Introduction

Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon or rectal cancer.

Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer.

Bowel cancer is one of the most common types of cancer diagnosed in the UK, with around 40,000 new cases diagnosed every year.

About 1 in every 20 people in the UK will develop bowel cancer in their lifetime.

Signs and symptoms

The three main symptoms of bowel cancer are blood in the stools (faeces), changes in bowel habit – such as more frequent, looser stools – and abdominal (tummy) pain.

However, these symptoms are very common and most people with them do not have bowel cancer. For example, blood in the stools is more often caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is usually the result of something you have eaten.

As almost 9 out of 10 people with bowel cancer are over the age of 60, these symptoms are more important as people get older. They are also more significant when they persist despite simple treatments.

Most people who are eventually diagnosed with bowel cancer have one of the following combination of symptoms:

  • a persistent change in bowel habit that causes them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools
  • a persistent change in bowel habit without blood in their stools, but with abdominal pain
  • blood in the stools without other haemorrhoid symptoms, such as soreness, discomfort, pain, itching or a lump hanging down outside the back passage
  • abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss

The symptoms of bowel cancer can be subtle and don't necessarily make you feel ill.

When to seek medical advice

Read about the symptoms of bowel cancer, and when you should see your GP to discuss whether any tests are necessary.

Your doctor will probably carry out a simple examination of your tummy and bottom to make sure you have no lumps.

They may also arrange for a simple blood test to check for iron deficiency anaemia – this can indicate whether there is any bleeding from your bowel that you haven't been aware of.

In some cases, your doctor may decide it is best for you to have a simple test in hospital to make sure there is no serious cause for your symptoms.

Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age.

Read more about diagnosing bowel cancer

Who's at risk?

It's not known exactly what causes bowel cancer, but there are a number of things that can increase your risk. These include:

  • age – almost 9 in 10 cases of bowel cancer occur in people aged 60 or over
  • diet – a diet high in red or processed meats and low in fibre can increase your risk
  • weight – bowel cancer is more common in people who are overweight or obese
  • exercise – being inactive increases the risk of getting bowel cancer
  • alcohol and smoking – a high alcohol intake and smoking may increase your chances of getting bowel cancer
  • family history – having a close relative (mother or father, brother or sister) who developed bowel cancer under the age of 50 puts you at a greater lifetime risk of developing the condition

Some people have an increased risk of bowel cancer because they have another condition that affects their bowel, such as severe ulcerative colitis or Crohn's disease, over a long period of time.

Read more about the causes of bowel cancer and preventing bowel cancer

Bowel cancer screening

Bowel screening is offered to men and women aged 50 to 74 across Scotland to help find bowel cancer early when it can often be cured.

Bowel screening involves taking a simple test at home every 2 years. The test looks for hidden blood in your poo, as this could mean a higher chance of bowel cancer.

Read more about screening for bowel cancer

Treatment and outlook

Bowel cancer can be treated using a combination of different treatments, depending on where the cancer is in your bowel and how far it has spread.

The main treatments are:

  • surgery – the cancerous section of bowel is removed; it is the most effective way of curing bowel cancer, and is all that many people need
  • chemotherapy – where medication is used to kill cancer cells 
  • radiotherapy – where radiation is used to kill cancer cells
  • biological treatments – a newer type of medication that increases the effectiveness of chemotherapy and prevents the cancer spreading

As with most types of cancer, the chances of a complete cure depends on how far it has advanced by the time it is diagnosed. If the cancer is confined to the bowel, surgery will usually be able to completely remove it.

Overall, 7 to 8 in every 10 people with bowel cancer will live at least one year after diagnosis. More than half of those diagnosed will live at least another 10 years. Every year, around 16,000 people die as a result of bowel cancer.

Read more about how bowel cancer is treated and living with bowel cancer

Signs and symptoms

The three main symptoms of bowel cancer are blood in the stools (faeces), a change in bowel habit, such as more frequent, looser stools, and abdominal (tummy) pain.

However, these symptoms are very common. Blood in the stools is usually caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is often the result of something you have eaten.

In the UK, an estimated 7 million people have blood in the stools each year. Even more people have temporary changes in their bowel habits and abdominal pain. Most people with these symptoms do not have bowel cancer.

As the vast majority of people with bowel cancer are over the age of 60, these symptoms are more important as people get older. These symptoms are also more significant when they persist in spite of simple treatments.

