Warning signs of bowel cancer: Symptoms & Treatment

What is bowel cancer?

This article highlights how to spot bowel cancer by detailing bowel cancer symptoms. It also covers bowel cancer diagnosis and treatment.

There are two main parts to the bowel, the small bowel and the large bowel.Food eaten ends up in the large bowel where water and some nutrients are absorbed leaving waste which passes through the bowel before leaving the body.

Bowel cancer (also known as ‘colorectal cancer’) starts in the lining of the large bowel (colon) or rectum. 

Cancer occurs when abnormal cells in the body divide and grow in an uncontrolled way. They can grow into surrounding tissues, organs and can spread to other parts of the body. 

How common is bowel cancer?

Bowel cancer is the fourth most common cancer in Britain.

The number of people in the UK diagnosed with bowel cancer is set to increase by around a tenth by 2040, according to the Bowelbabe Fund for Cancer Research UK, with bowel cancer cases rising from 42,800 to 47,700 each year.

The reason for the increase is the growth in the ageing population as older people are more likely to get cancer.

What causes bowel cancer?

It can be caused by genetic changes, lifestyle and environmental factors.

You may be more likely to get this cancer if:

• You are overweight.
• You are aged 50+.
• You are a smoker.
• A close relative had bowel cancer.
• You have inflammatory bowel disease, (e.g. Crohn’s disease).
• You have small growths in your bowel.
• You have Lynch Syndrome or Familial Adenomatous Polyposis (FAP).

What are bowel cancer symptoms?

According to the NHS, key symptoms are:

• Persistent blood in your poo. This occurs for no obvious reason or is linked with a change in bowel habit.

• Persistent change in your bowel habit. This is usually having to poo more and your poo may also become runnier.

• Persistent bloating or discomfort.

How do you reduce your risk of getting bowel cancer?

• Eat a healthy diet including at least five portions of fruit and vegetables a day.
• Exercise regularly.
• Lose weight if you are overweight.
• Drink less alcohol.
• Quit smoking.
• Eat less red and processed meat.

What should you do if you think you have bowel cancer?

You should be aware of what the symptoms are and see your GP to get any symptoms you have checked.

How do you diagnose bowel cancer?

A GP can refer you to a specialist for tests, if bowel cancer is suspected.

A main test for bowel cancer is a colonoscopy. A thin tube with a camera looks inside your bowel. During the colonoscopy, a small sample of the lining of your bowel may be taken for testing (called a biopsy).   

Bowel cancer screening

Regular bowel cancer screening is available to people in England aged 60-74. This programme is expanding in England to include people aged 50-59.

People in England aged 60-74 who are registered with a GP are automatically sent an NHS bowel cancer screening kit called the Faecal Immunochemical Test (FIT) every two years. FIT detects hidden blood in poo.

In Scotland, screening starts from the age of 50 and in Wales, people are asked to take part in screening between the ages of 51 and 74. In Northern Ireland, those over 60 are sent the tests.

What happens if I get a bowel cancer diagnosis?

If you have this cancer, you may need more tests to identify if the cancer has spread and what treatment is the most ideal for you.

• CT scan.
• MRI scan.
• PET scan.
• Blood tests.
• Genetic testing.

The results of these tests reveal how far the cancer has spread and if the cancer has been caused by changes in your genes.

How do you treat bowel cancer?

Where this cancer is located will affect the treatment that you might have. For example, the treatment for colon cancer can be different to the treatment for rectal cancer.

The treatment you have will depend on the size of the cancer, if it has spread to other parts of the body, if the cancer has certain genetic changes, your age and overall health and where your bowel cancer is located e.g. your colon, rectum or both. The treatment for colon cancer can be different to the treatment for rectal cancer.      

What are the treatments for bowel cancer?

You may be offered treatments including surgery, chemotherapy, radiotherapy and medicines.

Bowel cancer treatments include:

• Surgery.

Surgery may be conducted to remove cancer from the bowel. Part or all of the bowel may also need to be removed.

• Chemotherapy.

Chemotherapy is medicine that kills cancer cells. You may have it after surgery to try to prevent the cancer returning, if you are unable to have surgery or if cancer has spread to other parts of your body.

• Radiotherapy.

Radiotherapy uses radiation to kill cancer cells. A machine is used to target beams of radiation directly at tumours. You may have radiotherapy if the cancer is in your rectum or the cancer has spread to other parts of the body.

• Medicines.

Medicines or immunotherapy may be used to treat advanced bowel cancer that has spread to other parts of the body.

How can bowel cancer spread?

This cancer can spread to another part of the body through the lymphatic system. This is made up of lymph nodes, which are part of the body’s immune system. One of the first places bowel cancer spreads is to the lymph nodes in the tummy.

It can also spread through the bloodstream. The liver is a common place for bowel cancer to spread because blood flows directly from the bowel to the liver. The cancer can also spread into the lung or bone but this is less common.

Is bowel cancer curable?

Yes, it is curable. According to the NHS, if you have been treated with advanced bowel cancer, it may be hard to treat and not possible to cure.

