Bowel cancer – screening, symptoms and treatment (UCLH web chat) 

To mark Bowel Cancer Awareness Month this April, we are hosting a web chat on bowel cancer with consultant gastroenterologist Ed Seward.

Bowel cancer is the fourth most common cancer in the UK. Nearly all bowel cancers arise when there is an abnormal growth of cells in the large bowel (colon and rectum). Most begin as non-cancerous polyps that can be easily removed if caught early enough.

Our expert Ed Seward has been appointed as a National Clinical Advisor for Endoscopy and is working on a programme to shorten diagnostic waits for colorectal cancer. Ed joined UCLH in 2014 to work on ‘Bowel Scope’ for north and central London.  Bowel scope is the national plan to provide screening for bowel cancer and polyps to all 55 year olds.
Ed will be able to answer your questions on bowel cancer screening, symptoms, treatment and living with bowel cancer. Questions related to all aspects of bowel cancer are welcome.

To join in the conversation, simply visit this page at 1pm on Monday 4 April. To send your questions in advance, submit to webmaster@uclh.nhs.uk and Ed will try to answer your question on the day.

Please see a transcript of the web chat below.


12:27 UCLH: 
Good afternoon and welcome to our web chat. We will begin at 1:00pm, but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 1:00pm.

Dr Ed Seward will be joining us to take your questions on ‘Bowel cancer – screening, symptoms and treatment’ and will try to answer as many questions as possible within the hour long web chat.
 
1:00 Dr Ed Seward: 
Welcome to our web chat on the subject of bowel cancer. My name is Dr Ed Seward - and I am ready and waiting to take your questions.
 
1:01 [Comment From EJ: ] 
I am 64 year old man and have been having constant cramping and pain in my lower left abdomen. My GP ordered a sonogram - which showed nothing. Is a sonogram a diagnostic tool for bowel cancer? When I was 50, after months of lower left abdominal pain and fever, I was diagnosed with diverticulitis. After the inflamation settled down I had a colonoscopy. Several polyps were removed and I was told they were benign. About a year ago (nearly 13 years since the colonoscopy) I have been experiencing cramping and pain in that same area (but no fever). This discomfort has continued, and my GP has done nothing further after reviewing the results of the sonogram. At what point would a colonoscopy be ordered? How likely is it that non-maliginant polyps will become malignant (and lead to bowel cancer) if not removed? Since I had polyps removed over 10 years ago, should I continue to be checked for polyps and have them removed? Is diverticular disease a risk factor for bowel cancer?
 
1:01 Dr Ed Seward: 
Thanks EJ

Let me deal with your points in order…
An ultrasound is not a good test to rule out bowel cancer – you’re right you’ll need a further colonoscopy. It’s always difficult judging when to repeat, but generally I would have a low threshold for doing a further colonoscopy if you’ve had polyps in the past.
You’d normally repeat a colonoscopy after the discovery of polyps anyway – unless the polyps were ‘hyperplastic’ (in other words, no cancerous potential).
Diverticular disease is NOT a risk factor for bowel cancer

I hope that helps
 
1:02 [Comment From Jakki: ] 
Question - my mum died of bowel cancer at the age of 78. She was diagnosed ten years earlier. Should I have more than the routine bowel cancer screening from the age of 60?
 
1:03 Dr Ed Seward: 
Jakki

Thanks for this
I’m really sorry to hear about your mum. I can put your mind at rest, however, that your mum getting cancer at that age puts you at no increased risk – so taking part in the national bowel cancer program is a very good idea and should be enough to provide you with the reassurance you need
 
1:06 [Comment From Emma: ] 
For an elderly person, who was previously diagnosed with anal fissures (and from time to time noted bleeding apparently related to that, associated with passing hard compacted stools), is there a way of differentiating from that a symptom which could herald something more sinister? To what extent can constipation herald bowel cancer? Is there a way of differentiating constipation that could be attributable to medication from constipation that could, again, have a sinister explanation? Apart from fibrous fruit/vegetables, linseed, flaxseed etc, is there any new dietary advice that could help ward off bowel cancer? Will there be an upper age limit on the new screening or will it be available to all above 50? (I do hope the latter!). Thank you so much for any advice on the above.
 
1:07 Dr Ed Seward: 
Emma

That’s a really good question. It’s not easy at all to differentiate bleeding from a fissure, and something else like a polyp. I can tell you that the data tells us that the vast majority of people with constipation or bleeding don’t have anything to worry about, but my advice always is to get yourself checked out.
Current national screening starts at 55 in England although this program isn’t fully rolled out yet, otherwise it’s 60. But if you’ve got symptoms – see your GP and ask about a referral.
 
1:11 [Comment From Guest: ] 
What are the early signs and symptoms of bowel cancer?
 
1:11 Dr Ed Seward: 
The symptoms to look out for are bleeding from the back passage, a change in bowel habit (to diarrhoea or constipation) or if your doctor finds out your anaemic. Tummy pain with other symptoms like loss of weight could also be a symptom.
The thing to remember, though, is that bowel cancer is a feature of older age groups – so 95% of bowel cancer occurs in the over 50 age group and 99% of bowel cancer occurs in the over 45s, so if you’re younger than 45 with bowel symptoms, cancer is very very unlikely
 
1:17 [Comment From Guest: ] 
How does bowel cancer screening work?
 
1:17 Dr Ed Seward: 
There are currently 2 national programs ongoing in England – Bowel Scope which is a one off flexible sigmoidoscopy (limited camera examination of the first part of the bowel) which is open to every 55 year old, and the Bowel Cancer Screening Program which runs from 60-75 and involves screening a poo sample every 2 years for the presence of blood. There’s loads of information on www.nhs.uk website via ‘NHS Choices’ and I’d recommend having a look there in the first instance
Good luck!
 