Most patients with bowel cancer present with one of the following symptom combinations:

  • a persistent change in bowel habit, causing them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools
  • a persistent change in bowel habit without blood in their stools, but with abdominal pain
  • blood in the stools without other haemorrhoid symptoms, such as soreness, discomfort, pain, itching, or a lump hanging down outside the back passage
  • abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss

The symptoms of bowel cancer can be subtle and don't necessarily make you feel ill.

When to seek medical advice

Read about the symptoms of bowel cancer, and when you should see your GP to discuss whether any tests are necessary.

Your doctor will probably perform a simple examination of your tummy and bottom to make sure you have no lumps, as well as a simple blood test to check for iron deficiency anaemia – this can indicate whether there is any bleeding from your bowel you haven't been aware of.

In some cases, your doctor may decide it is best to have a simple test in hospital to make sure there is no serious cause for your symptoms.

Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age.

Read more about diagnosing bowel cancer

Bowel obstruction

In some cases, bowel cancer can stop digestive waste passing through the bowel. This is known as a bowel obstruction.

Symptoms of a bowel obstruction can include:

  • severe abdominal pain, which may initially come and go
  • not being able to pass stools when you go to the toilet
  • noticeable swelling or bloating of the tummy
  • vomiting

A bowel obstruction is a medical emergency. If you suspect your bowel is obstructed, you should see your GP quickly. If this isn't possible, go to the accident and emergency (A&E) department of your nearest hospital.

Want to know more?

Causes

Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.

Most cases of bowel cancer first develop inside clumps of cells on the inner lining of the bowel. These clumps are known as polyps. However, if you develop polyps, it does not necessarily mean you will get bowel cancer.

Exactly what causes cancer to develop inside the bowel is still unknown. However, research has shown several factors may make you more likely to develop it. These factors are outlined below.

Age

Your chances of developing bowel cancer increase as you get older. Almost 9 out of 10 cases of bowel cancer in the UK are diagnosed in people over the age of 60.

Family history

Having a family history of bowel cancer can increase your risk of developing the condition yourself, particularly if a close relative (mother, father, brother or sister) was diagnosed with bowel cancer below the age of 50.

If you are particularly concerned that your family's medical history may mean you are at an increased risk of developing bowel cancer, it may help to speak to your GP.

If necessary, your GP can refer you to a genetics specialist, who can offer more advice about your level of risk and recommend any necessary tests to periodically check for the condition.

Diet

A large body of evidence suggests a diet high in red and processed meat can increase your risk of developing bowel cancer.

For this reason, the Department of Health advises people who eat more than 90g (cooked weight) a day of red and processed meat cut down to 70g a day.

Read more about red meat and bowel cancer risk

There is also evidence that suggests a diet high in fibre could help reduce your bowel cancer risk.

Read more about eating good food and a healthy diet

Smoking

People who smoke cigarettes are more likely to develop bowel cancer, other types of cancer, and other serious conditions, such as heart disease.

Read more about stopping smoking

Alcohol

Drinking alcohol has been shown to be associated with an increased risk of bowel cancer, particularly if you regularly drink large amounts.

Read about drinking and alcohol for information and tips on cutting down

Obesity

Being overweight or obese is linked to an increased risk of bowel cancer, particularly in men.

If you are overweight or obese, losing weight may help lower your chances of developing the condition.

Inactivity

People who are physically inactive have a higher risk of developing bowel cancer.

You can help reduce your risk of bowel and other cancers by being physically active every day.

Read more about health and fitness

Digestive disorders

Some conditions affecting the bowel may put you at a higher risk of developing bowel cancer. For example, bowel cancer is more common in people who have had severe Crohn's disease or ulcerative colitis for many years.

If you have one of these conditions, you will usually have regular check-ups to look for signs of bowel cancer from about 10 years after your symptoms first develop.

Check-ups will involve examining your bowel with a colonoscope – a long, narrow flexible tube that contains a small camera – that is inserted into your rectum.

The frequency of the colonoscopy examinations will increase the longer you live with the condition, and will also depend on factors such as how severe your ulcerative colitis is and if you have a family history of bowel cancer.

Genetic conditions

There are two rare inherited conditions that can lead to bowel cancer. They are:

  • familial adenomatous polyposis (FAP) – a condition that triggers the growth of non-cancerous polyps inside the bowel
  • hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome – an inherited gene fault (mutation) that increases your bowel cancer risk

Although the polyps caused by FAP are non-cancerous, there is a high risk that, over time, at least one will turn cancerous. Most people with FAP will have bowel cancer by the time they are 50.