Survival for all stages of bowel cancer

According to NHS England figures for people diagnosed with bowel cancer in England between 2016 and 2020 and Office for National Statistics figures (Cancer survival by stage at diagnosis for England, 2019):

• Around 80% of people survive their cancer for 1 year or more.
• Almost 60% of people survive their cancer for 5 years or more.
• Almost 55% of people survive their cancer for 10 years or more.

Survival rates for bowel cancer for each stage

Stage 1 cancer

Around 90% of people with stage 1 bowel cancer (also called Dukes’ A) will survive their cancer for 5 years or more after they are diagnosed, according to Cancer Research UK. 

Stage 2 cancer

Around 85% of people with stage 2 bowel cancer (also called Dukes’ B) will survive their cancer for 5 years or more after they are diagnosed. 

Stage 3 cancer

Around 65% of people with stage 3 bowel cancer (also called Dukes’ C) will survive their cancer for 5 years or more after they are diagnosed. 

Stage 4 cancer

Around 10% of people with stage 4 bowel cancer (also called Dukes’ D) will survive their cancer for 5 years or more after they are diagnosed. 

If the cancer has spread into the liver and the surgeon can remove it, more than 40% of people will survive their cancer for 5 years or more after their operation. 

What affects bowel cancer survival?

According to Cancer Research UK, a person’s survival depends on the stage of the cancer when it was diagnosed. This means how far it has spread through the bowel and whether it has spread further. The type of cancer and grade of the cancer cells can also affect your survival. Grade means how abnormal the cells look under the microscope. A person’s general fitness also affects survival.

Some bowel cancers make a protein called carcinoembryonic antigen (CEA) and those with high levels before treatment may have a worse outlook. 

Bowel cancer can sometimes cause a blockage in the bowel which could develop into a perforation in the wall of the bowel. People with bowel cancer who have an obstruction or perforation of the bowel have a worse outlook. 

What support is available if I have bowel cancer?

Home care

Home care involves care staff visiting someone in their own home to provide support or/and care. It is arranged through the local council or through private home care agencies.

Different types of home care include personal care (assistance with showering. getting in and out of bed, help going to the toilet), help with household tasks, rehabilitation after a stay in hospital, nursing care and palliative care.

You can read this advice article for details about Types of homecare and visits. 

Helplines and support groups

• Bowel Cancer UK offers information and support for people affected by bowel cancer via its website: www.bowelcanceruk.org.uk.
• The charity’s Ask a nurse service can answer questions or concerns about bowel cancer: nurse@bowelcanceruk.org.uk.
• Bowel Cancer UK Online support groups Online support groups | How we can help | Bowel Cancer UK.
• Bowel Cancer UK forum Welcome to our forum – Bowel Cancer UK.
• Macmillan Cancer Support has a free helpline.Call 0808 808 00 00.
• Cancer Research UK has information on its website: www.cancerresearchuk.org.
• Cancer Research Nurse helpline: 0808 800 4040.
• Cancer Research Online cancer chat forum

What should I do if my cancer is terminal?

If your cancer is terminal, it is important to:

• Seek out counselling and support. Marie Curie offers care and support for people affected by terminal illness via its website www.mariecurie.org.uk and helpline: 0800 090 2309.
• Tell your family and friends. Let family and close friends know what to expect and what your wishes are in relation to funeral etc.
• Get your affairs in order – make sure you write a will and talk to your family/loved ones about it.
• Spend time with the people you love. Consider doing the things you want to do e.g. try to fulfil a bucket list.

Mum of two Dame Deborah diagnosed with bowel cancer at 35

Former deputy head teacher and journalist Dame Deborah, a mother of two, was diagnosed with bowel cancer in 2016, aged 35.

Prior to her diagnosis, Dame Deborah worked as a deputy head teacher at two secondary schools in Surrey.

After learning about her bowel cancer, she began working as a journalist detailing her cancer journey in The Times and then hosted the ‘You Me and the Big C’ podcast for the BBC alongside two other co-hosts living with cancer, Lauren Mahon and Rachael Bland.

She became famous for her podcasting and journalism detailing what life was like living with cancer and raising awareness of the symptoms she was experiencing.

‘Check your poo’

Dame Deborah advised: “Find a life worth enjoying, take risks, love deeply, have no regrets and always, always have rebellious hope. And finally, check your poo – it could just save your life”. 

In October 2018, she released her book ‘F*** You Cancer: How to Face the Big C, Live Your Life and Still Be Yourself’. Her second book is ‘How To Live When You Could Be Dead’.

Dame Deborah received end of life care at her family home in Surrey.

At the time, Dame Deborah tweeted: “The tweet I never wanted to write. The time has come to say goodbye. 5 years to prepare, doesn’t make it any easy”.

Shortly before her death, the mother of two set up a fundraising page called ‘Bowelbabe Fund for Cancer Research UK’ to raise money for bowel cancer.

It raised over one million pounds in less than 24 hours – exceeding her goal of £250,000. It has now raised £12.6m to date (24 January 2024).

In recognition of her fundraising, Dame Deborah was given a damehood by Prince William who visited her family home in Surrey to bestow the honour.

She passed away peacefully on 28 June surrounded by family.

Bowel Cancer UK, of which Dame Deborah was a patron, said she turned her bowel cancer diagnosis “into an incredible force for good” and as a result would save lives because of her campaigning.