25 May 2024

Bowel cancer: If you’re not worried, you should be, warns a GP

By: Dr. Mandeep Kang

Sometimes back, a patient came to consult me complaining of weight loss and overall feeling of laziness. The patient previously had a brief history of unexplained abdominal pains.

As a clinician these symptoms raised some ‘red flags’ and my suspicions of a bowel cancer were subsequently confirmed by further investigations, including a CT Colonoscopy test. Thankfully, the patient is on way to full recovery now.

Dr Mandeep Kang

Dr Mandeep Kang is a GP & urgent care physician in Hamilton. Dr Kang (MD; FRNZCGP; RNZCUC; Dip. in Skin Cancer Medicine, Skin Cancer Surgery, Sports Medicine –IOC & Football Medicine-FIFA, etc), is multi-linguist.

New Zealand has one of the highest rates of bowel cancer- also known as colon, rectal or colorectal cancer. According to Bowel Cancer New Zealand, every day, around 3 Kiwis die from bowel cancer, 3000 new cases are diagnosed every year and it is the second highest cause of cancer deaths- around 1200 every year.

Usually there are no noticeable symptoms in early stages of bowel cancer. This could mean any of us with a family history of bowel cancer and/or unexplained symptoms, could be suffering with this deadly disease, without realizing it.

More than a quarter (26%) of bowel cancers are diagnosed late and, hence, result in poorer outcomes.

While majority (two-thirds) cases of this cancer are diagnosed in people aged 65 years and above, this can affect people across the age spectrums. Recent stats show that 1 in 10 New Zealanders under the age of 50 are being diagnosed with this cancer. I have had patients as young as 30 years who have been diagnosed with bowel cancer.

Symptoms of bowel cancer

There is no specific symptom of bowel cancer as there can be an overlap of symptoms with less serious bowel conditions like irritable bowel syndrome, food intolerances and inflammatory bowel disease (Ulcerative colitis and Crohn’s disease).

Bowel cancer is cause of approx. 1200 deaths every year

However, some of the “Red Flags” that can make me, as a clinician, suspicious of bowel cancer include:

  • Presence of dark blood mixed with the faeces can be indication of cancer of the bowel. Presence of bright red blood either on toilet paper or separate from the faeces is usually caused by piles, fissures or polyps.
  • Change in bowel habits, with at least a six-week history of loose and frequent bowel motions with progressively worsening of symptoms over time
  • Unexplained weight loss with fatigue and lethargy
  • Night sweats and fever, and
  • Persistent abdominal pain with recurrent presentations to the primary care or emergency setting.

What would a GP normally do in such situations?

A comprehensive history of your symptoms – duration, intensity, frequency, etc along with a family history of bowel problems and cancers will help the GP understand and diagnose better.

Risk of bowel cancer increases if there is a positive case in first degree  (parents and siblings) or second degree (grandparents, aunts and uncles), and  if their age was under 54 years when first diagnosed.

Thorough physical examination including an abdominal and digital rectal exam (finger-in-the-bum test) usually would be another step.

Abdominal pain
Persistent abdominal pain needs to be investigated

Indication of an iron deficiency Anaemia in a blood test, will also prompt  further investigations.

If the GP has a suspicion of bowel cancer based upon presence of positive symptoms, they can refer you directly for either a Colonoscopy or a CT Colonoscopy (if you meet the criteria).

If you do not meet the criteria, you can refer you to a specialist who can then organize the appropriate investigation.

If you do not have symptoms, but have one or more first or second-degree relatives with a history of bowel cancer, then your GP can refer you for Surveillance Colonoscopy.

What can you do to lower your risk of bowel cancer?

Our diet also plays a role in causing bowel cancer as some recent studies have indicated.

A Otago University’s four-year study  found that “higher than average” consumption of lamb, pork and bread and highly processed (deli) meat such as salami and sausages, are associated with an increased risk. Therefore, there is a need to reduce consumption of red meats and replace this with poultry and fish.

The study also found evidence that dairy and low-fat diet plus regular vigorous exercise also lowers your risk of bowel cancer.

Additionally, you should replace highly refined grains with unrefined grains like brown/red/black rice and buckwheat, amaranth, millet and quinoa; consume more fruits, green leafy vegetables, legumes, and avoid high sugar and starchy food, etc.

As there may be no warning signs that bowel cancer is developing, bowel screening is your best bet of detecting cancer at an early stage, when it can often be successfully treated.

The National Bowel Screening Programme – rolled out by the Ministry of Health in 2017, offers free annual self-testing pack for eligible participants (who do not have symptoms of bowel cancer) between the ages of 60 to 74 years.

If a test result is positive, participants are invited for additional screening, usually a colonoscopy. 

Therefore, my advice would be to take bowel cancer seriously and to consult your GP if you have any concerns about any symptoms. If eligible, you should also do the free screening test every two years.

Editor’s Disclaimer: The above article is for information purposes only & is not intended to be a substitute for professional medical advice. Always seek the guidance of your doctor or other qualified health professional for any questions you may have regarding your health or a medical condition.

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