A B C D E F G H I J K L M N O P R S T U V W

BOWEL CANCER - CANCER OF THE COLON

What is Bowel Cancer ?

The colon and rectum (the large intestine) connect the small intestine to the anal canal (back passage). Both benign (harmless) and malignant (cancerous) growths may occur in them. Benign growths are known as polyps. Some benign polyps may develop into malignant growths over a period of time. Polyps and cancer can cause bleeding or the passing of mucus from the back passage. They may cause griping abdominal pain, and an alteration of bowel habit. The actual symptoms depend on whether the growth is ulcerating into the bowel, or producing a narrowing of the intestine.

Why does Bowel Cancer occur ?

No known cause exists for single benign polyps. Multiple polyps occur in the condition of familial polyposis coli, where more than one member of a family is affected. This is a rare inherited condition which may progress to form cancers of the bowel. Lack of fibre in the diet may be an important contributory factor. Single polyps or inflammatory conditions of the large bowel (such as ulcerative colitis) may progress to bowel cancer over a long period of time.

Treatment Involved for Bowel Cancer

DIAGNOSIS

Polyps and cancers can be diagnosed either by a barium x-ray or colonoscopy. Before either procedure, you will be given laxative drugs to empty the bowel. In a barium x-ray (enema), a solution is put into the back passage through a small tube to outline the bowel. For a colonoscopy, a slim and flexible telescope is passed into the rectum and beyond into the higher parts of the large bowel. You will be given some sedation while this is being done. If a polyp is found, it may be removed through the telescope without need for further (open) surgery. However, if a malignant growth (cancer) is found, it must be removed surgically. A ultrasound scan may be performed. This uses sound waves like radar to assess how extensive the disease actually is. Similar information can be obtained by using special (CT scan) x-rays or an MRI magnetic scan.

TREATMENT

For some growths of the rectum, you may be advised to have radiotherapy treatment before your operation. Normally, you will be admitted 1 2 days before operation, to be given laxatives to cleanse the bowel. Enemas to empty the rectum may also be given. A liquid diet of high-calorie drinks will be commenced. Twenty-four hours before operation, only clear fluids (water, flavoured drinks, tea or coffee without milk) are allowed. The operation is done through the abdomen under general anaesthesia. Depending on the position of the growth, this is removed and the ends of the intestine joined up again. It may occasionally be impossible to join the bowel up after removal. In these situations, a colostomy may be required. A COLOSTOMY is where the bowel opens onto the surface of the abdomen. This allows motions to drain direct into an attached bag. Under the anaesthetic, tubes may be inserted for use during and after the operation. An intravenous drip will allow fluids, drugs, antibiotics or blood to be given. The drip will be kept in until intake of fluids and food by mouth can be recommenced. A tube passed through your nose into the stomach prevents the accumulation of liquid within the stomach. This is left in place until normal emptying of the stomach has returned. An abdominal drain tube may be placed within the abdominal cavity to drain away any blood or fluid which accumulates. This will be removed 2 7 days after surgery. A urine catheter may be passed into the bladder to remove urine. This prevents the need for the patient to get up to pass urine in the immediate post-operative period. It is removed when the patient's condition is stable. Small amounts of fluid given by mouth may be started immediately after the operation. Larger quantities are withheld until the surgeons are sure that your bowel activity has returned to normal. This usually takes between 5 and 7 days. Immediately following the operation, the physiotherapist will visit to instruct on breathing exercises. This will help ensure that chest infections do not occur.

During Treatment of Bowel Cancer

Painkillers may be required regularly in the first 48 72 hours following operation. There may be griping abdominal pain, followed by the passage of wind. A normal bowel action indicates that recovery is almost complete. Once motions are being passed regularly, a normal diet is resumed. The length of hospital stay after such an operation is about 10 to 14 days from the day of operation : once the wound is healing satisfactorily, you can leave hospital. If a colostomy was necessary, you will only be able to return home when you and the nursing staff are happy that you are able to look after it.

After Treatment of Bowel Cancer

When you first return home, you will feel very weak. This is normal, and you will need to rest or sleep frequently during the day. Your strength will then gradually improve: about one month after returning home you should have recovered to about 70% of normal. It may be 2 to 3 months before you have fully recovered. For certain growths, further treatment with chemotherapy may be necessary. This is often a very mild form of treatment, with few side-effects.

If Bowel Cancer is Left Untreated

Growths of the bowel which are not treated will grow and spread. They may ulcerate, bleed and produce blood loss into the stools, causing anaemia. Some tumours may produce a blockage. Large tumours may invade neighbouring organs. Tumours may also spread to involve distant organs, in particular, the liver.

Effects on Family of Bowel Cancer

Patients with the condition of familial polyposis coli should have their relatives screened by colonoscopy. Some other types of cancer of the colon also tend to run in families, and your doctor may recommend that close relatives have regular blood tests or colonoscopy : it is better to treat the condition as early as possible.