Most bowel cancers start out as polyps, or small, mushroom-like growths on the inner lining of the bowel. These are very common and usually harmless, but occasionally they can become malignant over time.
How does it start?
Risk of bowel cancer rises with age and incidence rates begin to increase steeply after the age of 50 in the UK. Those over the age of 70 make up almost six in 10 (58 per cent) of new cases every year.
Who’s affected?
For the past century, Cancer Research UK has been helping fund research that has led to a better understanding of the disease, earlier detection and more effective treatments. Bowel cancer survival has more than doubled over the past 40 years in the UK. Currently, more than nine in 10 of those diagnosed at the earliest stage survive their disease for five years or more in England.
Right now, the charity is supporting doctors and scientists to improve existing treatments such as surgery, chemotherapy and radiotherapy, as well as exploring new ways to tackle the disease through targeted drug treatments and mobilising the body’s own defences to fight the disease. Cancer Research UK is also working to raise public awareness of bowel cancer symptoms, and lobbying for better screening programmes so that more people can be diagnosed at an earlier stage, when treatment is most likely to be successful.
What is Cancer Research UK
doing about it?
The timeline:
Charting cancer successes within living memory
1925
FIRST BOWEL CANCER ‘FAMILY TREE’
[Sigmoidoscopy]
1950
BOWEL CANCER GRADING SYSTEM
[Dr Cuthbert Dukes]
1987
[Sigmoidoscopy]
SCIENTISTS HOME IN ON BOWEL CANCER GENE
The hunt for the gene involved in hereditary bowel cancer had been going on for decades, but Cancer Research UK scientists significantly narrowed down the location of the gene, and the publication of their work in 1987 paved the way for its discovery by scientists in the US four years later.
The gene they found, known as the APC gene (adenomatous polyposis coli) helps suppress the uncontrolled cell growth that leads to tumours, so if
it’s not working properly, cancer can develop. Although genetic conditions that increase the risk of bowel cancer are rare, when they do occur they can lead to a much greater risk of developing the disease.
Discovery of the APC gene paved the way for research that now means we can provide genetic tests to identify people at high risk of bowel cancer.
2003
Cancer Research UK-funded study shows fibre cuts bowel cancer risk
EPIC, one of the largest studies of its kind across 10 European countries, found that a diet high in fibre reduces the risk of bowel cancer. Other findings from EPIC showed that eating too much red and processed meat and drinking too much alcohol
increases the risk, while exercise and keeping to a healthy weight reduces it. This is a key study that helped shape prevention advice on how to cut bowel cancer risk (see below).
2006
ROLLING OUT A NATIONAL SCREENING PROGRAMME
Cancer Research UK lobbied for and strongly encouraged the launch of the national bowel screening programme in 2006. It uses a test called the
faecal occult blood test (FOBt), which detects the presence of blood in poo, which may not be visible to the naked eye.
a hereditary form of bowel cancer. It proved an important resource for later work that led to the discovery of genes linked to the disease.
With Cancer Research UK’s support, scientists at St Mark’s Hospital in London, a specialist centre for intestinal medicine, established the first ever registry of families affected by
The charity supported the work of pathologist Dr Cuthbert Dukes, who devised a method of classifying bowel cancer. “Dukes’ staging” divides the cancer into four categories – A to D – according to how far it has invaded the bowel wall and other organs. The system was adopted worldwide and
helped doctors make an accurate diagnosis and plan treatment. Dukes’ staging is still used today, along with the more common TNM staging, which classifies cancers according to the size of the tumour and the extent to which the cancer has spread to other parts of the body.
My bowel cancer journey
Nicola Bourne watched her mum struggle through gruelling chemotherapy to treat her bowel cancer, so she was relieved when diagnosed herself, that recent advances in its treatment meant fewer hospital visits
When Nicola Bourne was diagnosed with bowel cancer in 2012 at the age of 31, she had a good idea of the treatments that lay ahead. Her mother had died of the disease three years before, having lived with it for six years.
But she was surprised at how much easier chemotherapy had become. “Mum had read about a new treatment but, at the time, the trials were under way and it was too late for her to take part,” says Nicola.
“When I had my cancer, it was the standard treatment. My son had just turned two and my daughter was only three months old. My son could see that I was very sick, so we always explained it in a language he would understand. Things like: ‘Mummy has an owee and the doctor is giving her special medicine’, and we have always tried to encourage both kids to ask plenty of questions.”
‘I could be at home
for my children
while I was treated’
She adds: “Being able to be at home made a big difference as I was more present for them and it gave me a much better quality of life. When you have intravenous chemo, you’re away all day.”
