Bowel Cancer

Bowel cancer is the most common cancer in Hong Kong. According to statistics of Hong Kong Cancer Registry in 2013, for every 10000 population, 66 people suffered from bowel cancer. Bowel cancer, if detected and treated early, is highly curable. Understanding the symptoms and causes of the disease enables early detection and treatment. Basic knowledge of the disease, treatment, necessary nursing and caring techniques ensure speedy recovery and reduce the risk of relapse. Healthy diet, appropriate physical exercise and screening program greatly reduce risk of bowel cancer.

(Special thanks to Dr. Y. T. Fu, Senior Medical Officer, Clinical Oncology, Queen Elizabeth Hospital for reviewing the information.)

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Colon is the last portion of the digestive system, consisting colon and rectum. Sometimes, there will be abnormal cell growth on the bowel wall, the emergence of polyps, ulcers or other forms of mass. Most of these are benign, but a small portion may develop into malignant tumors, becoming as bowel cancer.
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The exact cause of bowel cancer is still unknown. People with the following characteristics are found to have higher chance to develop bowel cancer :
  • Age over 50
  • With family history of bowel cancer
  • Suffered from or had family history of chronic colitis or colon polyps
  • Maintain a high-fat, high-cholesterol, low fiber diet 
  • Overweight (body mass index over 25)
  • Drink excessively
  • Smoker
  • physically inactive
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Effective ways to prevent bowel cancers includes:
  • adequate intake of dietary fiber: high fiber intake promotes the movement of your bowel and reduces constipation, avoid toxins and cancer-causing substances;
  • fruits and vegetables are rich in vitamins and anti-cancer substances, high intake of which helps preventing cancer;
  • reduce consumption of red meat;
  • cook with less oil; steam, bake, grill instead of pan-fry or deep-fry;
  • exercise regularly and maintain a healthy weight;
  • quit smoking, drink less
  • appropriate screening procedures
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Common signs and symptoms of bowel cancer include:

  • bloody/stained stool, black stool, stools with mucus, or rectal bleeding;
  • change in bowel habits (constipation or diarrhea), change shape of the stool (thin strip);
  • unexplained weight loss;
  • pain in the lower abdomen (distended abdomen or colicky abdominal pain);
  • feeling of unfinished bowel movement;
  • physical symptoms of anemia: cold hands and feet, fatigue, rapid heartbeat, shortness of breath, pale pallor, dizziness
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High-risk individuals and people with the above-mentioned symptoms should consult family doctors and arrange investigation as soon as possible. Bowel disease-related investigation include:
 

Colonoscopy
Colonoscopy is currently the best method to examine the lower digestive tract. By means of a flexible video-endoscope, the entire length of the colon as well as the terminal portion of the small bowel could be examined. The procedure generally lasts for 10 to 45 minutes.

Colonoscopy inspects the entire colon. Sigmoidoscopy is used to examine the last part of colon and rectum.

Colonoscopy is not only useful for diagnosis. With the use of different accessory equipments, it can perform biopsy and deliver targeted procedures such as removal of polyp.

Risk and Complications
Minor discomfort, including abdominal pain and distension is common. Major complications, including perforation, bleeding, heart and lung complications, infection or acute intestinal obstruction may happen. In general, the risk of major complications is less than 1%.  Patients should seek immediate help if they experience abdominal pain or discover blood in stools after the procedure.

Barium Enema Examination
Barium enema is a special x-ray procedure used for study of large intestine. Radiologist will introduce barium through a well-lubricated tube into the rectum. Liquid barium acts as a contrast to highlight specific areas in the body. The flow of the barium will be shown on a x-ray fluoroscope screen to indicate abnormality of the inner bowel wall. 

Rectal Examination
Physician will insert a gloved and lubricated finger into the rectum through the anus and palpates the insides for abnormal area or tumor.

Fecal Occult Blood Test
Bleeding in the bowel may not be physically apparent. This test checks for hidden blood in the stool.

If tumor is found, doctors may need to conduct computed tomography tests and other imaging studies. 
 

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PhotoThe commonly used treatment modalities for bowel cancer include:
 
Surgery
Surgical removal of tumor is the primary treatment for bowel cancer. It can cure both early stage bowel cancer and minority of cases who had already metastasized to liver or lungs. The recent advent of minimally invasive surgery not only speeds up rehabilitation, but also greatly reduces the risk of complications, although it is not suitable for every single patient. For rectal cancer, total mesorectal resection is advocated to improve treatment result. Temporary or permanent stoma may be necessary in individual patients.

Adjuvant Therapy
Adjuvant therapy can reduce the chance of relapse in certain patients. Adjuvant treatment to be considered includes radiation therapy and chemotherapy. Radiation therapy is the use of high-energy radiation to destroy cancer cells. It is mainly used in rectal cancer patients. Chemotherapy is the use of anti-cancer drugs to kill cancer cells. These treatments are usually given after the radical surgery, although some patients require such treatment before surgery to facilitate surgical resection.
Who needs adjuvant therapy :
  • Stage II patients
    Adjuvant treatment may be considered for Stage II colon and rectum cancer patients with high-risk features.
  • Stage III patients
    Adjuvant treatment is generally recommended in Stage III colon and rectum patients.
  • Stage IV patients
    Adjuvant treatment is considered only if all the metastatic lesions and the primary tumour are completely resected
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Patients with hypertension, diabetes mellitus, coronary heart disease, and other chronic diseases should take extra care.

Investigation
Patients in need of endoscopic therapy, such as polypectomy (removal of polyps), endoscopic hemostasis, as well as expansion and stent placement have higher risk of serious complications such as intestinal obstruction and bleeding.

Surgery
Poor healing of surgical wound of the bowel may lead to peritonitis and sepsis. Inflammation and urinary dysfunction may also happen. However, it is worth noting that the more commonly used minimally surgery for bowel cancer has greatly reduced the risk of complications in recent years. 

Adjuvant therapy
Common side effects of radiotherapy and chemotherapy include: fatigue, vulnerable to infection or bleeding, loss of appetite, nausea and vomiting, hair loss, constipation or diarrhea.

Medication can reduce the severity of side effects.

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There are a lot of things to take care during the recovery process. Better understanding will help patients face the disease with a positive attitude.

Regular follow-up

Patients' condition, treatment and clinical features are different. Doctors would discuss with the patient, closely monitor patient' s recovery, review and assess follow-up treatments and propose consultation arrangements base on individual needs.

Regular follow-up helps pick up recurrence of the tumor or new tumours, ensures timely treatment as well as minimizing complications. Getting treatment early improves patients’ chance of cure.

Stoma
Patients who have the tumor in the lower rectum may have temporary and permanent stoma. Stoma Nurses will assist patients to choose the stoma appliances and empower patients the proper usage of stoma appliances and stoma care.

Diet
Patients are suggested to avoid eating food items that are difficult to digest such as fatty food and those may irritate the bowel e.g. curry or spicy food.

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