April is Bowel Cancer Awareness month in the UK. Bowel cancer is one of the most common types of cancer present in the UK in those over the age of 60. According to Bowel Cancer UK, there are approximately 40,000 new cases diagnosed every year and it is estimated that 1 in every 20 people will develop bowel cancer in their lifetime. Unfortunately, there can be issues in detecting bowel cancer which can lead to late diagnosis, some of which are discussed in further detail below.
One of the issues in detecting bowel cancer is a lack of awareness of the symptoms, meaning that people do not necessarily seek assistance with symptoms when they should. This is made worse by the fact that the symptoms of bowel cancer can be confused with symptoms of other non-cancerous conditions. It has been reported by the charity Bowel Cancer UK, that the stage at which bowel cancer is diagnosed has a huge impact on survival and approximately 50% of people with bowel cancer in the UK are initially diagnosed at, or end up reaching, stage 4 (the worst stage). Furthermore, Cancer Research has reported that approximately 54% of bowel cancer cases in the UK are preventable.
According to the NHS, the common symptoms of bowel cancer are: a persistent change in bowel habit; bleeding; and abdominal pain, discomfort or bloating that is bought on by eating.
It is also worth noting that there are people with certain genetic conditions that are at a higher risk of developing bowel cancer, for example, people with Lynch Syndrome. Bowel Cancer UK stresses that it is important that these patients are identified and provided with additional testing for bowel cancer.
In the UK there is a bowel cancer screening programme. This is available to everyone over the age of 60 and is carried out via a home testing kit. Results usually come back around 2 weeks after. Tests are sent out to those that are eligible, every 2 years. From April 2021, the NHS in England is scheduled to begin rolling out bowel screening to people over the age of 55 via one-off testing by a doctor or nurses. This is a positive move and will greatly assist in detecting bowel cancer.
Research by Bowel Cancer UK has demonstrated that diagnosis through screening gives the best chance of an early diagnosis with 97% of people with bowel cancer that are detected through screening surviving more than five years, compared to 49% of those diagnosed via an emergency admission. However, only 10% of bowel cancers are currently being detected via screening, which is low.
When you first see a GP with any concern of bowel cancer, they will usually carry out a digital rectal examination to check for any lumps. If a GP is concerned that a patient has symptoms that could be due to bowel cancer, they can arrange for the patient to be referred to a specialist. Depending on the symptoms displayed this could mean an urgent referral is required.
There is guidance in place for GP’s that has been published by the National Institute for Health and Care Excellence (NICE) covering referrals for suspected cancer. Bowel Cancer UK called for the guidance to be reviewed to make it easier for patients to be referred to a specialist. The previous guidance was restricted to those with high-risk symptoms which were very limiting and meant many people that should have been referred to a specialist on the first appointment, were not, and had to see their GP multiple times before a referral. The new guidance is much wider and will allow patients with a wider range of symptoms to be referred more quickly. The hope is that this will improve the timeline of a patient’s diagnosis and increase the chances of survival.
It is also important to note that there is a risk that a GP may fail to refer a patient to a specialist when needed and that this can result in a delay in diagnosis and treatment.
At the referral appointment, there are a number of different tests that the specialist might undertake, depending on the symptoms. Some common examples are blood tests, a colonoscopy, or a CT scan. There is a risk that bowel cancer can still be missed at this stage, such as going undetected on a CT scan or results being misread or misinterpreted. Whilst a CT scan might be able to detect an abnormality, it is less effective at concluding if an abnormality, such as a lump, is benign or not.
This is something that patients should be aware of.
Overall, it is important to be aware of the potential issues in the detection of bowel cancer as discussed, and that if a patient has any concerns, these are followed up with their GP or specialist.