Bowel (colorectal) cancer

Bowel cancer affects the digestive system between the stomach and the anus. It can affect either the small bowel where our food is digested, or the large bowel (colon and rectum) where what remains of our food is turned into solid waste and expelled from the body.

This page deals primarily with cancer of the large bowel (also known as colon or colorectal cancer), which is more common than small bowel cancer.

Characteristic symptoms of colorectal cancer include changes in bowel habits and bleeding from the rectum. Treatment involves surgery, followed in some cases by chemotherapy or radiation therapy. In many cases, colorectal cancer is curable if detected sufficiently early in the course of the disease.

About the bowel and colorectal cancer

Bowel cancer, along with prostate cancer, is one of the most diagnosed cancers among New Zealand adults with around 3,000 new cases per year and 1,200 deaths. New Zealand has one of the highest rates of bowel cancer and deaths from bowel cancer in the western world.

The bowel is a 6 metre-long tube of muscle that is part of the digestive system extending from the stomach to the rectum and anus.

Colorectal cancer is an abnormal growth of cells lining the walls of the colon or rectum, and can be associated with polyps, which begin as non-cancerous (benign) fleshy growths that develop on the wall of the bowel. Polyps become more common as people age. The abnormal cell growth results in the formation of a malignant lump or tumour, which can affect bowel function.

Risk factors

It is not known what causes bowel/colorectal cancer, but several risk factors that appear to increase the likelihood of developing the disease have been identified.

Older age is associated with an increased risk of bowel cancer. Although bowel cancer can be diagnosed at any age, most people with colon cancer are older than 50 years.

A family history of bowel cancer or polyps — having a first-degree relative (father, mother, brother, sister) or second-degree (grandfather, grandmother, aunt, uncle) relative with bowel cancer or polyps — is a risk factor for bowel cancer.

The risk of developing the condition is also increased in people with an inflammatory bowel disease, primarily long-term ulcerative colitis but also some instances of Crohn's disease.

Diets high in meat and fat are believed to be a factor in the development of bowel cancer — countries with high rates of bowel cancer have a higher consumption of red meats, processed meats, and fat (especially animal or saturated fat) than countries with low bowel cancer rates.

Obesity, an inactive lifestyle, smoking, and high alcohol use are also associated with an increased risk of colorectal cancer.

Signs and symptoms

Signs and symptoms of colorectal cancer may include:

• Blood in the stools and/or bleeding from the rectum
• A change in bowel habits lasting longer than 6 weeks (e.g. loose stools, diarrhoea, or constipation)
• Stomach pain (often severe)
• Lumps or a mass in the abdomen
• Weight loss
• Weakness and tiredness (symptoms of iron deficiency anaemia).

Diagnosis

A diagnosis of colorectal cancer is made by a combination of tests including a digital rectal examination (where your doctor will feel for suspicious lumps using a gloved finger), testing for blood in the stools (faecal occult blood test), blood tests for anaemia, and x-rays of the digestive tract.

The definitive test for colorectal cancer is a colonoscopy. A colonoscopy is performed by a colorectal surgeon or gastroenterologist using a colonoscope (a thin, flexible, tubular instrument with a video camera at one end) to view the lining of the intestines and, if necessary, to take biopsy tissue samples for laboratory testing.

Staging of colorectal cancer

When colorectal cancer is diagnosed, additional tests (including MRI, CT and PET scans) are performed to determine the extent of the disease, which is a process called staging.

The staging for colorectal cancer is as follows:

• Stage I (least advanced cancer) — cancer involving only the innermost layers of the colon or rectum wall. The likelihood of cure for stage I cancer is over 90%, emphasizing the importance of early detection of the cancer
• Stage II — cancer exhibiting greater growth and extension of tumour through the wall of the colon or rectum into adjacent structures.
• Stage III — cancer involving spread of the cancer to local lymph nodes (metastasis).
• Stage IV (most advanced cancer) — cancer having spread (metastasized) to distant organs, usually the liver and lungs, or lymph nodes far from the original tumour.

Treatment

The primary treatments for colorectal cancer are surgery to remove cancer cells, and chemotherapy and radiation therapy to kill cancer cells.

