What is bowel cancer?
Bowel cancer, also known as colorectal cancer, can affect any part of the colon or rectum; it may also be referred to as colon cancer or rectal cancer, depending on where the cancer is located. The colon and rectum are parts of the large intestine. The colon is the longest part of the large intestine (the first 1.8 metres). It receives almost completely digested food from the cecum (a pouch within the abdominal cavity that is considered to be the beginning of the large intestine), absorbs water and nutrients, and passes waste (stool/feces/poo) to the rectum. The colon is divided into four parts.
The ascending colon is the start of the colon. It is on the right side of the abdomen. It continues upward to a bend in the colon called the hepatic flexure.
The transverse colon follows the ascending colon and hepatic flexure. It lies across the upper part of the abdomen. It ends with a bend in the colon called the splenic flexure.
The descending colon follows the transverse colon and splenic flexure. It is on the left side of the abdomen.
the sigmoid colon is the last part of the colon and connects to the rectum.
The proximal colon is the ascending colon and the transverse colon together. The distal colon is the descending colon and the sigmoid colon together.
What Is bowel polyps?
Most bowel cancers start as benign, non-threatening growths – called polyps – on the wall or lining of the bowel. Polyps typically grow in two shapes: flat or with a stalk. They can vary in size, ranging from a couple of millimeters to several centimeters. Polyps are fairly common. Around 15-40% of adults have polyps. They are more common in men and older adults. Polyps are usually harmless; however, adenomatous polyps can become cancerous (malignant) and if left undetected, can develop over time into a cancerous tumor.
The most common type of bowel cancer is called an adenocarcinoma, named after the gland cells in the lining of the bowel where the cancer first develops. Other rarer types include squamous cell cancers (which start in the skin-like cells of the bowel lining), carcinoid tumors, sarcomas, and lymphomas. In advanced cases, the cancerous tumor can spread (metastasize) beyond the bowel to other organs.
Types of bowel polyps
Some polyps grow flat and project outward from a broad base. Others can be depressed or project inward into the lining of the bowel. Doctors refer to these as sessile polyps. Pedunculated polyps, on the other hand, may appear raised, projecting out into the hollow center of the bowel. They may grow in the shape of a small cauliflower or mushroom suspended from a stalk or base. Adenomas typically have three growth patterns: tubular, villous, and tubulovillous.
Tubular adenomas are the most common type of bowel polyps, and usually account for 80% of all adenomatous polyps. Tubular adenomas are typically small pedunculated polyps, less than 1.2 centimetres in size. They usually have a tube-like or rounded shape. Tubular adenomas generally take years to form. Typically, the larger the polyp, the greater the risk it may become cancerous.
Villous Adenomas are generally larger pedunculated polyps and grow in a cauliflower-like shape. The term 'villous features' refers to the finger-like or leaf-like projections. Villous adenomas are more likely to become cancerous. They account for 5-15% of all adenomatous polyps.
Tubulovillous adenomas contain a mixture of tubular and villous growth. They usually have 25-75% villous features, and they account for roughly 5-15% of all adenomatous polyps.
Serrated adenomas contain tissues with a sawtooth look. There are two types: sessile serrated adenomas and traditional serrated adenomas. Most serrated adenomas are sessile and resemble small raised bumps. Sessile serrated polyps tend to carry a low risk of becoming cancerous as long as they do not contain major cellular changes. Traditional, or non-sessile, serrated adenomas are rarer and typically pedunculated. They carry a high risk of becoming cancerous.
Hyperplastic polyps are typically benign, and they are not usually a cause for concern. They will rarely become cancerous, as they have a low malignancy potential.
Inflammatory polyps occur most often in people with inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis. Some people may also refer to these as pseudopolyps, as they are not true polyps but a reaction to inflammation in the colon. Inflammatory polyps are usually benign and generally do not carry the risk of developing into bowel cancer.
Who should screen ?
Everyone over the age of 45 even if you have no symptoms, a faecal occult blood test should be done every 1 year.
Moderate family history of colon cancer:
- 1 or more immediate family diagnosed with bowel cancer under the age of 55 years or 2 or more immediate family members at any age should screen every 1 year from the age of 40.
- Should schedule an appointment with a gastroenterologist or surgeon to discuss routine preventative colonoscopy screening.
Strong family history of colon cancer:
- 3 or more immediate family or extended relatives diagnosed with bowel cancer under the age of 55 years or 3 or more immediate family at any age should screen every 1 year from the age of 35.
- Should schedule an appointment with a gastroenterologist or surgeon to discuss routine preventative colonoscopy screening.
High risk individuals:
- are those with a personal or family (immediate relative) with a history of:
- Colorectal (Colon) cancer or advanced adenoma before the age of 60
- Polypoid syndromes such as adenomatous polyposis which is an inherited condition that affects the gastrointestinal tract.
