Bowel cancer: everything you need to know about the disease, diagnosis and treatment

Bowel cancer is a malignant formation of the mucous membrane of one of the parts of the intestine: small or large. Small bowel cancer is quite rare, colon cancer is relatively common, and rectal cancer is among the top five, both in terms of morbidity and the number of deaths from cancer.
There are 510.000 cases of colon cancer registered in the world every year. Rectal cancer ranks 4th place in the structure of mortality in women and the 3rd place in men.

What is the survival rate for bowel cancer today?

Rectal cancer and most colon cancers are almost 100% preventable. The fact is that this type of cancer almost always occurs from polyps (with the exception of cases of squamous cell carcinoma and malignant ulcers). It takes 5, 10, or even 15 years before a polyp turns into a cancerous tumor.
Regular colonoscopy with mandatory removal of all polyps can prevent the disease. Scientists still disagree about the age at which screening colonoscopy begins. The most popular opinion is that if there is no family history of colon cancer, colonoscopy should be started from the age of 45, if there is such a history — at the age of 35. The approximate frequency of colonoscopy is once every 5 years. At the moment, the procedure can be performed under sedation, so that the patient does not feel discomfort.

Bowel cancer prevention

Preventive recommendations for bowel cancer are as follows: to prevent cases of squamous cell carcinoma, you should be vaccinated against oncogenic types of HPV and not neglect barrier contraceptives.
The risk of intestinal cancer is reduced by eating a large amount of fiber, reducing the amount of consumed nitrates (these substances are mainly found in sausages) and red meat, avoiding constipation.

How to understand that a person has bowel cancer?

In the early stages, bowel cancer is almost always asymptomatic. In rare cases, it is possible to see a formation or induration on the mucous membrane in the case of anal cancer. Typical symptoms of bowel cancer:
Stool retention, thinning and lengthening of the stool. This symptom indicates that there is a barrier in the intestinal area that prevents the normal movement of fecal;
Discharge of a large amount of mucus during defecation;
The appearance of blood or bloody discharge during defecations, if the tumor is located in the lower intestines and darkening of the stool, if in the upper;
Constant pain syndrome, which is localized in the same area, does not pass for a long time and is not associated with eating and changing the body position — this means that the tumor has grown into the nerve fibers of the intestine;
Sometimes patients can group a dense formation in the abdominal cavity.

Symptoms of late-stage bowel cancer

At later stages, the tumor begins to exert a systemic effect on the body and the corresponding symptoms appear:
Lack of appetite;
Nausea;
Weakness and apathy;
Severe weight loss of 5 kg or more for no apparent reason.
When metastases appear, other organs are affected, most often the liver and lungs, which also cause specific symptoms — yellowing of the skin, itching, shortness of breath, hemoptysis, respiratory failure, and so on.

Complications of bowel cancer

Bowel cancer can cause specific complications and is often diagnosed when they occur. The most common are intestinal obstruction and bleeding. Both of these situations are acute surgical pathologies that require urgent medical care.
Patients with bowel cancer have several persistent symptoms, most of the symptoms are explained by more common and less dangerous causes, such as hemorrhoids, but medical examinations should never be neglected.

Bowel cancer diagnostics

If intestinal cancer is suspected (most often colon cancer), the patient goes to a proctologist or an oncoproctologist. A mandatory survey plan includes:

• Complaints;
• Family history;
• Finger examination of the rectum for the presence of acute gastrointestinal bleeding;
• Transrectal ultrasound, which can show a thickening of the rectal wall, which indicates the presence of a formation.

Colonoscopy is an important diagnostic element for suspected bowel cancer.
If there is a suspicion of bowel cancer or in order to completely exclude the probability of colon cancer, a colonoscopy will be performed on the same day — an examination of the intestines through a natural opening. If polyps are present, they will be removed, and all suspicious areas will be taken for a biopsy. The biopsy result is usually ready in 10-14 days.
Histological examination of the tumor, on the basis of which the diagnosis is made, is performed as a result of such a biopsy, but there are rare situations when the tumor is not available on endoscopic biopsy. Then the doctor offers other options — most often a minimally invasive operation.
If we are talking about a suspected formation in the small intestine, fibrogastroduodenoscopy (examination of the stomach and upper duodenum using a manipulator and a camera) will be offered as an endoscopic examination.