As people with FAP have such a high risk of getting bowel cancer, they are often advised by their doctor to have their large bowel removed before they reach the age of 25.

Families affected can find support and advice from FAP registries such as The Polyposis Registry provided by St Mark's Hospital, London.

Removing the bowel as a precautionary measure is also usually recommended in people with HNPCC because the risk of developing bowel cancer is so high.

Want to know more?

Diagnosis

When you first see your GP, they will ask about your symptoms and whether you have a family history of bowel cancer.

They will then usually carry out a simple examination of your abdomen (tummy) and your bottom, known as a digital rectal examination (DRE).

This is a useful way of checking whether there are any lumps in your tummy or back passage. The tests can be uncomfortable, and most people find an examination of the back passage a little embarrassing, but they take less than a minute.

If your symptoms suggest you may have bowel cancer or the diagnosis is uncertain, you will be referred to your local hospital initially for a simple examination called a flexible sigmoidoscopy.

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of bowel cancer and refer people for the right tests faster.

To find out if you should be referred for further tests for suspected bowel cancer, read the NICE 2015 guidelines on suspected cancer: recognition and referral.

Flexible sigmoidoscopy

A flexible sigmoidoscopy is an examination of your rectum and some of your large bowel using a device called a sigmoidoscope.

A sigmoidoscope is a long, thin, flexible tube attached to a very small camera and light. It is inserted into your rectum and up into your bowel.

The camera relays images to a monitor, and can also be used to take biopsies, where a small tissue sample is removed for further analysis.

It is better for your lower bowel to be as empty as possible when sigmoidoscopy is performed, so you may be asked to carry out an enema – a simple procedure to flush your bowels – at home beforehand. This should be used at least two hours before you leave home for your appointment.

A sigmoidoscopy can feel uncomfortable, but it only takes a few minutes and most people go home straight after the examination.

More detailed tests

Most people with bowel cancer can be diagnosed by flexible sigmoidoscopy. However, some cancers can only be diagnosed by a more extensive examination of the colon.

The two tests used for this are colonoscopy and computerised tomography (CT) colonography. These tests are described in more detail below.

Colonoscopy

A colonoscopy is an examination of your entire large bowel using a device called a colonoscope, which is like a sigmoidoscope but a bit longer.

Your bowel needs to be empty when a colonoscopy is performed, so you will be advised to eat a special diet for a few days beforehand and take a laxative (medication to help empty your bowel) on the morning of the examination.

You will be given a sedative to help you relax during the test, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. This is not usually painful, but can feel uncomfortable.

The camera relays images to a monitor, which allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer. As with a sigmoidoscopy, a biopsy may also be performed during the test.

A colonoscopy usually takes about an hour to complete, and most people can go home once they have recovered from the effects of the sedative.

After the procedure, you will probably feel drowsy for a while, so you will need to arrange for someone to accompany you home. It is best for elderly people to have someone with them for 24 hours after the test. You will be advised not to drive for 24 hours.

In a small number of people, it may not be possible to pass the colonoscope completely around the bowel, and it is then necessary to have CT colonography.

Find out more about what a colonoscopy involves

CT colonography

CT colonography, also known as a "virtual colonoscopy", involves using a computerised tomography (CT) scanner to produce three-dimensional images of the large bowel and rectum.

During the procedure, gas is used to inflate the bowel using a thin, flexible tube placed in your rectum. CT scans are then taken from a number of different angles.

As with a colonoscopy, you may need to have a special diet for a few days and take a laxative before the test to ensure your bowels are empty when the test is carried out.

This test can help identify potentially cancerous areas in people who are not suitable for a colonoscopy because of other medical reasons.

A CT colonography is a less invasive test than a colonoscopy, but you may still need to have colonoscopy or flexible sigmoidoscopy at a later stage so any abnormal areas can be removed or biopsied.

Want to know more?

Further tests

If a diagnosis of bowel cancer is confirmed, further testing is usually carried out to check if the cancer has spread from the bowel to other parts of the body. These tests also help your doctors decide on the most effective treatment for you.