1:20 [Comment From Jo: ] 
My mum has bowel cancer, I just wanted to check whether I am at higher risk? and if so what can i do if anything to prevent this?
 
1:20 Dr Ed Seward: 
Hi Jo
I’m sorry to hear about your mum – the same advice applies in that it very much depends how old your mum was when she was diagnosed as having bowel cancer – but if she’s over 50 this absolutely puts you at no increased risk. If in doubt, check with your GP but the vast majority of bowel cancers have no genetic predisposition involved
 
1:22 [Comment From Alice: ] 
I am in my 40s and have recently passed very dark coloured stools, am losing weight and occasionally pass blood - should I get checked?
 
1:22 Dr Ed Seward: 
Alice

There are of course a large number of possible reasons for your symptoms, and because of your age, cancer is very unlikely. However, if you’re concerned, I’m a big believer in getting yourself checked out – so please don’t hesitate to run your symptoms past your GP and see what they think. I hope things go well.
 
1:26 [Comment From Dee: ] 
I found a little bit of blood in my stool. Could I have bowel cancer?
 
1:26 Dr Ed Seward: 
Dee
As we’ve discussed, although bleeding can be a symptom of cancer, the vast majority of people with bleeding have nothing to worry about and it just turns out to be piles or similar. But if you’re over 50, personally I would get it checked out
 
1:27 [Comment From Guest: ] 
can having piles lead to cancer?
 
1:27 Dr Ed Seward: 
No - but piles can mask the symptoms of cancer so it's always worth considering being checked if you're over 50 or worried
 
1:31 [Comment From Nina: ] 
I have recently been diagnosed with bowel cancer and am not coping well. Where can I go for help with my feelings and emotions?
 
1:33 Dr Ed Seward: 
Nina
I’m really sorry to hear that – a cancer diagnosis can be a very lonely place for the person involved, and sometimes friends and relations may not know what to do or say.
You should have a named specialist nurse who will have introduced themselves when you were diagnosed and they can be as brilliant source of practical and emotional help. They’ll also be able to put you in touch with a counselor who can talk things through with you. The various bowel cancer charities (Bowel Cancer UK, Beating Bowel Cancer) are also really helpful, and will be able to provide additional help and assistance.
 
1:35 [Comment From Guest: ] 
should we be more forceful with GPs if showing symptoms as my GP thinks she knows it all and rarely likes to refer on unless patient kicks up a stink
 
1:35 Dr Ed Seward: 
I don’t think it’s too controversial to say that if you have symptoms suggestive of bowel cancer, and you’re over 45 or 50, then I think it is entirely reasonable to be referred up and be checked out at hospital. You shouldn’t have to make a fuss over these things – it’s why we have fast track referral pathways nowadays to make it easy for people to be referred up. Best of luck!
 
1:39 [Comment From Donna: ] 
What is the chance of surviving bowel cancers?
 
1:39 Dr Ed Seward: 
Donna

That’s another good question. Survival for bowel cancer is directly related to the ‘stage’ of the cancer – so how early or late the cancer is diagnosed. Early bowel cancer is associated with survival rates of 95% or even higher, so the emphasis is very much on catching it early. That is why we have national screening programs for bowel cancer – because these have been demonstrated to catch bowel cancer at earlier, more curable stages. So, please get yourself checked out early if you develop bowel symptoms, and if you’re the right age – take part in screening programs.
 
1:44 [Comment From Guest: ] 
my cousin passed away from bowel cancer 18m ago - she ignored bleeding from rectum for 2 years and was diagnosed at stage 4 when she collapsed at work - what is being done to ensure ethnic minorities are encouraged to go for screening as this is a taboo subject in our culture and not often discussed.
 
1:44 Dr Ed Seward: 
You’re absolutely right – this is a big issue. Take up rates for bowel cancer screening can vary from over 60% in some areas of London to less than 30% in others, and ethnicity can affect take up. There are programs concentrating on engaging with religious communities and the like so efforts are being made – but we need to do more to cross these cultural boundaries to engage with everyone in the community. I think things are getting better – but it can be an uphill struggle
 
1:47 [Comment From Roxanne: ] 
Are there certain food types that I should be eating / avoiding?
 
1:48 Dr Ed Seward: 
I’m often asked about diet and bowel cancer. The data comes from large ‘observational’ studies and sometimes they can contradict one another but the basic advice is to be mindful of the amount of red meat, and particularly processed meat, that you eat. Ideally, you should restrict this to no more than 2 occasions a week. A diet high in fibre is probably protective from bowel cancer, and vitamin D and calcium may also be protective. Anti-oxidant vitamins may also help.
 
1:53 [Comment From I: ] 
what are my chances of survival if i have secondary bowel cancer
 
1:54 Dr Ed Seward: 
Secondary bowel cancer means that the cancer has spread away from the bowel to another organ in the body – usually the liver or lungs. When I started as a doctor we used to be very pessimistic about this – nowadays it can still be curable with surgery, or heat treatment to the areas affected (ablation) or with modern chemotherapy treatments, or with a range of other treatments. Yes, it is more challenging than early bowel cancer, but it is still curable depending on the extent and position of the spread of the cancer. The treatments offered also depend on how fit and well you are – what we call your ‘performance status’. I very much hope your team will be able to offer you the treatments needed to get rid of the cancer and back on your feet again. Best wishes.
 
2:05 UCLH: 
Thank you for joining us today in our live web chat. We hope you found the chat useful and some of your questions have been answered.

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