Bowel cancer is Australia’s second biggest cancer killer. The bad news is it’s hard to avoid, especially if you are over 50, but the good news is it can be treated well if found early.
June is Bowel Cancer Awareness Month – Bowel Cancer Australia’s signature event to raise awareness of Australia’s second deadliest cancer.
Associate Professor Kynan Feeney heads the Department of Cancer Services at St John of God Murdoch Hospital, in Western Australia, and is a member of its Medical Advisory Committee.
A/Prof Feeney says that while bowel cancer claims more than 5000 Australians each year, with about 15,500 new annual diagnoses, it’s one of the most treatable cancers.
He says that while the incidence of bowel cancer is on the rise, that’s partly due to better testing.
The Federal Government’s National Bowel Cancer Screening Program sends out free cancer screening tests to all eligible Australians aged 50 to 74, with a repeat test every two years.
”At St John of God Murdoch Hospital we are seeing quite a few asymptomatic patients whose cancer has been picked up using the kits, proving that they are working,” he said.
“The cancer gets picked up early before it spreads. These are patients who would otherwise never have presented to their doctor because they have no symptoms.
“Late colon cancer can produce symptoms such as a change in bowel habit, bleeding from the rectum, persistent abdominal pain and cramps, and blood in the stool/pan/toilet paper.
“But patients with early stages of cancer or polyps are often asymptomatic. That’s why we do the screening, particularly in the early stages, so we can pick it up before it gets too advanced. Then the cure rate is much higher and the treatment is less severe.”
A/Prof Feeney says the most thorough examination to exclude colon cancer is a colonoscopy, but due to its cost and complexity, it’s impossible to test the whole population that way. He says there is also a small chance of complications from a colonoscopy, so it’s not the perfect tool.
That’s why the bowel cancer screening kits, while also not perfect, have been the main method for general population screening in Australia.
The test, known as an immunochemical faecal occult blood test, is a clean and simple procedure you do at home.
It looks for very small amounts of blood in the bowel motion, which may be a sign of cancer or other bowel problems.
You will be informed if the test is negative, but if positive you will be asked to contact your doctor, who may recommend further tests such as a colonoscopy.
Bowel Cancer Australia says the disease doesn’t discriminate, affecting men and women, young and old. But by far the risk of bowel cancer rises with age.
So how do we avoid it?
“Advancing age is the highest individual risk factor for these cancers,” A/Prof Feeney says. “As in most ‘lifestyle’ cancers – colon, breast, uterine, kidney, that kind of cancer – the biggest risk factor is age.
“It doesn’t mean you cannot get cancer when you are young, as unfortunately we do see this from time to time, but the risk rises as you get older, particularly from around 50 years onward.”
He says most cancers are “sporadic”, in that it’s difficult to attribute the onset of a person’s cancers to a particular cause..
“Lifestyle factors such as what we eat and how much we exercise, do make a big difference for the whole population. For example, if 20 million Australians don’t exercise we would anticipate seeing a huge rise in the number of cases of colon cancer, but who will get it is somewhat random.
“This doesn’t mean we shouldn’t exercise or live a healthy lifestyle of course, because exercise, for example will reduce our risk not only of colon cancer, but many other cancers, and is also positive benefit for many other parts of our health and wellbeing, such as cardiovascular, brain and emotional health amongst other positives.
“But what it does mean is that even if you exercise, look after yourself and do all the right things, it’s still important to get your screening tests done, as unfortunately, cancer can still occur in people who don’t have any risk factors for cancer. In a sense, screening for cancer is a part of healthy lifestyle management.
“If you have a family history of cancers, say your mum, aunty or grandma, talk to your doctor about screening at an earlier age, as in a small proportion of people with a known genetic risk in your family, will need to consider a different screening schedule. Your doctor can advise you if this is the case.
“There are also rare conditions such as inflammatory bowel disease that may mean a different colon cancer screening schedule would be more appropriate.”
Still, A/Prof Feeney says, exercise, being overweight, and alcohol consumption are risk factors for the development of colon cancer. Experts are also finding red meat, especially processed red meat, is not good for the bowel and may contribute a small amount to the incidence of colon cancer. Some recent studies have also linked high sugar intake, particularly high intake of sugar-sweetened beverages, to an increased risk of colon cancer, particularly in younger adults.
“So if you are obese and eat bacon for breakfast every day, and sausages on the weekend, drink excessive amounts of alcohol, and don’t exercise, you would have a higher risk for developing colon cancer than a healthy weight vegetarian who exercises every day and doesn’t drink alcohol. But both of these people still need to have screening. Because it all comes back to catching it early.”
“So if you have a positive screening test, your GP may refer you to have a colonoscopy, and if we find a polyp, you can have the polyp off, and usually that’s it. Sometimes we have to do a little bit of surgery if the polyp was larger, but generally, that means you’ve dodged a bullet.”
“If it’s bigger, and has become a more advanced cancer we can’t just remove it with an endoscope, we may have to go in, do surgery, and remove the surrounding lymph nodes. If it has spread further and has a chance of recurrence, that’s when you come for chemotherapy.”
A/Prof Feeney says there have unfortunately been few breakthrough treatments for advanced colon cancer in the past 10 years, other than for a very rare genetic-linked colon cancer that can be treated and cured, even if it has spread, with a new type of immunotherapy.
“So keep fit, adopt a healthy lifestyle, and keep your screening up. You want to get treated earlier, pick things up before they become too serious to hopefully avoid any major surgery. Don’t be afraid to do screening, it may avoid having to do something more serious down the track and may save your life.”