These tests can include:

  • a CT scan of your abdomen and chest – this will check if the rest of your bowel is healthy and whether the cancer has spread to the liver or lungs
  • a magnetic resonance imaging (MRI) scan – this can provide a detailed image of the surrounding organs in people with cancer in the rectum

Staging and grading

Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer.

Staging refers to how far your cancer has advanced. Grading relates to how aggressive your cancer is and how likely it is to spread.

This is important, as it helps your treatment team choose the best way of curing or controlling the cancer.

A number of different staging systems are used by doctors. A simplified version of one of the common systems used is outlined below.

  • stage 1 – the cancer is still contained within the lining of the bowel or rectum
  • stage 2 – the cancer has spread beyond the layer of muscle surrounding the bowel and may have penetrated the surface covering the bowel or nearby organs
  • stage 3 – the cancer has spread into nearby lymph nodes
  • stage 4 – the cancer has spread beyond the bowel into another part of the body, such as the liver

There are three grades of bowel cancer:

  • grade 1 – a cancer that grows slowly and has a low chance of spreading beyond the bowel
  • grade 2 – a cancer that grows moderately and has a medium chance of spreading beyond the bowel
  • grade 3 – a cancer that grows rapidly and has a high chance of spreading beyond the bowel

If you are not sure what stage or grade of cancer you have, ask your doctor.

Treatment

If colon cancer is at a very early stage, it may be possible to remove just a small piece of the lining of the colon wall. This is known as local excision.

If the cancer spreads into muscles surrounding the colon, it will usually be necessary to remove an entire section of your colon. This is known as a colectomy.

There are two ways a colectomy can be performed:

  • an open colectomy – where the surgeon makes a large cut (incision) in your abdomen and removes a section of your colon
  • a laparoscopic (keyhole) colectomy – where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of colon

During surgery, nearby lymph nodes are also removed. It is usual to join the ends of the bowel together after bowel cancer surgery, but very occasionally this is not possible and a stoma is needed.

Both open and laparoscopic colectomies are thought to be equally effective at removing cancer and have similar risks of complications.

However, laparoscopic colectomies have the advantage of a faster recovery time and less postoperative pain. It is becoming the routine way of doing most of these operations.

Laparoscopic colectomies should be available in all hospitals that carry out bowel cancer surgery, although not all surgeons perform this type of surgery. Discuss your options with your surgeon to see if this method can be used.

Surgery for rectal cancer

There are a number of different types of operation that can be carried out to treat rectal cancer, depending on how far the cancer has spread.

Some of the main techniques used are described below:

Local resection

If you have a very small, early-stage rectal cancer, your surgeon may be able to remove it in an operation called a local resection (transanal resection).

The surgeon puts an endoscope in through your back passage and removes the cancer from the wall of the rectum.

Total mesenteric excision

In many cases, however, a local resection is not possible. Instead, a larger area of the rectum will need to be removed.

This area will include a border of rectal tissue free of cancer cells, as well as fatty tissue from around the bowel (the mesentery). This type of operation is known as total mesenteric excision (TME).

Removing the mesentery can help ensure all the cancerous cells are removed, which can lower the risk of the cancer recurring at a later stage.

Depending on where in your rectum the cancer is located, one of two main TME operations may be carried out. These are outlined below.

Low anterior resection

Low anterior resection is a procedure used to treat cases where the cancer is in the upper section of your rectum.

The surgeon will make an incision in your abdomen and remove the upper section of your rectum, as well as some surrounding tissue to make sure any lymph glands containing cancer cells are also removed.

They will then attach your colon to the lowest part of your rectum or upper part of the anal canal. Sometimes they turn the end of the colon into an internal pouch to replace the rectum.

You will probably require a temporary stoma to give the joined section of bowel time to heal.

Abdominoperineal resection

Abdominoperineal resection is used to treat cases where the cancer is in the lowest section of your rectum.

In this case, it will be necessary to remove the whole of your rectum and surrounding muscles to reduce the risk of the cancer regrowing in the same area.

This involves removing and closing the anus and removing its sphincter muscles, so there is no option except to have a permanent stoma after the operation.

Bowel cancer surgeons always do their best to avoid giving people permanent stomas wherever possible.

Stoma surgery

Where a section of the bowel is removed and the remaining bowel joined, the surgeon may sometimes decide to divert your stool away from the join to allow it to heal.

The stool is temporarily diverted by bringing a loop of bowel out through the abdominal wall and attaching it to the skin – this is called a stoma. A bag is worn over the stoma to collect the stool.

