Bowel cancer awareness month: Common questions answered

By Amy Warnock

Human colon cancer cells with the cell nuclei stained red and the protein E-cadherin stained green. Credit: NCI Center for Cancer Research

Bowel cancer is the fourth most common cancer in the UK, accounting for around 11% of all new cancer cases between 2017-2019.

Unfortunately, bowel cancer is the second biggest cause of cancer death in the UK. It’s often detected late and can spread to other organs, like the liver, where it becomes very difficult to treat.

Our researchers are dedicated to beating bowel cancer for everyone. Step by step, day by day, we’re discovering new ways to prevent, detect and treat the disease and save lives.

To help raise awareness around bowel cancer, and the research we are doing, here we’re answering some the most common questions on bowel cancer.

What is bowel cancer?

To start off at the beginning, what do we mean when we talk about bowel cancer?

The bowel, also known as the intestine, is split into 2 parts - the small bowel and the large bowel. The large bowel includes the colon, the back passage (rectum) and the bowel opening (anus).

Bowel cancer is any cancer that starts in the colon or the rectum. It’s also called colorectal cancer.

Cancer that starts in the small bowel is classified separately, as is cancer that starts in the anus.

Is bowel cancer curable?

Yes, bowel cancer is curable.

Like most cancers, the earlier it’s caught the better. When diagnosed at the earliest stage around 9 in 10 people in England survive their disease for at least 5 years. But that drops to around 1 in 10 when diagnosed at the latest stage.

That’s why something our researchers are focusing on is developing new ways to detect bowel cancer at an earlier stage, when treatment is more likely to be successful.

Research spotlight: Using AI to develop blood tests to detect bowel cancer early

Dr Oleg Blyuss and his team at University College London are investigating a non-invasive blood test for bowel and other cancers.

They’re using artificial intelligence (AI) to help them sift through huge amounts of data to identify new clues in blood that could help to spot bowel cancer early.

They’re looking at data from people over long periods of time and considering risk factors for cancer to develop their test. This could one day lead to a more comfortable way to detect bowel cancer that could be used alongside other tests for people at higher risk.

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What causes bowel cancer?

Your risk of developing bowel cancer depends on lots of things like age, genetics and other factors, including what we eat.

Our research has helped to show that we can reduce our risk of bowel cancer by eating a high-fibre diet, eating less processed and red meat, keeping a healthy weight, stopping smoking completely and drinking less alcohol.

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Is bowel cancer hereditary?

There are some inherited conditions or syndromes that can increase the risk of bowel cancer. For example, Lynch Syndrome is caused by inherited changes to certain genes and leads to an increased risk of some cancers, including bowel cancer.

Our researchers are currently working on a project called LynchVax to help people with this condition in the future by developing a vaccine to reduce their risk of bowel and other cancers.

There are also other genes associated with increased bowel cancer risk. Professor Ian Tomlinson, one of our researchers at the University of Oxford, has identified 40 genes linked to bowel cancer and is exploring in detail how errors in these genes could lead to an increased risk of bowel cancer. By understanding more about these genes, it could help researchers to identify new ways to tackle bowel cancer in the future.

Carla’s story

Carla, now 40, was diagnosed with bowel cancer in 2021.

“I started to feel not myself, very tired even getting myself upstairs, and I could feel my heart pounding out of my chest even when I did something as simple as brushing my hair.

“I thought it was something pre-menopausal or perhaps down to having become unfit during lockdown, but by October I felt I needed to call my GP.”

In January 2021 Carla had a colonoscopy during which her doctor saw a tumour and suspected bowel cancer. The doctor took some biopsies and later confirmed the diagnosis.

“I was told they needed to operate right away. Along with the tumour, 37 lymph nodes were removed during the surgery and cancer was found in two of them, so I was then diagnosed stage 3 and told I would need three months of chemotherapy.”

She was initially prescribed a combination of oxaliplatin and capecitabine and struggled with side effects such as nausea and fatigue. The chemotherapy also reduced the levels of white blood cells and platelets in her blood, so rather than completing the fourth round of chemotherapy, Carla was discharged for surveillance.

In 2022, Carla was diagnosed with Lynch syndrome – an inherited condition that increases the risk of bowel cancer. Because of this she requires regular check-ups and may also need to consider preventative surgery.

“It’s been tough living through the cancer experience, but I’m getting there. It is very treatable if it is caught early enough. I would like to see media campaigns help dismiss the stereotype that it’s strictly an old person’s disease.”

What are the first signs of bowel cancer?

Bowel cancer symptoms can include bleeding from your bottom, blood in your poo or a change in your normal bowel habits, such as looser poo, pooing more often than usual or constipation. Symptoms can also be more general, such as unexplained tiredness or breathlessness, losing weight without trying to, tummy pain or a lump in your tummy.

Importantly, you know your body best. If you notice anything that’s unusual for you, it’s best to get it checked out by your GP. It probably won’t be cancer, but if it is, spotting it at an early stage means treatment is more likely to be successful.

Learn how to break the taboo that could be getting in the way of early diagnosis by reading why we need to talk about poo.

Shutterstock/Vitaliy Abbasov

Geraldine’s story

Geraldine, now 79, was diagnosed with stage 4 bowel cancer in 2011 after she noticed blood in her stools. 

“A couple of years before I was diagnosed, I’d had some bleeding but no pain. I’d always been slim because I’m very active, but a couple of friends noticed I’d lost weight. I just put it down to my active lifestyle and didn’t give it any more thought.  Every now and then I’d go to the loo and there’d be a show of fresh blood, but I assumed it was piles.

“My symptoms started getting worse and the blood was changing colour – now it looked like my stools were turning black.  I knew that could be a sign of something serious, so I eventually went to see my GP who referred me for a test where a camera was put up my lower bowel.”

