When my father was diagnosed with colon cancer, he didn’t have any symptoms. It was luck that led him to the doctor’s office for the screening that saved his life. Colon cancer can be aggressive, but it can also be caught early or prevented altogether.

 Colorectal cancer is the third most prevalent cancer in men and the second most common among women worldwide. According to Cancer Research UK, over 41,000 new cases of colorectal cancer are diagnosed each year. However, crucially, more than half of these cases are preventable and more than one in two people diagnosed with bowel cancer in England survive their disease for 10 years or more.

 While colorectal cancers have historically affected people over 50, a 2017 study shows a concerning rise in colorectal cancer cases among millennials who now face twice the risk of developing colorectal cancer compared to those born in 1950. Dr Zaid Ardalan, a consultant gastroenterologist at The Alfred Hospital in Melbourne, Australia, says “this shift could be attributed to lifestyle changes, such as diet, physical activity, and obesity rates”.

 What’s the difference between bowel, colorectal and colon cancer?

There’s much confusion about the terms “bowel cancer”, “colorectal cancer” and “colon cancer”; types of cancer that occur in various parts of the digestive system. Dr Katherine Aitkens, a clinical oncologist, explains what they refer to: “We normally use the term ‘bowel cancer’ to talk about colon or rectal cancer, sometimes called ‘colorectal cancer’. There are other parts of the bowel that can become cancerous such as the small bowel or anus, which are less common.”

 What is colon cancer?

Colon cancer specifically refers to cancer that begins in a part of the large intestine known as the colon. The colon, which is approximately five feet in length, is the long tube primarily responsible for transporting digested food to the rectum and eventually out of the body. Colon cancer develops when certain polyps, or abnormal cells, proliferate within the inner lining of the colon, gradually transforming it from a non-cancerous state to a cancerous one.

 Typically, colon cancer develops gradually and progresses through various stages over several years. However, with advancements in screening tests and treatment options, early detection can prevent polyps from becoming cancerous and, even if the cancer does develop, there are many treatments that can help control it.

 When to see a doctor

Colon cancer can be present without symptoms. Due to its slow progression, regular screenings are necessary for detecting issues early (more on this below). However, if you notice any of the following  common signs or symptoms for more than two weeks, don’t hesitate to contact your doctor for further assessment.

 Change in bowel habit such as diarrhoea, constipation, or the feeling of incomplete bowel emptying

  • Blood in stool or on toilet paper after wiping
  • Abdominal pain, aches or cramps that won’t go away
  • Persistent bloating. A bloated stomach can have various causes, but persistent bloating lasting over two weeks or accompanied by symptoms like vomiting or blood in stool requires evaluation
  • Unintentional weight loss
  • Fatigue and shortness of breath
  • Vomiting

 What causes colon cancer?

Colon cancer, like many cancers, results from a mixture of genetic, environmental and lifestyle factors. Notably, it affects proportionally more men than women and individuals of Black ethnicity more than other racial groups. And while it commonly afflicts people aged 50 and above, there has been a steady uptick in cases among people aged 20 to 49, with an annual increase of about 1.5 per cent.

 Which lifestyle choices can increase the risk?

Red and processed meat: Eating too much red meat and processed meat like ham and bacon, is proven to increase the risk of colon cancer. In fact, 13 per cent of bowel cancer cases in the UK are linked to eating these meats, according to Cancer Research UK. The Government recommends that people should eat no more than 70g of red and processed meat a day, which amounts to about two sausages

Lack of fibre: In the UK, 30 per cent of bowel cancer cases are caused by eating too little fibre. “A simple way to include more fibre in your diet,” Dr Zaid Ardalan, a gastroenterologist, suggests, “is to consume two servings of fruit and five servings of vegetables daily.” A few of the best examples include kiwifruits (with the skin on), raspberries, blackberries, avocado, broccoli and brussels sprouts

Smoking: Smoking increases your risk of developing colon cancer. More research is needed before a similar direct association is made with vaping

Excessive alcohol consumption: When asked to define this, Mr Christopher Chan, a colorectal surgeon, pointed to the 2020-2025 Dietary Guidelines for Americans, which suggest limiting intake to two drinks or fewer per day for men, and one drink or fewer per day for women

Obesity: Cancer Research UK estimates that 11 per cent of bowel cancers in the UK are linked to being overweight or obese. Keeping a lower BMI reduces the risk

Lack of exercise: Physical activity has been shown to reduce your risk of colon cancer

 What medical conditions can increase the risk?