When the stoma is made from the small bowel (ileum) it is called an ileostomy, and when it is made from the large bowel (colon) it is called a colostomy

A specialist nurse, known as a stoma care nurse, can advise you on the best site for a stoma prior to surgery.

The nurse will take into account factors such as your body shape and lifestyle, although this may not be possible where surgery is performed in an emergency.

In the first few days after surgery, the stoma care nurse will advise on the care necessary to look after the stoma and the type of bag suitable.

Once the join in the bowel has safely healed, which can take several weeks, the stoma can be closed during further surgery.

In some people, for various reasons, rejoining the bowel may not be possible or may lead to problems controlling bowel function, and the stoma may become permanent.

Before having surgery, the care team will advise you about whether it may be necessary to form an ileostomy or colostomy, and the likelihood of this being temporary or permanent.

There are patient support groups available that provide support for patients who have just had or are about to have a stoma. You can get more details from your stoma care nurse, or visit the groups online for further information.

These include:

Learn more about coping with a stoma after bowel cancer

Side effects of surgery

Bowel cancer operations carry many of the same risks as other major operations, including bleeding, infection, developing blood clots, or heart or breathing problems. 

The operations all carry a number of risks specific to the procedure. One risk is that the joined up section of bowel may not heal properly and leak inside your abdomen. This is usually only a risk in the first few days after the operation.

Another risk is for people having rectal cancer surgery. The nerves that control urination and sexual function are very close to the rectum, and sometimes surgery to remove a rectal cancer can damage these nerves.

After rectal cancer surgery, most people need to go to the toilet to open their bowels more often than before, although this usually settles down within a few months of the operation.

Radiotherapy

There are two main ways radiotherapy can be used to treat bowel cancer. It can be given before surgery to shrink rectal cancers and increase the chances of complete removal, or be used to control symptoms and slow the spread of cancer in advanced cases (palliative radiotherapy).

Radiotherapy given before surgery for rectal cancer can be performed in two ways:

  • external radiotherapy – where a machine is used to beam high-energy waves at your rectum to kill cancerous cells
  • internal radiotherapy (brachytherapy) – where a radioactive tube is inserted into your anus and placed next to the cancer to shrink it

External radiotherapy is usually given daily, five days a week, with a break at the weekend. Depending on the size of your tumour, you may need one to five weeks of treatment. Each session of radiotherapy is short and will only last for 10 to 15 minutes.

Internal radiotherapy can usually be performed in one session before surgery is carried out a few weeks later.

Palliative radiotherapy is usually given in short daily sessions, with a course ranging from 2 to 3 days, up to 10 days.

Short-term side effects of radiotherapy can include:

  • feeling sick
  • fatigue
  • diarrhoea
  • burning and irritation of the skin around the rectum and pelvis – this looks and feels like sunburn
  • a frequent need to urinate
  • a burning sensation when passing urine

These side effects should pass once the course of radiotherapy has finished. Tell your care team if the side effects of treatment become particularly troublesome. Additional treatments are often available to help you cope with the side effects better.

Long-term side effects of radiotherapy can include:

If you want to have children, it may be possible to store a sample of your sperm or eggs before treatment begins so they can be used in fertility treatments in the future.

Chemotherapy

There are three ways chemotherapy can be used to treat bowel cancer:

  • before surgery – used in combination with radiotherapy to shrink the tumour
  • after surgery – to reduce the risk of the cancer recurring
  • palliative chemotherapy – to slow the spread of advanced bowel cancer and help control symptoms

Chemotherapy for bowel cancer usually involves taking a combination of medications that kill cancer cells. They can be given as a tablet (oral chemotherapy), through a drip in your arm (intravenous chemotherapy), or as a combination of both.

Treatment is given in courses (cycles) that are two to three weeks long each, depending on the stage or grade of your cancer.

A single session of intravenous chemotherapy can last from several hours to several days.

Most people having oral chemotherapy take tablets over the course of two weeks before having a break from treatment for another week.

A course of chemotherapy can last up to six months, depending on how well you respond to the treatment. In some cases, it can be given in smaller doses over longer periods of time (maintenance chemotherapy).

Side effects of chemotherapy can include:

  • fatigue
  • feeling sick
  • vomiting
  • diarrhoea
  • mouth ulcers
  • hair loss with certain treatment regimens, but this is generally uncommon in the treatment of bowel cancer
  • a sensation of numbness, tingling or burning in your hands, feet and neck

These side effects should gradually pass once your treatment has finished. It usually takes a few months for your hair to grow back if you experience hair loss.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection.

