NEARLY 98% of people will survive bowel cancer if it’s detected at stage 1, a figure that drops to 10% if diagnosed at stage 4.
April is bowel cancer awareness month and the Irish Cancer Society said that the symptoms and diagnosis of bowel cancer was one of the top four pages visited on their website in 2016, and was looked-for more than any other specific cancer type.
Bowel cancer is the most common cancer diagnosed in Ireland with the latest figures saying that over 2,500 people are diagnosed every year, and approximately 300 of these cases are in Cork.
Around 1,000 people die from the disease annually, making it the second most common cause of cancer death in Ireland. While the numbers of new cases per year continue to rise, survival rates have increased gradually with five in 10 surviving five years post-diagnosis in 1994 compared with six in 10 in 2012.
Joan Kelly, Cancer Support Manager with the Irish Cancer Society said “Bowel cancer usually occurs in people over 60 years of age and is often diagnosed in the later stages. However, if bowel cancer is caught early, it is extremely treatable.
“During the Month of April the Society will be campaigning to make everyone in Cork aware of the signs and symptoms of bowel cancer. This year we have also developed an easy to use online Bowel Health Checker (www.cancer.ie/bowelhealth) which is a short quiz designed to inform people about staying healthy, being aware of their bowel health and informing people about the signs and symptoms of bowel cancer. Once completed, there is a handy printout to take to your doctor should it be needed.
“Also vital in improving bowel cancer survival rates is informing about the State’s free screening programme — BowelScreen. In its first screening round, from October 2012 to December 2015, BowelScreen had a screening uptake rate of just four in ten people, meaning an average of six in ten people are not taking up the offer of screening. Screening is vital in diagnosing cancers early and we need to see it as a central part of a healthy lifestyle. If we’re eligible for free screening, we should take it up.”
According to new figures from the UK, the number of younger people with bowel cancer has increased by 45% since 2004. There are currently more than 2,500 new cases a year in the UK in under-50s — and they are much more likely to be diagnosed late.
According to Bowel Cancer UK, three out of five will be diagnosed with cancer that’s already stage 3 or 4. A third (34%) only find out they have cancer in an emergency situation, after having to visit A&E, for instance, because symptoms have reached a crisis point — despite the fact they may have been seen a doctor numerous times.
Mark and Beth Lyson recall how their daughter Hannah — the 20-year-old who amassed thousands of followers when she blogged about fighting bowel cancer, before passing away in January this year — was “back and forth to the doctor” for years.
At first diagnosed with an inflamed gut, later in 2013, her GP said she probably had irritable bowel syndrome [IBS], the common, benign condition associated with a range of digestive symptoms. Hannah was prescribed medications to help with chronic constipation and worsening back pain, but no tests were carried out.
“The main thing she went back with was her back, she was always complaining about her back,” says Beth, aged 55. “Then in August 2015, she went to Florida with her boyfriend and was sick a few times. We thought perhaps it was something she was eating, because of the doctor saying it was irritable bowel.”
But the vomiting continued, on and off. “She’d be sick for a day, then she’d go a couple of weeks and be fine, then she’d be sick again,” says Beth.
Mark, aged 52, recalls encouraging Hannah to return to the doctor, but “she was saying, ‘Well it’s a waste of time going because they don’t do anything’.”
The tipping point came when summer 2016 approached.
“Hannah was due to go to Camp America last June, and we were getting frightened that she couldn’t go, she was in that much pain,” explains Mark.
Beth took Hannah to see an on-call GP, and pleaded that tests be done to make sure she was well enough for her trip to the US.
All they wanted was reassurance it was safe to allow their daughter to jet off to America. But two weeks later, in May 2016, Beth and Mark found out that their sporty, Disney-loving 19-year-old girl, who didn’t drink, didn’t smoke — didn’t fit any of the at-risk categories — had a tumour in her bowel, and four tumours in her liver.