A family history of colon cancer: If a member of your immediate family has had bowel cancer, your risk increases, and you should speak to your doctor about screening early

Inflammatory bowel disease: Conditions such as chronic ulcerative colitis, characterised by persistent inflammation and ulceration in the colon and rectum, and Crohn’s colitis, causing inflammation in the colon as part of Crohn’s disease, elevate the risk of developing colon cancer

Inherited conditions: Conditions such as Lynch syndrome, a genetic predisposition, is associated with heightened risks in particular of colorectal and endometrial cancer. Familial adenomatous polyposis, an inherited disorder leading to the formation of numerous colon and rectal polyps, can also predispose the individual to developing colon cancer

A family history of polyps or having many polyps: These are detected during screening

 Can you prevent colon cancer?

The good news is that lifestyle changes can play a significant role in preventing more than half of all bowel cancers. Mr Chan emphasises that by minimising risk factors, we can lower the chances of developing the condition. To reduce the risk of colorectal cancer, it’s advised that you:

  •  Only drink alcohol in moderation
  • Maintain a healthy weight
  • Quit smoking
  • Adopt a healthy diet, incorporating plenty of fruits and vegetables and reducing consumption of red meat and processed foods. Some studies suggest that drinking coffee might also help lower the risk of colon cancer
  • Reduce stress and embrace an “anti-inflammatory lifestyle”. “While it may not receive as much attention in mainstream discussions, there is growing evidence to support stress reduction as a means of decreasing inflammation in the body,” says Mr Chan
  • Keep track of your family medical history, as genetics can play a role in predisposing individuals to certain types of cancer

 Why screening is crucial

Screening tests can detect precancerous polyps before they become cancerous tumours. If left undetected, the cancer grows, spreading to lymph nodes and, in advanced stages, spreading to other organs like the liver or lungs.  

 Screening age and overview

In England, everyone aged 60 to 74 is offered a bowel cancer screening home test kit every two years, although this is expanding to include those aged 50 to 59. In Scotland, screening starts from age 50, and in Wales it is 51. The screening test is a FIT (faecal immunochemical test) that looks for tiny traces of blood in a sample of faeces, which can be a sign of polyps. If the test finds anything unusual you might be asked to go to hospital for further tests to rule out or confirm cancer, such as a colonoscopy.

 “The gold standard for screening is still colonoscopies,” says Dr Ardalan. Though sometimes viewed with dread, a colonoscopy is a pain-free medical procedure in which a flexible tube with a camera is used to examine the inside of the colon and rectum for abnormalities like polyps or signs of cancer. Colonoscopies are crucial for colorectal cancer screening and diagnosing gastrointestinal conditions, and if you have symptoms or concerns you should request one.

 In recent years, the NHS has expanded its screening programme, urging people to begin screening for colorectal cancer at the age of 50. However, Dr Ardalan observes a notable shift towards even earlier screening, beginning at age 45 – a trend propelled by the increasing incidence of colorectal cancer among younger demographics.

 For those with a family history of the disease, Mr Chan suggests screening “five years prior to your family member’s age at diagnosis of the illness”.

 What treatment options are available?

Treatment varies based on the size of the cancer, whether its spread to other organs, its genetic code and your age and overall health.

 “Treatment should always be discussed by a multidisciplinary panel of cancer specialists. The final treatment plan may include surgery, chemotherapy, and/or radiotherapy, used selectively or in combination. Immunotherapy, a newer targeted treatment, is suitable for certain tumours with specific genetic profiles,” Mr Chan explains.

 Managing a colon cancer diagnosis

“What I tell patients is that the success and tolerance of cancer treatment is helped by patients staying physically active, eating healthily and being mentally resilient,” says Dr Ardalan. Recent studies indicate that engaging in movement-based activities like yoga, tai chi and dance therapy, as well as practising meditation, can have profound effects on the wellbeing of cancer patients. These activities have been shown to reduce hospitalisations and alleviate common side effects of cancer treatment such as anxiety, depression, and fatigue.

 The most important takeaway advice is that colon cancer can be caught early, or even prevented. Despite enduring numerous life-threatening surgeries, my dad now lives cancer-free. I hope this advice encourages others to prioritise their wellbeing, seek testing, and talk openly about symptoms if they arise.

 Source: The Telegraph