Inform your care team or GP as soon as possible if you experience possible signs of an infection, including a high temperature (fever) or a sudden feeling of being generally unwell.

Medications used in chemotherapy can cause temporary damage to men's sperm and women's eggs. This means that for women who become pregnant or for men who father a child, there is a risk to the unborn baby's health. 

It is therefore recommended you use a reliable method of contraception while having chemotherapy treatment and for a period after your treatment has finished.

Find out more about chemotherapy  

Biological treatments

Biological treatments, including cetuximab, bevacizumab and panitumumab, are a newer type of medication also known as monoclonal antibodies.

Monoclonal antibodies are antibodies that have been genetically engineered in a laboratory. They target special proteins found on the surface of cancer cells, known as epidermal growth factor receptors (EGFR).

As EGFRs help the cancer grow, targeting these proteins can help shrink tumours, and improve the effect and outcome of chemotherapy.

Biological treatments are therefore usually used in combination with chemotherapy when the cancer has spread beyond the bowel (metastatic bowel cancer).

These treatments are not available to everyone with bowel cancer. The National Institute for Health and Care Excellence (NICE) has specific criteria that need to be met before these can be prescribed.

Cetuximab is only available on the NHS when:

  • surgery to remove the cancer in the colon or rectum has been carried out or is possible
  • bowel cancer has spread to the liver and cannot be removed surgically
  • a person is fit enough to undergo surgery to remove the cancer from the liver if this becomes possible after treatment with cetuximab

Cetuximab, bevacizumab and panitumumab are available on the NHS through a government scheme called the Cancer Drugs Fund. All these medications are also available privately, but are very expensive.

More information on all of the above is available from:

Living with bowel cancer

Talk to others

Your GP or nurse may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP surgery will have information on these.

Some people find it helpful to talk to others with bowel cancer at a local support group or through an internet chat room.

Beating Bowel Cancer offers support services to people with bowel cancer. They run a nurse advisory line on 08450 719 301 or 020 8973 0011 available 9am to 5.30pm Monday to Thursday, and 9am to 4pm on Fridays. You can also email a nurse at nurse@beatingbowelcancer.org.

The organisation also runs a national patient-to-patient network called Bowel Cancer Voices for people affected by bowel cancer and their relatives.

Find more support from Bowel Cancer Voices and cancer support groups

Your emotions

Having cancer can cause a range of emotions. These may include shock, anxiety, relief, sadness and depression.

Different people deal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you.

However, you and your loved ones may find it helpful to know about the feelings that people diagnosed with cancer have reported.

Read about the emotional effects of cancer

Recovering from surgery

Surgeons and anaesthetists have found using an enhanced recovery programme after bowel cancer surgery helps patients recover more quickly.

Most hospitals now use this programme. It involves giving you more information about what to expect before the operation, avoiding giving you strong laxatives to clean the bowel before surgery, and in some cases giving you a sugary drink two hours before the operation to give you energy. 

During and after the operation, the anaesthetist controls the amount of IV fluid you need very carefully, and after the operation you will be given painkillers that allow you to get up and out of bed by the next day.

Most people will be able to eat a light diet the day after their operation.

To reduce the risk of blood clots in the legs (deep vein thrombosis), you may be given special compression stockings that help prevent blood clots, or a regular injection with a blood-thinning medication called heparin until you are fully mobile.

A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home within a few days.

With the enhanced recovery programme, most people are well enough to go home within a week of their operation. The timing depends on when you and the doctors and nurses looking after you agree you are well enough to go home.

You will be asked to return to hospital a few weeks after your treatment has finished so tests can be carried out to check for any remaining signs of cancer. You may also need routine check-ups for the next few years to look out for signs of the cancer recurring.

Read more about what to expect after your operation for bowel cancer

Diet after bowel surgery

If you have had part of your colon removed, it is likely your stools (faeces) will be looser – one of the functions of the colon is to absorb water from stools.

This may mean you need to go to the toilet more often to pass loose stools. Inform your care team if this becomes a problem, as medication is available to help control it.

You may find some foods upset your bowels, particularly during the first few months after your operation.

Different foods can upset different people, but food and drink known to cause problems include fruit and vegetables that are high in fibre, such as beans, cabbages, apples and bananas, and fizzy drinks, such as cola and beer.