Nicola later discovered that the disease had affected four generations of her family. “There’s obviously a genetic reason and they tested some of my mum’s cells that were still on file but weren’t able to find the genetic link. With DNA, they don’t know how much there still is to be discovered.”
After a year of intensive treatment, Nicola’s illness went into remission and she has since remained cancer-free. Nicola is hopeful that future research into the disease will be able to help other families who may be at high risk of bowel cancer.
“The focus on genetics means so much to me because of my children,” she says. “If you know you have a high chance of bowel cancer, you can stay ahead of it. I try to support Cancer Research UK in any way I can as there’s still so much to learn and discover about the illness.
“As my kids got older, they have asked me more questions, which I have answered as honestly as possible so they now know that I had an illness called cancer. They also now know that the reasons we take part in so many Cancer Research UK campaigns is because they raise money to help people like mummy get better, and I just love being able to tell them that.
“My wish is that one day every parent can tell their child that they are cancer-free.”
2017
IMPROVED HOME BOWEL SCREENING TEST
The Faecal Immunochemical Test (FIT) detects the blood protein haemoglobin in a poo sample so it can show up microscopic amounts of blood, a warning sign of bowel cancer. It’s now replacing the previous home screening test for people over 60 (50 in Scotland) that was introduced in 2006.
FIT is an improvement on the previous test as it can determine the amount of blood present, rather than just detect if it’s there. It’s also specific to
human blood, so haemoglobin that comes from eating meat won’t produce a false positive. Plus, it’s much less fiddly to perform than the old test as you only need to take one poo sample rather than multiple. Cancer Research UK has played a key part in the rollout of FIT, giving guidance on how the programme should be set up, including advice on setting the thresholds for further testing.
RECEIVED ONE OF THESE IN THE POST?
WHAT IS IT?
Everyone over 60 (50 in Scotland) who is registered with a GP will receive a FIT test (Faecal Immunochemical Test) in the post.
It consists of a small plastic container with a stick attached to the lid.
WHAT DO I DO WITH IT?
Your kit will come with instructions but to put it simply, you just scrape the tip of the stick along your poo, put it back in the bottle and pop it in the freepost packaging for return to the lab.
WHAT DOES THE NHS DO WITH IT?
The sample will be tested to see if there is any blood present. If you have an abnormal result, your GP will be informed and will contact you for further tests.
SHOULD I TAKE PART IN BOWEL SCREENING?
Detecting cancer at an early stage can increase the chances
of survival, but the decision to take part in screening is a personal one. Your bowel screening kit will come with information on the benefits and harms of taking part and you can also visit the Cancer Research UK website for more information.
MY TEST DOESN’T LOOK LIKE THAT.
The new FIT test is being rolled out across the country at slightly different times, so you may have the older kit, known as the gFOBT (guaiac faecal occult blood test). This test is very similar but requires you to send multiple samples instead of one. If you want to take part in screening, don’t wait for a new test, as you won’t automatically be sent the new FIT test until your next invitation in two years time.
Bowel cancer: know the symptoms
Early diagnosis is the key to successful treatment. When it comes to bowel habits, what’s “normal” spans quite a range – a few times a day to a few times a week. It’s vital to know your own body and what’s normal for you. If you notice any changes that aren't normal for you or have lasted longer than usual, visit your GP. Most of the time it won't be cancer but it's important to get checked out.
What to look for
A change in bowel habit, such as going more often, having looser poos, or regularly becoming constipated.
Blood in your poo.
Persistent pain, bloating, or a lump in your stomach.
Losing weight for no obvious reason.
Reduce your risk
More than half of bowel cancers could be prevented in the UK. Here are some of the positive steps you can take to reduce your risk:
Cut back on red
and processed meat.
The less you eat, the lower your risk. Consider taking meat-free days or switching to recipes that use fresh chicken or fish instead.
Eat more high-fibre foods.
Such as wholegrains, nuts, seeds, oats, beans and lentils. It’s thought that fibre helps prevent bowel cancer in several ways, including improving the transit of food through your digestive system.
Maintain a healthy
weight.
Fat cells produce more hormones and growth factors which can cause cells to divide more quickly, raising the risk of bowel and other cancers.
Drink less alcohol.
Alcohol consumption produces harmful chemicals that can damage cells. No type of alcohol is better or worse than another: it’s the total amount you drink that counts. The less you drink, the lower your risk.
Stop smoking.