For most people with stage I and stage II colorectal cancer, surgery alone is the only treatment required. However, once the cancer has spread to local lymph nodes (stage III), the risk of the cancer returning remains high even if all visible evidence of the cancer has been removed by the surgery. In this case, chemotherapy is likely to be used to lower the risk of the cancer returning.

Chemotherapy

There are several different options for chemotherapy for the treatment of colorectal cancer. The simplest treatments involve a single type of chemotherapy drug, given either by pill or by injection into a vein, but often a combination of chemotherapy drugs is recommended. Chemotherapy is typically given for a total of 6 months.

Once colorectal cancer has spread to other parts of the body (stage III and IV cancer), chemotherapy is the best treatment, and although not curative it can extend life expectancy and quality of life. Chemotherapy might also be used to shrink a large cancer to make it easier to remove with surgery.

Radiation therapy (radiotherapy)

Radiation therapy involves the use of powerful beams of energy to kill cancer cells. It is usually used for cancer of the rectum since tumours in the rectum are often more difficult to remove surgically than are tumours in other parts of the bowels. Radiation therapy might also be used to shrink a large cancer to make it easier to remove with surgery.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. This includes the use of man-made drugs that act like antibodies in the immune system. Targeted drug therapy is typically reserved for people with advanced colon cancer and is usually combined with chemotherapy.

Immunotherapy

Immunotherapy is a type of targeted therapy used in the treatment of advanced colon cancer to boost the body’s immune system ability to fight cancer. In some cases, cancer cells are tested to see if they are likely to respond to immunotherapy.

Prevention

The specific cause of bowel cancers is not known but lifestyle factors may contribute to its development. Therefore, making the following lifestyle changes, or modifications, may lower the risk of developing bowel cancers:

• Maintaining a healthy body weight
• Being physically active
• Eating a diet rich in whole grains, cereals, fruit, and vegetables
• Reducing intake of red or processed meats, animal fats, salt, and sugars
• Drinking alcohol in moderation
• Stopping smoking.

Screening for bowel cancer

The aim of screening is to find bowel cancer at an early stage before it spreads, which increases the chances that it can be successfully treated.

In New Zealand, the National Bowel Screening Programme is a free programme to help detect bowel cancer. A bowel screening test is offered every two years to men and women aged 60 to 74 years who are eligible for publicly-funded healthcare. More information, including who should do the test, is available by calling 0800 924 432.

Further information

The Cancer Society of New Zealand operates a phone service staffed by specialist nurses to support patients diagnosed with cancer, including bowel/colorectal cancer, as well as their friends and families.

Cancer Society of New Zealand
Freephone: 0800 CANCER (226 237)
Website: www.cancernz.org.nz

Bowel Cancer New Zealand is a nationwide patient-led charity that aims to reduce the impact of bowel cancer on the community by raising awareness and providing education, advocacy, research, and support services for bowel cancer patients and their families.

Bowel Cancer New Zealand
Email: [email protected]
Website: www.bowelcancernz.org

References

Dragovich, T. (2020). Colon cancer (Web Page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/277496-overview [Accessed: 24/11/20]
Jackson, C., et al. (2014). Rectal cancer: future directions and priorities for treatment, research and policy in New Zealand. N Z Med J. 2014;127(1395):63–72.
Ministry of Health (2017). Cancer: historical summary 1948–2017 (Report). Wellington: New Zealand Government Ministry of Health. https://www.health.govt.nz/publication/cancer-historical-summary-1948-2017 [Accessed: 24/22/20] New Zealand Guidelines Group (2012). Bowel cancer (Booklet PDF). Wellington: New Zealand Ministry of Health. http://www.health.govt.nz/system/files/documents/publications/bowel-cancer-2012-update_consumer.pdf
NHS (2019). Bowel cancer (Web Page). Redditch: National Health Service (NHS)England. https://www.nhs.uk/conditions/bowel-cancer/ [Accessed: 24/11/20]
O’Toole, M.T. (Ed.) (2017). Colorectal cancer. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MO: Elsevier.

Last updated: December 2020

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