Unfortunately, the cancer had already spread to her liver, meaning that she was unable to have an operation to remove the tumour in her bowel.

Geraldine was given chemotherapy – a combination of oxaliplatin and capecitabine.

“After four cycles I had another scan which showed a complete response so at last I was able to have the surgery on my bowel.  Luckily, I was pretty much back to normal and line-dancing once more within a month.”

During later check-ups, doctors found further tumours in her liver but luckily, they were all operable. Geraldine has now been cancer-free for 11 years.

"Had I known more about bowel cancer symptoms, I would have gone much sooner to my doctor. 'Don't delay, go straight away'!”

“My message to anyone who has just been diagnosed, or is going through treatment is don’t give up, be active as much as possible, rest when you need it, each day is a bonus so enjoy it!”

What is bowel cancer screening?

Early detection of bowel cancer is key to making treatment more likely to be successful, and screening is an important tool to making that happen.

The Faecal Immunochemical Test (FIT) looks for invisible traces of blood in small poo samples and can help detect bowel cancer before it causes noticeable symptoms, or even prevent it from developing. In England, the age at which you’re eligible to receive an at-home FIT test every two years is expanding to everyone aged 50-74.

If a FIT test does find traces of blood this does not necessarily mean cancer. A positive FIT test will usually be followed up by further tests, such as a colonoscopy, to help pinpoint the diagnosis.

Find out more about FIT tests in our video:

Research spotlight: Improving the accessibility of life-saving screening services

Data shows that people with intellectual disabilities are much less likely to access screening. Evidence has also suggested there is an increased likelihood of dying from bowel cancer among people with intellectual disabilities.

That’s why Professor Katie Robb in Glasgow wants to understand how to make bowel screening more accessible for this group of people. She’s working with people with intellectual disabilities, their carers and healthcare specialists to identify and overcome the barriers to screening that currently exist.

This work could help change government policies to improve access to screening, which would ultimately save lives.

What does a colonoscopy feel like?

A colonoscopy is a medical procedure that involves a doctor putting a long flexible tube with a camera on its end up a patient’s back passage to take pictures inside the bowel.

It can be used to help find the causes of bowel symptoms as well as to take samples to check for signs of cancer.

Colonoscopies can be uncomfortable but shouldn't be painful.

You can find out more about having a colonoscopy in our video:

Research spotlight: A tiny swimming robot to detect bowel cancer

Colonoscopies can be uncomfortable and off-putting for some people and can be especially challenging for people who are at high-risk of bowel cancer and may need to have more regular colonoscopies. That’s why our researchers are working on developing new ways to detect bowel cancer.

Dr Elena Cojocaru and her team in London hope to revolutionise bowel cancer diagnosis, using a robotic pill called the SampleCam.

Once the pill is swallowed, it will travel through the bowel, taking pictures with tiny cameras and using its mechanical arms to collect samples of potentially cancerous cells. SampleCam will then send the images to a computer that can identify early signs of bowel cancer using artificial intelligence. The cell samples will be sent to a lab where scientists can analyse them.

This tiny swimming robot is in development. But in the future, it has the potential to make bowel cancer screening kinder and more accessible, ultimately allowing more bowel cancer cases to be detected earlier and saving lives.

What is bowel cancer treatment like?

Treatment for bowel cancer can vary depending on whether you have colon or rectal cancer, but it can include surgery, chemotherapy, radiotherapy and immunotherapy.

Treatment will also depend on a number of other factors including how far the cancer has grown, whether it has spread elsewhere in the body and the patient’s general health.

Why are more young people getting diagnosed with bowel cancer?

Our statistics show that around 5 in 100 bowel cancer cases in the UK occur in people under 50. While that’s only a small proportion of total bowel cancer cases, it’s also true that more people than ever before are being diagnosed with the disease under 50.

We’re still not sure exactly what’s causing this, but it could be due to a variety of factors, such as changes in diets and lifestyle factors over generations.

We’re supporting researchers who are trying to get to the bottom of this, to understand who’s at risk and develop better ways to prevent and treat the disease in younger people.

A picture of people's legs walking across a road

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Research spotlight: Cutting-edge technology to understand why people are getting bowel cancer younger

With scientists from France, India, Italy, the US and the UK, Cancer Grand Challenges team PROSPECT are studying data from millions of individuals around the world alongside more than 2,500 samples from people with early-onset bowel cancer.

They’re using cutting-edge techniques to analyse this data to identify unknown causes of the disease in people’s genetic backgrounds or lifestyles. Their work will help fuel the design of new prevention and treatment strategies that are targeted to the specific risk factors faced by different groups of people.

This work has the potential to answer one of the most challenging questions in research today to ultimately save lives.

What are researchers doing about bowel cancer?

We’re the largest funder of bowel cancer in the UK and over the years our researchers have made great strides in progress for people with bowel cancer. For example, we've helped develop many of the drugs used to treat bowel cancer, including fluorouracil, capecitabine and oxaliplatin. These treatments have saved lives and will continue to do so in the future.

But we’re also funding many new and innovative research projects into bowel cancer, from learning about how to prevent the disease to developing cutting edge treatments.

We’re jointly funding Add-Aspirin, a large international clinical trial that aims to find out if aspirin could stop or delay certain types of cancer from coming back. Led by Professor Ruth Langley in London, the trial will help researchers work out who is most likely to benefit from aspirin, and who is at risk of its side effects. If the trial finds people who benefit from aspirin, this cheap and readily available drug could improve survival for people who have had cancer before, by giving them the best chance of it not returning in the future.

But our work isn’t done yet. We want to bring about a world where everybody lives longer, better lives, free from the fear of cancer – no matter who they are or where they’re from.

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