Bowel cancer

The bowel is part of the digestive system. It's divided into the small bowel and the large bowel, and the large bowel is made up of the colon, rectum and anus.

When people say bowel cancer, they usually mean one of these:

• colon cancer
• rectal cancer

Cancer that starts in the colon or rectum is also sometimes called colorectal cancer. What's written here on bowel cancer applies to anyone with either colon cancer or rectal cancer.

Clinical Oncologist Katherine Aitken explains bowel cancer in a video, where she gives an overview of the symptoms, diagnosis and treatment.

In the UK, about 44,100 people get cancer in the colon or rectum each year. Bowel cancer is more common in older people. But the number of younger people, those 50 and under, who are diagnosed with it is increasing.

Cancer can also start in the anus or in the small bowel:

• anal cancer
• small bowel cancer

If you're not sure which type you have, ask your doctor, cancer doctor or specialist nurse for more information.

Contact a doctor as soon as possible if you notice any of the following symptoms, especially if they last for 4 or more weeks. Do this even if you've had bowel screening tests recently.

• blood in your poo (stools)
• bleeding from your bottom
• a recent change in your poo, particularly looser poo or pooing more regularly
• new pain in your abdomen (tummy) that won't go away
• you've recently lost weight without trying
• more pale and tired than usual

If you're worried about bowel cancer, Macmillan Cancer Support have more information about bowel cancer symptoms.

Doctors don't know the exact causes of bowel cancer. But some risk factors can raise your chance of developing it.

Having one or more risk factors doesn't mean you'll definitely get bowel cancer. And some people with no risk factors at all do get it.

Risk factors include:

• age
• dietary or lifestyle factors
• being overweight
• having an inflammatory bowel condition
• a family history of bowel cancer

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

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

The specialist doctor will examine you, and you will usually have some tests. These include:

• a rectal examination
• blood tests
• a faecal immunochemical test (FIT)

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

You'll 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 look at the inside of the whole bowel. Or you might have a sigmoidoscopy, which looks at the inside of the rectum and the part of the colon closest to the rectum.

You can read more information about bowel cancer screening. Macmillan Cancer Support also 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.

Your test results help the doctors work out the size and position of the bowel cancer and whether it has spread. This is called staging.

The grade is decided by a doctor who looks at the cancer cells under the microscope. How the cells look gives an idea of how quickly the cancer might grow or spread.

Once the doctors know the stage and grade, they can plan the best treatment for you.

A team of specialists will meet to discuss the best possible treatment for your bowel cancer. This is called a multidisciplinary team (MDT).

Your doctor, cancer specialist or nurse will explain the different treatments and their side effects. They'll also talk to you about the things to consider when you make treatment decisions.

Before your treatment starts, your cancer team might talk to you about preparing for it. This is sometimes called prehabilitation. It supports you in improving your fitness, health and wellbeing before treatment, and it can also help you recover more quickly.

Your treatment will depend on the stage of the cancer and where it is in the bowel. It also depends on your general health and your preferences.

Chemotherapy for bowel cancer uses anti-cancer drugs to destroy cancer cells. You may have it before or after surgery. Doctors use it to treat both colon cancer and rectal cancer.

Radiotherapy uses high-energy rays (radiation) to destroy cancer cells in bowel cancer, and doctors often use it to treat rectal cancer.

You might have radiotherapy at the same time as chemotherapy. This is called chemoradiation.

If your bowel cancer has come back or spread to other parts of the body, you may have treatment with a targeted therapy or immunotherapy drug. You'll usually need tests on the bowel cancer cells first. The results support you and your doctor in deciding which cancer drug treatment is best for you.

Chemotherapy is also commonly used to treat advanced bowel cancer. Surgery, ablation and different types of radiotherapy can be used too, depending on where in the body the bowel cancer has spread.

You may have some treatments as part of a clinical trial. Your doctor will explain if this is available.

Bowel cancer and its treatment can affect your sex life. Changes may get better over time, but sometimes they are permanent. If you have any problems or are worried about this, talk to your doctor or nurse. They can explain what to expect, and there are often things that can help and support you.

Some treatments for bowel cancer can affect whether you can get pregnant or make someone else pregnant. If this worries you, talk to your doctor before you start treatment.

Recovery after bowel cancer treatment can take time, and 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. If your lifestyle is already healthy, you may still choose to make some positive changes after treatment.

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

You should know where to get support or information if you need it. People often need support even some time after bowel cancer treatment, but it's not always easy to know who to ask for help.

To find support:

• ask your doctor 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, as their cancer information and support specialists can offer guidance and help you find what you need

Don't include personal information, such as your name, location or any personal health conditions.