The chemicals in cigarettes increase the risk of 15 different cancers, including bowel cancer. Free stop-smoking services have been shown to roughly triple the likelihood of success compared to going “cold turkey” alone. Talk to your doctor or pharmacist, and visit the NHS Smokefree website to find out what will work for you.
Stay active.
Regular exercise can help you keep a healthy weight, which reduces the risk of 13 different types of cancer. And if you’re doing a lot of physical activity, it can help reduce the risk of bowel cancer directly by keeping your digestive system working efficiently and reducing inflammation.
Donate today to help Cancer Research UK make more incredible strides forward in diagnosis, prevention and treatment of cancer. No matter how small or large, your gift will lead to dramatic changes to cancer outcomes in your lifetime.
For example:
£40 could pay for a cancer biopsy, where a tiny sample of someone’s tumour is taken for research
£250 could buy 500 plastic dishes, essential for scientists to grow and study cells in the lab
£1,000 could help fund a clinical trial of a new, more effective treatment for bowel cancer
Join Cancer Research UK on its mission towards the day when all cancers are cured.
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THE FUTURE: How Cancer Research UK plans to continue tackling bowel cancer
1 in 15 men
and 1 in 18
women
will be diagnosed with bowel cancer during their lifetime
54%
of bowel cancer cases in the UK are preventable
More than eight in 10 new cases are diagnosed in people over the age of 60.
90%
Almost
new cases are
diagnosed in people over the age of 60
£24 million
on bowel cancer research
Last year Cancer Research UK spent
Bowel cancer incidence is projected to fall by 11 per cent by 2035. Here are just a few examples of the work that’s going on to help achieve this, and to improve treatments for those who do develop the disease.
LESS INVASIVE SURGERY:
Advances in surgery mean that many patients are able to have keyhole surgery rather than major surgery, which makes the recovery after the operation a lot quicker and less distressing. Doctors are also looking into giving chemotherapy to shrink tumours before surgery, which is showing encouraging results.
IMPROVING IMMUNE RESPONSE:
Immunotherapy research is looking at how to stop cancer cells evading the immune system and resisting treatment. Current immunotherapies only benefit a small amount of patients with bowel cancer – those whose tumour shows a particular pattern of genetic change with lots of mutations. So what is being done to find an immunotherapy that will work for more bowel cancer patients? A large international collaboration using sophisticated genetic analysis has shown there are likely to be four subtypes of bowel cancer. In one subtype, which makes up around 30 per cent of people, healthy cells called fibroblasts, which are found in the area surrounding the tumour, can protect it from radiotherapy and chemotherapy, leading to poor treatment outcomes. Professor Tim Maughan, chair of Cancer Research UK’s Clinical Research Committee, says: “The behaviour of a given bowel cancer seems to be determined by the interaction or conversation between the cancer cells, the fibroblasts and the immune cells. As researchers, we need to tune in to this conversation, understand how it controls disease behaviour – especially the immune response – and learn how to change it to improve cure rates.”
UNDERSTANDING THE MICROBIOME:
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Saving lives in our lifetime: Bowel cancer
In this long read we examine how survival from bowel cancer has more than doubled in the UK over the past 40 years, and how exciting innovations in screening and treatment techniques could massively improve those outcomes
JUMP TO
Timeline
Case Study
Symptoms
Prevention
Bowel cancer is the fourth most common cancer in the UK, with around 42,000 new cases diagnosed each year. Also known as colorectal cancer, it affects the last section of the digestive system, which consists of the large bowel, or colon, and the rectum, or back passage.
What is it?
Produced by Telegraph Spark
Words Caroline Roberts Commissioning Editor Jess Spiring
Sub-Editor Loveday Cuming Designer Sandra Hiralal
Digital Developer Pedro Hernandez Picture Editor Emma Copestake
Web Producer Katherine Scott Project Manager Alex Brooksbank
When diagnosed at its earliest stage,
with bowel cancer will survive their disease for five years or more, compared with around one in 10 people when diagnosed at the latest stage in England
more than nine in 10 people
The human gut is home to trillions of microbes, and we each have our own unique combination. This is known as the microbiome. Funded through Cancer Research UK’s Grand Challenge initiative, a multidisciplinary international collaboration, researchers will try to determine how this affects the development of bowel cancer as well as our individual response to drug treatment. In the future, this could lead to treatments that manipulate the microbiome to help combat the disease.
Even if you notice a change isn’t on the list, talk to your doctor
Could a breath test detect cancer in the future?
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Scientists say ‘thank you’ to cancer trial participants
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