You may find it useful to keep a food diary to record the effects of different foods on your bowel.

Contact your care team if you find you are having continual problems with your bowels as a result of your diet, or you are finding it difficult to maintain a healthy diet. You may need to be referred to a dietitian for further advice.

Read more about diet and bowel cancer and your diet after bowel cancer 

Living with a stoma

If you need a temporary or permanent stoma with an external bag or pouch, you may feel worried about how you look and how others will react to you.

Information and advice about living with a stoma – including stoma care, stoma products and stoma-friendly diets – is available on the ileostomy and colostomy topics.

For those who want further information about living with a stoma, there are patient support groups that provide support for people who may have had, or are due to have, a stoma.

You can get more details from your stoma care nurse, or visit support groups online for further information. The Ileostomy and Internal Pouch Support Group organisation provides a unique visiting service for anyone wishing to speak with someone who has been through similar surgery.

Find out more about coping with a stoma after bowel cancer

Sex and bowel cancer

Having cancer and receiving treatment may affect how you feel about relationships and sex. Although most people are able to enjoy a normal sex life after bowel cancer treatment, you may feel self-conscious or uncomfortable if you have stoma.

Talking about how you feel with your partner may help you both support each other. Or you may feel you'd like to talk to someone else about your feelings. Your doctor or nurse will be able to help.

Find more informaiton on body image and intimate relations and sex and bowel cancer

Financial concerns

A diagnosis of cancer can cause money problems because you are unable to work, or someone you are close to has to stop working to look after you.

There is financial support available for carers and yourself if you have to stay off work for a while or stop work because of your illness. 

Visit Macmillan for information on prescriptions and your finances

 

The following organisations could also offer help or information:

Dealing with dying

If you are told there is nothing more that can be done to treat your bowel cancer, your GP will still provide you with support and pain relief. This is called palliative care. Support is also available for your family and friends.

Find out more about end of life care

Visit the following organisations for further support:

Prevention

There are some things that increase your risk of bowel cancer that you can't change, such as your family history or your age.

However, there are several ways you can lower your chances of developing the condition.

Diet

Research suggests making changes to your diet can help reduce your risk of bowel cancer.

It may help prevent bowel cancer if you eat:

  • less cured and processed meat, such as bacon, sausages and ham
  • less red meat and more fish
  • more fibre from cereals, beans, fruit and vegetables

The Department of Health advises people who eat more than 90g (cooked weight) of red and processed meat a day to cut down to 70g to help reduce their bowel cancer risk. 

Read more about red meat and bowel cancer risk and eating good food and a healthy diet

Exercise

There is strong evidence to suggest regular exercise can lower the risk of developing bowel and other cancers.

It is recommended adults exercise for at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week.

Read more about keeping active

Healthy weight

Being overweight or obese increases your chances of developing bowel cancer, so you should try to maintain a healthy weight if you want to lower your risk.

You can find out if you are a healthy weight by using the BMI chart

Changes to your diet and an increase in your physical activity will help keep your weight under control.

Read more about losing weight

Stop smoking

If you smoke, stopping can reduce your risk of developing bowel and other cancers.

Quit Your Way Scotland is an advice and support service for anyone trying to stop smoking in Scotland. To speak with an advisor, phone 0800 84 84 84 from 8.00am to 10.00pm, every day. Calls are free from landlines and mobiles. 

Your GP or pharmacist can also provide help, support and advice if you want to give up smoking.

Read more about stopping smoking

Cut down on alcohol

Drinking alcohol has been linked to an increased risk of developing bowel cancer, so you may be able to reduce your risk by cutting down on the amount of alcohol you drink.

If you drink most weeks, to reduce your risk of harming your health:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over three days or more if you drink as much as 14 units a week 

Read more about alcohol units and get tips on cutting down

Bowel cancer screening

Although screening cannot stop you getting bowel cancer, it can allow the condition to be detected at an earlier stage, when it is much easier to treat.

As well as making lifestyle changes and keeping an eye out for possible symptoms of bowel cancer, taking part in bowel cancer screening when it is offered can help reduce your chances of dying from the condition.

Bowel screening is offered to men and women aged 50 to 74 across Scotland. If you’re 75 or over, you can still take a bowel screening test every 2 years. However, you’ll need to request a new test kit each time.

Read more about bowel cancer screening