Janaína Maria Felix explains how nurses and doctors are able to detect and treat colorectal cancers

Many people with a stoma have one due to a diagnosis of bowel cancer. In my experience as a specialist stoma nurse, I have cared for a lot of people who have had this condition. Bowel cancer can be a frightening experience, but it is often curable, and people can often live long and happy lives after this diagnosis.

What is bowel cancer

Bowel cancer refers to any tumour that begins in the colon (large bowel), rectum and/or anus. Like any cancer, it begins when one cell starts to replicate itself uncontrollably. Typically, the cancer grows slowly in the bowel, and will eventually cause symptoms there. If these are caught in time, complete cure is possible. However, if the tumour is allowed to grow undetected, it can press against, and invade, the surrounding organs, or it can migrate through the bloodstream or lymph nodes, making treatment more difficult. Untreated bowel cancer will eventually be fatal.

Who gets bowel cancer?

Bowel cancer can happen to anyone, but it is much more likely to appear in some groups of people than others. For example, bowel cancer is far more common in older people than younger people, and almost 9 in 10 people with the condition are aged 60 years or over.1 Therefore, people are encouraged look out for symptoms as they age.

There are lifestyle factors that can increase the chance of getting bowel cancer. Evidence suggests that these cancers are more common in people who are overweight, who smoke and who drink a lot of alcohol, as well as those whose diets are low in fibre and high in calories, fats and/or red meat.

Bowel cancer has a genetic connection, as 30% of people who are affected have another family member who has had the same condition², and so it is worth being aware of your family history. Bowel cancer can also develop as a result of another medical condition, so extra vigilance is recommended for people with any of the following:

• Chronic constipation

• Inflammatory bowel disease, including Crohn’s disease or ulcerative colitis

• Certain inherited genetic conditions, including Lynch syndrome, Gardner syndrome or even Peutz-Jeghers syndrome, which account for 5% of bowel cancers.²

What to look out for

It is important that people look out for early signs of bowel cancer and report them as soon as possible. The main signs are the persistent appearance of:

• Blood in stools that appears for no clear reason

• Change in bowel habits, which can mean diarrhoea or constipation, as well as flatulence

• Discomfort and pain in the tummy that is caused by eating and going to the toilet, which can lead to weight loss and constant tiredness (fatigue).

More often than not, these potential signs of bowel cancer are actually symptoms of something else, but it is important to get them checked out. If you have any of these symptoms and they don’t go away after a few days, you should report them to a GP or other relevant health service.

Diagnosis

There are a variety of tests that can help determine the cause of these symptoms. At first, there are simple tests that can be done at home, such as a faecal occult blood test. If cancer is suspected, it will be necessary to go into hospital for more complex tests, such as a radiography scan, a digital rectal examination (exploration with a finger) or a colonoscopy.

A colonoscopy involves the use of camera at the end of a flexible tube to look for visible signs of cancer. This includes looking for polyps, which are abnormal growths of tissue on the walls of the colon. Polyps are usually harmless (benign), but they can occasionally develop into cancer (pre-malignant or malignant), so they should ideally be removed.

Ways to treat it

Being diagnosed with bowel cancer is a frightening experience, but it is often treatable, and many people live long lives after such a diagnosis. The types of treatment available, and how likely they are to work, will depend on how far the cancer has progressed. Treatment options can also be affected by the person’s age, general health and medical history.

A cancer can be cured if all the affected cells are removed from the body. Therefore, bowel cancer is usually cured with an operation, known as a resection, to surgically remove the affected section of bowel. Thanks to modern medicine and the invention of the stoma, a person can live a good quality life without some or all of their large bowel. The amount of bowel removed will determine what happens next:

If only a short section of bowel is removed, the two ends can be rejoined. A temporary stoma will be created to divert output away from the join while it heals. Once the join has healed, the stoma can be reversed and normal bowel function resumed

If a longer section of bowel is removed, it may not be possible to reconnect it. In these cases, the surgeon will create a permanent stoma

In some cases, when even the entire large bowel is removed, it is possible to create an artificial internal pouch (sometimes called a J pouch) out of the end of the small bowel (ileum). This internal pouch acts like the large bowel and can make it possible to resume relatively normal bowel function.

During a resection, the surgeon will also collect nearby lymph nodes to see if the cancer has spread outside the bowel. Bowel cancer that has spread outside the bowel is more difficult to treat, and the chance of success is not as high. However, there are still options to slow or completely cure the cancer, including:

• Chemotherapy, in which medicine is used to kill cancer cells

• Radiotherapy, in which radiation is used to kill cancer cells

• Targeted therapies, which are medicines that slow the cancer and improve the effect of chemotherapy.

Janaína

What happens next

People who have had surgery for bowel cancer will most likely have a stoma, either temporarily or for life. Either way, they will need specialist support to prepare them manage their stoma on their own and minimise any complications. Ideally, this support should begin before the operation, but this may not be possible in an emergency.

Getting a stoma can be a shock and a challenge, but it can also be life-saving. With a little time and the right support, having a stoma should not be a barrier to living an active, comfortable and fulfilled life. This magazine is here to provide practical advice and inspiration to help people with a stoma live their best lives, but it is essential to also seek professional support from a stoma care specialist whenever necessary.

Through a nurse’s eyes

When Jose entered the hospital corridor for his surgery, he looked so frightened that it was like seeing a sheep going to the slaughterhouse. He was very tall, with an elegant demeanour, but this could not hide his anxiety.

My thoughts went back to the doctor’s office, 30 days before, when we had broken the news to Jose. After the words ‘rectal cancer’ were spoken, I heard nothing for minutes, and the only thing that moved was his mouth. The diagnosis had shaken his foundations and triggered every instinct of uncertainty and fear. After the first shock, I managed to gather myself and help the doctor explain what we could do to help.

By the time of his operation, Jose was still crestfallen, shaken and worried. I approached him in the corridor, said ‘Okay, let’s go’ and helped him into the operating theatre.

When Jose emerged from the operation, with a new stoma on his side, he was like a new man. He let us all know how strong and secure he now felt, and he swore not to give up or let the challenges of his stoma hold him back. He was determined to grasp the opportunities he was given and live his best life.