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Below the belt

by Simone McClenaughan | 31 Dec 2012

Let’s be frank. No one really likes to talk about the state of his or her bowel movements. But this approach isn't the most helpful for your health.

“Bowel movements are a natural, normal part of your body’s functioning,” says Dr Ronald McCoy from the Royal Australian College of General Practitioners.

When it comes to bowel cancer, which kills 78 Australians every week, paying attention to bowel movements, especially if you’re over 50, can make all the difference to surviving.

“Once you turn 50, your risk of bowel cancer doubles,” warns Julien Wiggins, CEO of Bowel Cancer Australia. “Ninety-three per cent of bowel cancer patients in Australia are over the age of 50.” One in 12 Australians will develop bowel cancer before they turn 85.

Australia has one of the highest rates of bowel cancer in the world, with over 14,000 people being diagnosed annually. Wiggins suggests this can be attributed to our ageing population, that not enough people are screening and because a western lifestyle is a strong contributing factor to the disease.

Bowel cancer is also known as colorectal cancer, which means cancer of the colon or rectum. The cancer starts off as a polyp, an initially benign, mushroom-shaped growth on the lining of the bowel wall. Some polyps develop into cancer and some don’t.

“Cancer can be prevented by having the polyps removed,” says Wiggins.

Basic bowel health

The definition of normal when it comes to your bowel health is different for everyone and it’s up to you to be aware of this. “Your bowels don’t understand what’s normal – you’re the one that has to keep an eye on it,” advises Dr McCoy

Be conscious of changes in your bowel movements’ colour and consistency, as well as the frequency of bathroom visits. “Some people don’t even look at their bowel motions – and they should,” says Dr McCoy.  

However, just because things change down there every now and then, it doesn’t mean you have cancer. By the same token, just because there are no obvious changes, you may not necessarily be in the clear.

Warning signs can include ongoing changes in bowel habits, bleeding or blood in the toilet bowel, feeling like you haven’t emptied your bowel completely, abdominal pain, unexplained weight loss and fatigue, and low iron count or anaemia.

If you do experience any symptoms, it is crucial that you see your doctor.

Screen to survive

Bowel cancer is the second most fatal form of cancer in Australia, behind lung cancer. If it’s detected early, there’s a 90 per cent survival rate. If it’s detected late, the chances are lowered to seven per cent. The way to catch it early is screening.

“We have proof that we can prevent deaths via screening,” says Associate Professor Eva Segelov, Chair of Clinical Oncological Society of Australia’s Gastrointestinal Cancer Group and medical oncologist.

The problem is that 60 per cent of people receiving free screening kits from the government aren’t doing it. “Bowel Cancer Australia has researched why people aren’t screening – it’s because they’re embarrassed,” reveals Wiggins. “You can do the test in private at home and you don’t have to tell anyone. But don’t sit on your symptoms, talk to your GP,” he says.

Screening can be done at home using a Faecal Occult Blood Test (FOBT). You take samples from two separate bowel motions and then send it to a lab where it’s checked for traces of blood. Results are mailed to you and your GP and further testing will be arranged if necessary. The screening tests have a 90 per cent success rate of detecting abnormalities in your system. 

Generally, early stage bowel cancer is a malignant polyp or localised cancer and is removed via surgery with the possibility of adjunct chemotherapy if cancer is detected in the accompanying lymph nodes. If colorectal cancer is locally advanced, it’s treated with chemotherapy and radiotherapy before surgery with some more chemotherapy afterwards. Treatment can last for weeks, months and even years in some cases.

“While there are standard protocols based on many years of research from clinical trials, treatment is finessed to the individual circumstances and needs of each patient. Treatment plans are discussed in multidisciplinary meetings where groups of cancer experts give their opinions,” explains Professor Segelov.

One thing is for certain though; bowel cancer is most successfully treated when it’s detected early.