Bowel cancer usually refers to cancer of the colon or rectum. Small bowel and anal cancers are less common.
Causes/Factors
- Familial adenomatous polyposis (FAP) - familial cancer syndromes
- Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome
- inflammatory bowel disease
- Age
- Smoking/alcohol
- Obesity
Presentation
- Change in bowel habit (usually to more loose and frequent stools)
- Unexplained weight loss
- Rectal bleeding
- Unexplained abdominal pain
- Iron deficiency anaemia (microcytic anaemia with low ferritin)
- Abdominal or rectal mass on examination
NICE Guidelines for 2WW
- Over 40 years with abdominal pain and unexplained weight loss
- Over 50 years with unexplained rectal bleeding
- Over 60 years with a change in bowel habit or iron deficiency anaemia
Investigations
FIT screen
Faecal immunochemical tests (FIT) look very specifically for the amount of human haemoglobin in the stool
Useful to screen people who don’t quite meet the criteria for a 2WW.
National screening program - 60-74 get a kit sent to them every 2 years
Colonoscopy - gold standard. Lesions can be biopsied or tattooed for surgery
CT - may be considered in patients who are not fit for a colonoscopy and/or look for metastases
CEA antigen - tumour marker. Not useful for screening but may help predict relapse
Staging
TNM staging - was previously Duke’s but has been replaced.
Management
- Surgical resection - ideal treatment, removing the whole tumour
- Chemotherapy
- Radiotherapy
- Palliative care
Hartmann's Procedure
An emergency procedure that involves the removal of the rectosigmoid colon and creation of an colostomy. The rectal stump is sutured closed. The colostomy may be permanent or reversed at a later date. Common indications are acute obstruction by a tumour, or significant Diverticular disease.
Complications/red Flags
- Bleeding, infection and pain
- Incisional Hernias
- Intra-abdominal adhesions
- Damage to nerves, bladder, ureter or bowel
- Post-operative Ileus
- Anaesthetic risks
- Leakage or failure of the anastomosis
- Requirement for a stoma
- Failure to remove the tumour
- Change in bowel habit
- Venous thromboembolism (DVT and PE)