Preparation for a colonoscopy

In order not to delay the initial examination for several visits, it is better to come to the doctor prepared: it is necessary to cleanse the large intestine and come for an examination on an empty stomach. This will allow the survey to be carried out without obstacles.
Specify the rules of preparation when making an appointment with your doctor, informing about all your health features, medications taken and drug intolerances.
If, after endoscopic examination, the suspicion of bowel cancer is confirmed, the patient is prescribed either CT of the chest, abdomen and pelvis with intravenous contrast or PET-CT. In foreign countries, preference is given to PET-CT, in the CIS countries — to conventional computed tomography, this is due to the availability of the reserch. In rectal cancer, in addition to CT examination, it is also mandatory to have an MRI of the small pelvis.
Also, patients undergo general clinical examinations before starting treatment:

• General blood test;
• General urinalysis;
• ECG;
• Blood biochemistry;
• Coagulogram;
• If necessary, you can consult related specialists such as a cardiologist or endocrinologist.

Bowel cancer treatment

Colon cancer treatment methods depend on the stage of the disease, the age and general condition of the patient. Without going into the specifics of specific clinical situations, the treatment regimen can be presented as follows:
Treatment regimens consistent with international protocols.
The first stage only requires removal of the tumor.
The second and third stages require chemoradiotherapy before surgery for rectal cancer, which is located no higher than 10 cm from the anus and chemotherapy before surgery for all other types of bowel cancer.
The type and volume of the operation depends on the location of the tumor and the degree of damage to the surrounding tissues. In rectal cancer, the typical operation is a low anterior rectal resection. With the defeat of the higher located parts of the large intestine — right-sided and left-sided hemicolectomy, resection of the large intestine, resection of the small intestine.
When performing radical surgery on the rectum, a three-month stoma removal is often required — removal of the large intestine onto the abdominal wall to remove feces. Sometimes (in cases of extensive damage, nonviability of the intestine or multiple genetically determined intestinal damage), a total colectomy is required — removal of the entire intestine and lifelong removal of the stoma.
All these types of operations in most patients can be performed laparoscopically, without causing major trauma to the patient. This is important for bowel function and the ability of the rectal sphincter to retain stool.
The fourth stage of intestinal cancer is caused by the presence of metastases in other organs and requires a complex approach.
In the absence of metastases directly in the abdominal cavity, a large percentage of patients can be completely cured. In this case, patients are most often prescribed several courses of chemotherapy to transfer metastases in all organs to a state in which they can be removed, and then surgery is performed. After surgery, patients are usually also given chemotherapy and often targeted therapy — therapy that targets specific features of the tumor (mutations and receptors).

Colon Cancer Frequently Asked Questions

Here we have tried to collect the questions that are more often in patients with bowel cancer and give clear answers to them.

How long do patients with bowel cancer live?

About 60% of patients with stage I-III live for 5 years or more if they have been radically treated. At the 4th stage, a lot depends on the possibility of surgical treatment and the capabilities of the clinic.

How much does bowel cancer treatment cost?

The cost of treating bowel cancer depends on the cost of consumables, utility costs, payment for medical work and the number of bed-days. Consumables are produced by only a few companies in the world, and their cost is the same in all clinics and countries. The higher cost of treatment is formed mainly due to more expensive rates of payment for medical work.
The cost of bowel cancer treatment depends on the stage of cancer, clinic, clinical situation, previous treatment and the prices of consumables.
If we talk about treatment on a very average and general level, then its cost in Turkey will be about $10.000 — 15.000, in Israel $30.000 — 35.000, in Europe $20.000 — 25.000.

Can fecal occult blood test be used as a screening method?

If a colonoscopy is contraindicated for the patient, a fecal analysis for hidden blood is performed. However, this method has many false positive results due to a reaction to hemorrhoids and anal fissures and does not react in any way to non-bleeding malignant polyps.

What is a stoma and is it possible to do without it?

A stoma is the removal of the intestine to the surface of the abdominal wall to remove feces. This is a common stopgap measure after bowel cancer surgery. It is necessary so that the newly created anastomosis (stitched parts of the intestine) does not fall apart under the pressure of fecal.
In rare cases, with a high blood supply to the intestine, a young age and laparoscopic surgery, it is possible to perform a one-stage operation without removing the stoma. However, this is more the exception than the rule. This solution requires a very high qualification of the surgeon.

Statistical materials were taken from the guidelines of the National Cancer Institute in America NCCN.
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