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Bowel cancer
Bowelcancerisdiagnosedinmorethan3,400Victoriansandover12,500Australianseveryyear. Itmostlyaffectspeopleover50yearsofagebutitcanhappeninyoungerpeople.Cancerofthe bowelisalsoknownascolorectalcancer. Thebowelisthelongtubethatabsorbswaterandnutrientsfromfoodandprocesseswaste productsintofaeces.Itincludesthesmallbowel,colonandrectum. Bowelcancerusuallybeginsintheliningofthecolonorrectum.Ifuntreated,itspreadsdeeper intothewallofthebowel.Fromthere,itcanspreadtolymphnodesinthearea.Later,bowel cancercanspreadtotheliverorlungs. Symptoms Themostcommonsymptomsofbowelcancerare: Bloodormucusinthefaeces Anunexpectedchangeinbowelhabit(forexample,diarrhoeaorconstipationforno obviousreason) Generaldiscomfortintheabdomen(feelingsofbloating,fullnessand/orcramps) Constanttiredness Weaknessandpaleness.

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Risk factors Thecausesofbowelcancerarenotclearlyunderstood.However,weknowthatsomeriskfactors makeitmorelikelythatapersonwilldevelopbowelcancer.Theseinclude: Gettingolderbowelcancermorecommonlyaffectspeopleovertheageof50 Inheritingoneoftwouncommongeneticdisorders:familialadenomatouspolyposis(FAP) orhereditarynon-polyposiscolorectalcancer(HNPCC) Apersonalorstrongfamilyhistoryofbowelcancer Havingulcerativecolitis(inflamedcolonlining)formorethaneightto10years. Intheearlystages,bowelcanceroftencausesnosymptoms.Peopleatrelativelyhighrisk ofbowelcancercanarrangewiththeirdoctortohaveregularteststocheckthat everythingisOK.

Screening for bowel cancer Screeningmeanslookingforsignsofadiseaseinhealthypeoplewhodonothavesymptoms.It willnotalwayspreventbowelcancerbutitcanhelpfindcancerorcolorectalpolyps(whichcan becomecancerous)asearlyaspossible.Theearlieracancerisfound,theeasieritistotreatand themorelikelyitwillbecurable.Bowelcancerishighly(90%)curableiffoundatanearlystage. BowelcancerscreeningisnowaccessibletoVictoriansaged50,55,and65yearsofage.The screeningtestthatisusediscalledthefaecaloccultbloodtest(FOBT).Thisisasimpletestforthe earlysignsofbowelcancer.Itinvolvestakingtinysamplesfromtwoorthreebowelmotionsusing atestkit.Thesamplesarecollectedathomeandthensenttoalaboratoryfortesting. Tofindoutmoreaboutbowelscreening,contactTheCancerCouncilHelplineon131120. Diagnosis Severaltestscanbeusedtodiagnosebowelcancerincluding: Rectalexamination Sigmoidoscopy/colonoscopy Bariumenema

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X-ray,ultrasound,rectalultrasound,CTscanorMRIscan Bloodtests,includingacarcinoembryonicantigen(CEA)testCEAisproducedinhigh quantitiesbysomecancercells,especiallyinbowelcancer.

Bowel cancer stages Knowingifandhowfarthecancerhasspreadiscalledstagingthedisease.Staginghelpsyour doctorstoworkoutthebesttreatmentforyou.InAustralia,thestagingsystemforbowelcanceris theAustralianClinicoPathologicalStagingSystem(ACPS): StageAthecancerisconfinedtothebowelwall. StageBthecancerhasspreadtotheoutersurfaceofthebowelwall. StageCcancerisfoundinlymphnodesnearthebowel. StageDcancerisfoundatdistantsites:forexample,intheliverorlungs. YoumayalsohearabouttheDukessystem,whichisliketheACPS.DukesStageAequals ACPSStageA,andsoon.

AnotherstagingsystembeingusedmoreofteniscalledtheTNMsystem.Itrecordshowfarthe tumour(T)hasspreadthroughthebowelwall,iflymphnodes(N)areaffectedbythecancerand whetherthecancerhasspread(metastasised)tootherpartsofthebody(M). Askyourdoctortoexplainthestageofyourcancerinawayyoucanunderstand.Thiswillhelpyou tochoosethebesttreatmentforyoursituation. Treatment Surgeryisthemaintreatmentforbowelcancer.Thesurgeonremovesthesectionofthebowel affectedbycancerandthenjoinsthetwoends.Astoma(anopeningofthebowelontothe abdomen)issometimesmadeduringthesurgery.Yourbowelmotionswillcomethroughthestoma intoabag. Stomasareusuallytemporary,whilethebowelheals,butsomepeoplehavethempermanently. Manypeoplefindthisdifficulttodealwith.Youwillbegivenalotofeducationandsupportabout havingastoma. Chemotherapyorradiotherapyisnearlyalwaysusedinadditiontosurgery. Alltreatmentshavesideeffects.Thesewillvarydependingonthetypeoftreatmentyouare having.Manysideeffectsaretemporarybutsomemaybepermanent.Yourdoctorwillexplainall thepossiblesideeffectsbeforeyourtreatmentbegins. Sometimes a cure is not possible Ifthebowelcancerhasspreadtootherpartsofthebody,itisnotalwayspossibletocure. However,inalotofpeople,itisstilllikelythatthecancercanbekeptundercontrolforquitea longtime.Thisdependson: Whereandhowfarthecancerhasspread Whattreatmentyouhavehadinthepast Thetypeofbowelcanceryouhave.

Treatmentforcontrolofcancermayincludechemotherapy,radiotherapy,surgery,immunotherapy and/orpain-relievingdrugs.Youmayhearyourdoctorcallyourtreatmentpalliative.Thissimply meanstreatmentthatisdesignedtorelievesymptomsratherthancure. Reducing your risk Youcanhelptoreduceyourriskofbowelcancerby: Eatingahealthydiet,includingplentyofvegetablesandfruitandonlysmallamountsof animalfat Maintainingahealthybodyweight Exercisingregularly Notsmoking.

Followingthisadvicedoesntmeanthatyouwillnevergetbowelcancer,butitcanreduceyourrisk andhasotherhealthbenefitstoo. Where to get help

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Yourlocaldoctor Colorectalspecialist TheCancerCouncilVictoria,CancerHelplineTel.131120 MultilingualCancerInformationLine,Victoria-seetheCCVwebsiteforcontactdetails

Things to remember

Mostbowelcancersdiagnosedatanearlystagearecurable. Ifyouareatriskofbowelcancer,discusswithyourdoctorwhetheryouneedtohave regulartests. Youcanreduceyourriskofbowelcancerbyeatingahealthydiet,maintainingahealthy bodyweight,exercisingregularlyandnotsmoking.

This page has been produced in consultation with, and approved by:

CancerCouncilVictoria

Copyight 1999/2009StateofVictoria.ReproducedfromtheBetterHealthChannel(www.betterhealth.vic.gov.au)at nocostwithpermissionoftheVictorianMinisterforHealth.Unauthorisedreproductionandotherusescomprisedinthe copyrightareprohibitedwithoutpermission. ThisBetterHealthChannelfactsheethaspassedthrougharigorousapprovalprocess.Forthelatestupdatesandmore informationvisitwww.betterhealth.vic.gov.au.

Bowelcancer

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