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Web chat: Bowel cancer awareness with Dr John P Martin 22 April
Everyone, including patients, the public, GPs and other healthcare professionals are invited to join us, and you are welcome to submit your questions anonymously.
You can submit your questions here starting at 13.30 on Friday 22 April. You are also welcome to email your questions to web@imperial.nhs.uk or tweet your questions to @ImperialNHS.
Comment From Guest
How do you diagnose bowel cancer?
John Martin:
There are a variety of tests to diagnose bowel cancer. The most commonly used test is a colonoscopy, where a flexible tube is passed around the bowel to directly examine the colon. There are, however, alternatives such as a special CT scan, which allows similar views of the bowel.
John Martin:
Screening tests, such as looking for blood in the stool, do not test for cancer. Those people with an abnormal result, however, are at increased risk of having a polyp or cancer and will be offered a colonoscopy to check.
Comment From Lee
What are the symptoms of bowel cancer?
John Martin:
Common symptoms include blood in stools and changes in bowels, particularly if they become more frequent or looser than usual. If you are at all concerned about symptoms like these, it is important to speak to your GP.
Comment From Guest
what about barium enema?
John Martin:
Barium enema has been shown to be less sensitive at diagnosing bowel cancer when compared to CT or colonoscopy. It is therefore an outdated test and should not be performed.
Comment From Guest
What causes bowel cancer? A member of my family had it, and I am concerned I will get it too?
John Martin:
Bowel cancer is a common cancer, so it is not unusual to have affected family members. However, there are genetic factors, which in combination with environmental triggers can cause the disease. Most people are not at increased risk if they have affected family members. However, if there are many relatives with the disease or relatives that get a bowel cancer below the age of 50, it would be worth discussing with your GP.
Comment From Guest
Is there an age bracket of who are more commonly affected of this problem?
John Martin:
The risk of bowel cancer increases with age. It is uncommon, but not impossible, below the age of 50.
Comment From Guest
What causes bowel cancers in young children and would a parent look out for
John Martin:
Bowel cancer does not occur in young children. If they have symptoms that are similar – including blood in their stools or loose stools – it is likely to be something else. Regardless, you should consult your GP if your child has these symptoms.
Comment From Guest
I have coeliac disease, am I more likely to get bowel cancer?
John Martin:
No. Coeliac disease affects the small intestine, so there is an increased risk of problems in the small bowel as a result. People with coeliac disease are not at increased risk of bowel cancer, but still have average risk of getting this common cancer. As a result, symptoms should be taken seriously.
Comment From Philomena
What treatments are there?
John Martin:
The major important treatment for bowel cancer is surgery. Depending on the site of the cancer and how advanced it is, it may be that radiotherapy or chemotherapy would be suggested in addition, either before or after surgery.
Comment From Guest
Can you get bowel cancer at any age? I'm 25 and I very occasionally see blood when I got to the toilet. Its not very often, so I wasn't concerned. However do you think I'd be at risk?
John Martin:
A bowel cancer at your age would be extremely unlikely. If your symptoms are only intermittent, have been there for a while, and are not getting worse, then they are likely to be something like haemorrhoids. If the bleeding is getting worse, more frequent, or is associated with diarrhoea, then see your GP.
Comment From Guest
How many people are screened for bowel cancer annually?
John Martin:
Roughly six million people every year. All English residents between the ages of 60 and 74 are offered a screening test for bowel cancer every two years. The uptake of this is around 50 per cent. In addition, there is a new screening programme offering a limited examination of the bowel to all 55 year olds, although this is not yet fully implemented.
Comment From Guest
Why do you only screen people aged 60-75 and not lower?
John Martin:
The evidence from clinical trials supports screening in this age group and there is not data to support extending this programme to a younger group.
Comment From Guest
Is there anything you can do to prevent bowel cancer?
John Martin:
There are many factors which have been linked to a small increased risk of developing bowel cancer. These include: high red meat intake, lack of fruit and vegetables, smoking, alcohol, lack of exercise. Some drugs such as aspirin do potentially reduce the risk of developing bowel cancer, but it is currently not advised to take these to prevent a cancer. The most important thing you can do is to seek medical advice if you develop any symptoms, such as blood in your stools or loose stools, and to participate in the screening programmes if you are eligible.
