symptoms like blood in the stool or have positive Faecal immunohistochemical testing (FIT test) that detects small amount of blood in faeces (stool), which would not normally be visible. Although bowel polyps are not normally cancerous, they will need to be removed if found, as if left untreated some may eventually turn into cancer.
Polyps can be of various types;
Hyperplastic polyps are usually small and generally regarded as harmless.
Adenomas are a common type of polyps. There is a small risk that that adenoma may, in time, be cancerous. This change usually takes place after number of years.
Polyposis syndromes: They are group of rare inherited conditions that cause multiple bowel polyps in young people that have a high chance of developing into bowel cancer. This includes Familial adenomatous polyposis (FAP), Hereditary nonpolyposis colorectal cancer (HNPCC)/Lynch’s syndrome, Gardner’s syndrome, Turcot’s syndrome, Peutz-Jeghers syndrome, Cowden’s disease, and Familial juvenile polyposis. - Anal Intraepithelial Neoplasia (AIN): This term means there are abnormal cells in the lining of the back passage (anus). It is also called anal squamous intraepithelial lesions (SILs). AIN is not cancer but the cells might develop into cancer in the future. This is diagnosed by taking a sample of skin (biopsy) to be examined under a microscope. It is divided into grades 1 to 3. The grade relates to how abnormal these cells look under a microscope.
AIN 1 – the cells are slightly abnormal
AIN 2 – the cells are moderately abnormal
AIN 3 – the cells are severely abnormalAnother system for grading refers to AIN or SIL as low grade or high grade. In low grade SIL (LSIL or AIN 1) the cells are slightly different to normal anal cells. In high grade SIL (HSIL or AIN 2 to 3) the cells are moderately to severely different from normal anal cells.Low grade SIL (AIN 1) doesn’t usually require treatment. Repeating the skin samples might be required to confirm a diagnosis. Treatment of High grade SIL (AIN 2 to 3) might include surgical excision for localised disease or skin creams such as imiquimod or 5 Fluorouracil (5-FU), if the disease is affecting multiple parts. Clinical review in clinic and arranging mapping biopsies under general anaesthesia every 6 months are key to ensure resolution and no progression to anal cancer.