“She already had her case packed for America, she was that organised,” recalls Mark. “She had her T-shirts, shorts, flip-flops and all these things. The case was in the conservatory with name tags on it... It was devastating.”
Even the doctors were shocked, saying it was the youngest case they’d ever seen. And it was shocking, but looking back, Beth and Mark, from Burscough, Lancashire, can see that opportunities to discover the cancer sooner were missed.
“Bowel cancer in younger patients is becoming more common; we don’t really know why,” says Willie Hamilton, professor of primary care diagnostics at the University of Exeter Medical School.
What he and his colleagues — who’ve teamed up with Bowel Cancer UK’s Never Too Young Campaign, Durham University and University Hospital of North Tees — are certain of, is that more can be done to ensure young people with bowel cancer get diagnosed as early as possible.
Based on research, they’re launching a new risk assessment tool, published in the British Journal Of General Practice and funded by the Department of Health, designed to help GPs identify when symptoms in the under-50s might indicate a serious bowel condition, including cancer or inflammatory bowel diseases like Crohn’s, as opposed to more common conditions like IBS.
A scoring system will indicate whether the GP should simply monitor how the symptoms progress, recommend tests such as checking stool samples for signs of inflammation, or refer somebody for an urgent colonoscopy or to a specialist.
“The key thing is we now have a much stronger idea which patients with bowel symptoms might have an unpleasant disease — like cancer. We know which symptoms, like rectal bleeding or diarrhoea, should be tested, and what test to use,” says Hamilton.
Systems like this level out the playing field too, as often symptoms can be vague, plus the severity of symptoms doesn’t always reflect the seriousness of the underlying cause.
For Dave Smale, aged 36, who was diagnosed with stage 4 bowel cancer this January, the only symptom was stomach pain. “He started getting stomach pains, which correlated with when he’d been eating,” explains his wife Katie, aged 31. “We later found out this was because everything was trying to come past the tumour in his bowel, it was obstructing everything. But at the time, we were racking our brains about what it could be. We thought perhaps it could be a food intolerance, or IBS.”
That’s what Dave’s GP thought too at first. But a few months on, the pain became severe, and Dave was referred for tests. He was told he could be facing a diagnosis of Crohn’s disease, but the results were far worse — cancer, that had spread to his liver and stomach lining.
Dave’s already had major bowel surgery and is currently undergoing chemo, with more surgeries to come. Life’s been turned upside down for the couple, but their 15-month-old daughter, Maisie, is keeping them laughing and little things, like pre-chemo date nights, plus support from family and friends is helping.
Katie’s grateful Dave persisted with going back to the doctor, and says “I think he’d started Googling about how people had been misdiagnosed with IBS and it turned out to be something worse”.
Of course, “IBS is real, common and troublesome”, stresses Professor Hamilton. “We need to identify bowel cancer as early as we can, but we do have to remember most patients with bowel symptoms do not have cancer. GPs have always had to do a delicate balancing act between testing too few patients and testing too many.
“Most patients can be managed entirely within their GP’s surgery, but some will benefit from tests of their faeces, and a few will need an urgent colonoscopy.”
In the eight months Hannah fought bowel cancer, she managed to inspire thousands, and help fundraise, through her positive blog posts.
“No parent should have to go through what we went through,” says Beth. “When it’s caught early, you can save somebody’s life. People need to wake up.
“Even when she was really poorly, Hannah always wanted to keep positive, she’s always been like that, she wanted to raise awareness with her blogs and videos.”
To speak to a cancer nurse on any aspect of bowel cancer contact the Cancer Nurseline on Freephone 1800 200 700, email firstname.lastname@example.org or drop into one of 13 Daffodil Centres in hospitals nationwide.
For information on Daffodil Centre locations and opening times email email@example.com.
Or visit www.cancer.ie/bowel for further information on bowel cancer and to take the Online Bowel Health Checker.
The Irish Cancer Society’s bowel cancer awareness campaign is kindly supported by Merck.