John Martin:
Diet has some effect on developing bowel cancer, so I would suggest eating fruit and vegetables and avoiding too much red meat, especially processed or barbequed meat. However, it is still possible to develop a bowel cancer despite an excellent diet, so it is important to seek medical advice if you develop any symptoms, such as blood in your stools or loose stools, and to participate in the screening programmes if you are eligible.
Comment From Guest
Can bowel cancer spread?
John Martin:
Yes, like any cancer, bowel cancer can spread. The most common site would be to the liver or lymph nodes.
Comment From guest
Is there a role for FOB testing outside of the national screening programme
John Martin:
No, because of its lack of sensitivity. FOBt should not be used to investigate patients with symptoms of bowel cancer. These people are already at risk because of their symptoms. FOBt within the screening programme identifies a high-risk group from asymptomatic individuals.
Comment From Guest
I am feeling fine, yet I have been invited to the screen programme? Where did you get my details?
John Martin:
If you are registered with a GP and in the appropriate age group – either age 55 or between 60 and 74 – then you will be invited to participate in the screening programme. Screening is for people who have no symptoms, to try to pick up cancer or polyps earlier.
Comment From Guest
If you have bowel cancer do you have to change the way you live? Things like your diet and exercise?
John Martin:
Most people with bowel cancer, after treatment, will return to normal life, although some may have more frequent bowel motions. In most cases, there is no need to change your diet or exercise. A small portion have other problems, but these are rare.
Comment From Anil - nurse
How can genomics help the management of bowel cancer in the future or today?
John Martin:
Genomics currently has a limited role in the management of bowel cancer. Some chemotherapy drugs are not effective in tumours with certain gene types.
Comment From Guest
I had abnormal test results from the screening, should I be worried?
John Martin:
Most people with an abnormal test do not have cancer, so do not be unduly concerned. It is, however, important to have the colonoscopy to ensure that there is no cancer present. With an abnormal test there is a high incidence of colonic polyps, which can be removed and prevent the development of cancer in the future.
Comment From Anil - nurse
My father was treated for bowel cancer 15 years ago and has had no further complications. What is the risk of me developing bowel cancer?
John Martin:
Bowel cancer is a common cancer, so it is not unusual to have affected family members. Most people are not at increased risk if they have affected family members. However, if there are many relatives with the disease or relatives that get a bowel cancer below the age of 50, it would be worth discussing with your GP.
Comment From Guest
I found the FoBt test kit difficult to complete. Are there any other easier tests available?
John Martin:
Not at the moment, but in the next year or so, a different stool test is being introduced, which is much easier to complete and is more accurate.
Comment From Guest
You mentioned avoiding barbequed meat. I was of the impression that barbequed meat is healthy?
John Martin:
Barbequed meat has been associated with a high risk of bowel cancer.
John Martin:
We do not contact patients to encourage them to participate with the programme. However, the benefits of screening in terms of reducing death rates for colon cancer are proven. Although it is distasteful, it has the potential to be life-saving.
Comment From K Medlow
How do you persuade a patient to comply with the FOB screening when they find it distateful?
John Martin:
We do not contact patients to encourage them to participate with the programme. However, the benefits of screening in terms of reducing death rates for colon cancer are proven. Although it is distasteful, it has the potential to be life-saving.
Comment From David
What are the current survival rates?
John Martin:
Survival rates are related to stage of disease at diagnosis. Overall, one year survival is about 75 per cent. Five-year survival is about 58 per cent. It is therefore important to diagnose the disease early, as this has a major impact on survival.
Comment From David
Are there any precursor genes that can be tested, like the one for breast cancer?
Comment From Guest
Is there any clinical research happening into genetic bowel cancer? Lynch syndrome runs in my family but its a recent discovery for us and I dont know much about it?
John Martin:
Genetic testing is not performed in people without a strong family history of bowel cancer. In families with a history suggestive of an inherited, genetic condition such as Lynch syndrome, testing can be undertaken within a family cancer clinic. This is important because if the genetic defect is identified, family members can be tested and only those carrying the gene will require the intense surveillance. If no testing is done, then it is normally assumed that everyone is at risk, so all family members will need surveillance.
Comment From Guest
is one sex more likely to get it than another
John Martin:
Bowel cancer is slightly more common in men, but is common in both sexes.
John Martin:
That's all the time we have today - thanks so much for participating!
John Martin:
If you have any questions later, feel free to email them to web@imperial.nhs.uk or tweet them to @ImperialNHS and we will pass them along to Dr Martin. Thanks again!