DEFINITION

Bowel Cancer is cancer that starts as a tumour or growth on the inside wall of the bowel. The bowel is made up of two sections - the small bowel and the large bowel (the large bowel consists of the colon and the rectum). Most Bowel Cancers occur in the large bowel.

DESCRIPTION

RISK FACTORS
- Age. The risk of developing Bowel Cancer increases with age and rises after the age of 40 and peaks between the ages of 60 and 75.
- People with ulcerative colitis , granulomatous colitis and familial polyposis have an increased risk of developing Colon Cancer depending on when they developed the particular condition and how many years they have had the condition.
- Bowel Cancer appears to be associated with a diet high in animal protein, fat and refined carbohydrates and low in fibre.
- Family History. People with only one first-degree relative (parent, brother or sister, child) or second-degree relative (grandparent, aunt, uncle, niece or nephew) with Bowel Cancer diagnosed AFTER the age of 55 are at a slightly increased risk of developing Bowel Cancer.
People who have a first-degree relative (parent, brother or sister, child) with Bowel Cancer diagnosed BEFORE the age of 55, or two first-degree or one-first degree plus one second-degree relative (grandparent, aunt, uncle, niece or nephew) on the same side of the family with Bowel Cancer diagnosed at any age are at a moderately increased risk of developing Bowel Cancer.
People with three or more family members who have been diagnosed with Bowel Cancer and people whose families have the inherited disorders - hereditary non-polyposis colorectal cancer or familial polyposis have a potentially high risk of developing Bowel Cancer.

PREVENTION

- Maintain a healthy weight.
- Have a healthy diet which is low in fat and high in fruit and vegetables (5 or more servings each day of fruit and vegetables) and high in fibre (especially wholegrain cereal fibres which include wholegrain rice, pasta and breads and wheat bran). Vegetables provide strong protection against Bowel Cancer, particularly cruciferous vegetables (e.g. bok choy, broccoli, brussels sprouts, cabbage, cauliflower, swedes, turnips). Evidence suggests that a diet high in fat increases the risk of developing Bowel Cancer.
- Limit alcohol intake and avoid smoking. Alcohol consumption may increase your risk of Bowel Cancer and smoking is associated with a higher risk of developing Bowel Cancer.
- Have regular exercise. Regular physical exercise can protect against Bowel Cancer.
- Talk to your Doctor about a Bowel Cancer screening routine that is suitable for you.
Almost all cases of Colon Cancer begin with the development of non-cancerous polyps in the colon. These polyps can later become cancerous, often without any symptoms to let you know they are there. Detection and removal of precancerous polyps can prevent most colon and rectal cancers.

SIGNS AND SYMPTOMS

- Bleeding from the rectum (anus) (seen on toilet paper when the bottom is wiped or in the faeces or in the toilet bowl).
- A change in bowel habit (e.g. diarrhoea or constipation).
- Symptoms of anaemia.
- Abdominal pain.
- Weight loss.
- Bloating.
- Feeling that the bowel does not empty completely (called "incomplete evacuation").

These signs and symptoms can be caused by other conditions (e.g. haemorrhoids may cause bleeding from the anus). See your Doctor for a diagnosis.

Remember that Bowel Cancer frequently begins without symptoms, so it is important to begin routine bowel screenings - see the Health Management section of this topic and ask your Doctor for advice.

TREATMENT OPTIONS

Always consult your Doctor for diagnosis and advice. In no way is this information intended to replace the advice of a registered medical practitioner.
Early detection of Bowel Cancer leads to cure in the majority of patients.
Talk to your Doctor about a Bowel Cancer screening routine that is suitable for you. You should have regular bowel checks if you are over 50 years of age. People with a family history of Bowel Cancer or an inherited disorder may need to begin screening earlier than this - people with familial polyposis may need to start regular screening at age 12; people with hereditary non-polyposis colorectal cancer and those with a potentially high risk of developing Bowel Cancer may need to start screening at age 25; people with a moderately increased risk of developing Colon Cancer should be screened from age 50 or at the age when they are ten years younger than when their family relative was first diagnosed with Bowel Cancer. Ask your Doctor for advice. If you have any symptoms of Bowel Cancer, you should contact your Doctor immediately.

There are several tests used to detect polyps, cancer, or other abnormalities.
- A digital rectal examination is an examination in which the doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas.
- A faecal occult blood test (FOBT) is used to check for hidden blood in the stool. Sometimes cancers or polyps can bleed and FOBT is used to detect small amounts of bleeding.
- A double contrast barium enema is a series of x-rays of the colon and rectum. The patient is given an enema with a solution that contains barium, which outlines the colon and rectum on the x-rays.
- A colonoscopy is an examination of the rectum and entire colon using a lighted instrument called a colonoscope. Polyps can be removed during a colonoscopy.
- A sigmoidoscopy is an examination of the rectum and lower colon using a lighted instrument called a sigmoidoscope.
Colonoscopy allows a physician to view the entire colon through an endoscope while sigmoidoscopy shows only the more easily reached, sigmoid or left-hand section of the colon.

If Colon Cancer is present, your Doctor will discuss the treatment options with you. This may include surgery, radiation therapy and/or chemotherapy.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice.
1) Follow the Diet Hints.
2) If you are experiencing any of the signs and symptoms mentioned above, ask your Pharmacist or Doctor for advice.
3) Rectal bleeding or a long-term change in bowel habits should be investigated by your Doctor as these are the two most common indicators of Colon Cancer.
4) If you have any queries regarding medication that has been prescribed for you, ask your Pharmacist for advice.
5) A high fibre diet is recommended as a means of helping to prevent colorectal Cancer. Ask your Pharmacist to recommend a soluble fibre supplement such as psyllium or slippery elm if your diet is inadequate.
6) Consider some nutritional supplements if the diet is inadequate.

DIET HINTS

- Have a healthy diet which is low in fat and high in fruit and vegetables (5 or more servings each day of fruit and vegetables) and high in fibre (especially wholegrain cereal fibres which include wholegrain rice, pasta and breads and wheat bran). Vegetables provide strong protection against Bowel Cancer, particularly cruciferous vegetables (e.g. bok choy, broccoli, brussels sprouts, cabbage, cauliflower, swedes, turnips). Evidence suggests that a diet high in fat increases the risk of developing Bowel Cancer.
- Limit alcohol intake. Alcohol consumption may increase your risk of Bowel Cancer.
- Replacing vegetable oil or other types of cooking oils with olive oil may help to prevent and even fight Bowel Cancer.
- Drink plenty of water. Drinking between 6 to 8 glasses of fresh, filtered water each day is recommended. Adequate water intake helps to prevent constipation and dehydration.

- For dietary advice during cancer treatments, see the Cancer - Chemotherapy and Cancer - Radiotherapy topics on the Healthpoint.

VITAMINS/MINERALS/HERBS

Always consult your Doctor before taking any dietary supplements for advice on any possible side effects or drug interactions. This is particularly important during cancer therapy, as many chemotherapy drugs act by blocking the effects of certain vitamins.
- Ginseng (Panax) may help fight the formation of new cancer cells in colorectal Cancer.
- Flavonoids such as rutin and apigenin may have cancer-preventing and cancer-fighting properties.
- The antioxidant effects of vitamin A, vitamin C and vitamin E may help protect normal cells from being damaged during radiotherapy treatment.
- Phytosterols (plant sterols) may offer protection against Bowel Cancer. It is believed they help boost the immune system and interfere with the growth of cancerous tumours.

ORGANISATIONS and SUPPORT GROUPS

See the Australian Cancer Society topic on the Healthpoint.

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