Bowel cancer

What causes bowel cancer?

Doctors don't fully understand what causes bowel cancer. What they do know is that certain risk factors can raise a person's chances of developing it.

Having one or more of these risk factors doesn't mean bowel cancer is certain to follow. And some people who have none of these risk factors still go on to develop it.

Risk factors include:

• age
• diet and lifestyle
• being overweight
• having an inflammatory bowel condition
• a family history of bowel cancer

Macmillan Cancer Support have more information about the causes and risk factors of bowel cancer.

If you have symptoms, you will usually start by seeing your GP, who will examine you. If they think your symptoms could be caused by cancer, they will refer you to a specialist doctor.

The specialist will examine you and you will usually have some tests. These include a rectal examination, blood tests, and a faecal immunochemical test, also called FIT.

Macmillan Cancer Support have more information about tests for bowel cancer.

You will usually also have a test called a colonoscopy. This is when a doctor or nurse uses a thin tube with a camera at the end to examine the inside of the whole bowel.

Or you might have a sigmoidoscopy instead. This is used to examine the inside of the rectum and the part of the colon closest to the rectum.

Read more information about bowel cancer screening.

Macmillan Cancer Support have more information about the tests you may have and how bowel cancer is diagnosed.

Get Checked Early has more information on what to expect when getting checked.

Waiting for test results can be a difficult time. Macmillan Cancer Support have more information that can help.

Staging and grading of bowel cancer

The results of your tests help your doctors find out more about the size and position of the cancer, and whether it has spread. This is called staging.

A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread.

Knowing the stage and grade helps your doctors plan the best treatment for you.

Your cancer specialists will sit together as a team to work out the best possible treatment plan for you. This is called a multidisciplinary team, or MDT.

Your doctor, cancer specialist, or nurse will walk you through the different treatment options and their side effects. They will also talk with you about the things worth weighing up when you decide on treatment.

Before your treatment begins, your cancer team may talk to you about getting ready for it. This is sometimes called prehabilitation. It helps you improve your fitness, health, and general wellbeing beforehand, and it can also help you recover faster afterward.

Macmillan Cancer Support has more information on preparing for bowel cancer treatment (prehabilitation).

Which treatment is right for you depends on the stage of the cancer and where it sits in the bowel. Your general health and your own preferences matter too.

Surgery

Surgery is often used to remove the part of the bowel affected by cancer. This operation may be done as open surgery or as keyhole surgery, through a few small cuts in the abdomen.

Macmillan Cancer Support has more information on surgery for colon cancer and surgery for rectal cancer.

Chemotherapy

Chemotherapy uses anti-cancer drugs to destroy cancer cells. You may be given chemotherapy before or after surgery. It is used to treat both colon and rectal cancer.

Radiotherapy

Radiotherapy uses high-energy radiation to destroy cancer cells. It is often used to treat rectal cancer.

Sometimes radiotherapy is given alongside chemotherapy. This combined approach is called chemoradiation.

Advanced bowel cancer

If your bowel cancer has come back or spread to other parts of the body, you may be treated with a targeted therapy or an immunotherapy drug. You will usually need tests done on the bowel cancer cells so that you and your doctor can decide on the best drug treatment for your situation.

Chemotherapy is also commonly used for advanced bowel cancer. Depending on where in the body the cancer has spread, surgery, ablation, or various forms of radiotherapy may also be used.

Macmillan Cancer Support has more information on treatment for advanced bowel cancer.

Some treatments may be offered to you as part of a clinical trial. Your doctor will let you know if this is an option for you.

Macmillan Cancer Support has more information on cancer treatment options and on getting organised before cancer treatment.

After bowel cancer treatment

You will have regular check-ups during treatment and for some time afterward, usually continuing for up to 5 years. These may include regular blood tests and other investigations.

Let your doctor or specialist nurse know as soon as possible if you notice any problems or new symptoms between appointments.

Macmillan Cancer Support has more information on follow-up care after treatment.

Sex life

Bowel cancer and its treatment can affect your sex life. These changes often ease with time, though for some people they remain permanent. If you have concerns or worries about this, speak with your doctor or nurse. They can tell you what to expect, and there is often help available.

Macmillan Cancer Support has more information on your sex life after bowel cancer.

Body image

Bowel cancer and its treatment can change how you see and feel about your body. This is known as body image.

Macmillan Cancer Support has more information on managing body image concerns.

Fertility

Some cancer treatments can affect your ability to become pregnant or to get someone else pregnant. If this concerns you, it is important to speak with your doctor before treatment starts.

Support after bowel cancer

Once bowel cancer treatment ends, people often experience a mix of feelings. You may feel relief that treatment is over, alongside worry about what lies ahead.

Macmillan Cancer Support offers further support. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat with Macmillan specialists online
• use the Macmillan bowel (colon and rectal) cancer forum, where you can talk with others affected by bowel cancer, ask questions, and share your experience

Other organisations offering information and support include:

• Bladder and Bowel Community
• Bowel Cancer UK
• Colostomy UK
• IA, the Ileostomy and Internal Pouch Association

Wellbeing and recovery

It can take time to recover after bowel cancer treatment. Some days you may feel better than others.

Looking after yourself can help speed up your recovery. Even small lifestyle changes may improve your wellbeing and long-term health.

Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment.

Macmillan Cancer Support have more information on leading a healthy lifestyle after treatment.

It’s important to know where to get support or information if you need it. People often need support even some time after bowel cancer treatment. But sometimes it’s difficult to know who to ask for help.

To find support:

• ask your GP or someone from your cancer team for advice about support in your area
• search cancercaremap.org to find cancer support services near you
• call Macmillan Cancer Support free on 0808 808 00 00 or talk online – their cancer information and support specialists can offer guidance and help you find what you need

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