- Hereditary nonpolyposis colorectal cancer (Lynch Syndrome)
- Peutz-Jeghers syndrome which is a rare disorder in which growths called polyps form in the intestines.
- Should schedule an appointment with a gastroenterologist or surgeon to discuss routine preventative colonoscopy screening
If you are unsure of your risk profile, speak to your general practitioner regarding your screening frequency.
What are the symptoms of bowel cancer?
During the early stages of bowel cancer, people may have no symptoms, which is why screening is so important. As a cancerous tumor grows, it can narrow and block the bowel resulting in changes to the size, shape, and/or color of poo, with or without rectal bleeding. These symptoms are often attributed to haemorrhoids or simply ignored. Cancers occurring in the left side of the colon generally cause constipation alternating with diarrhea, abdominal pain, and obstructive symptoms, such as nausea and vomiting. Right-sided colon lesions produce vague, abdominal aching, unlike the colicky pain seen with obstructive left-sided lesions. Anaemia (low red blood cell count) resulting from chronic blood loss, weakness, weight loss, and/or an abdominal mass may also occur when bowel cancer affects the right side of the colon. Patients with cancer of the rectum may present with a change in bowel movements; rectal fullness, urgency, or bleeding; and tenesmus (cramping rectal pain).
Risk factors
Bowel cancer risk factors can be categorized into modifiable and non-modifiable factors. Modifiable factors include lifestyle choices such as lack of regular exercise, low fruit and vegetable intake, a diet low in fiber and high in fat, obesity, alcohol abuse, tobacco use, and poor oral hygiene. These risks can be addressed through diet and lifestyle changes. Smoking, excessive consumption of red and processed meats, alcohol intake, and being overweight or obese are specifically highlighted as modifiable risk factors.
Non-modifiable factors, which cannot be changed, include age, family history, hereditary syndromes (such as Lynch Syndrome), personal or family history of polyps or colorectal cancer, inflammatory bowel disease, type 2 diabetes, and old age. Certain diseases like Type II diabetes, closely linked cancers (e.g., ovarian or digestive system cancers), and inflammatory bowel diseases (IBD) such as Crohn’s and Ulcerative Colitis are mentioned as contributing to increased risk.
A person’s risk category also depends on how many close relatives have bowel cancer and their age at diagnosis. Someone with several close relatives diagnosed with bowel cancer before age 50 has a much higher risk than someone with no close relatives with bowel cancer. In some family members, bowel cancer develops due to an inherited gene mutation. Some of these cause specific conditions, such as Lynch syndrome, Familial Adenomatous Polyposis (FAP), or Attenuated Familial Adenomatous Polyposis.
The risk of bowel cancer increases with age, with the majority of cases diagnosed in individuals over the age of 50.
Individuals with a family history of bowel cancer, especially in first-degree relatives (parents, siblings, or children), may have an increased risk.
If you have a history of colorectal polyps or bowel cancer, your risk of developing the disease is higher.
Chronic conditions such as Crohn’s disease or ulcerative colitis increase the risk of bowel cancer.
Certain genetic conditions, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC), can significantly increase the risk of bowel cancer.
A diet high in red and processed meats and low in fiber has been associated with an increased risk of bowel cancer.
Lack of physical activity, obesity, smoking, and excessive alcohol consumption have been linked to a higher risk of bowel cancer.
People with type 2 diabetes may have an increased risk of developing bowel cancer.
Rates of bowel cancer vary among different racial and ethnic groups, with higher rates observed in some populations.
Previous radiation treatment for other cancers, especially in the abdominal area, may increase the risk.
How can I reduce my bowel cancer risk?
Lifestyle changes and regular screening can help prevent colorectal cancer.
Lifestyle changes to help prevent colorectal cancer include:
- Eating a healthy diet rich in fruits, vegetables and more fibre, eating less red and processed meats, drinking plenty of water
- Not smoking tobacco
- Keeping an active lifestyle
- Maintaining a healthy body weight
- Limiting alcohol consumption
People who suspect they may have colorectal cancer should speak to their healthcare provider right away.
Regular screening for colorectal cancer (secondary prevention) is the best way to catch the disease early.
Treatments are more likely to cure the disease in the early stages.
Studies have shown that screening can reduce both the incidence and mortality of colorectal cancer through early detection and removal of precancerous growths.
Stool-based tests are non-invasive screening methods used to detect the presence of colorectal cancer or precancerous polyps in the stool. The common type of stool-based tests is the fecal occult blood test (FOBT).
Individuals with a family history of colorectal cancer or certain genetic conditions may benefit from genetic counselling and genetic testing to assess their risk and determine appropriate screening measures.
How is bowel cancer diagnosed?
If a person experiences symptoms suggestive of bowel cancer for two weeks or longer, they should be referred by their GP to a specialist for colonoscopy within 30 days in order to investigate the cause. Even if the person is not experiencing any symptoms suggestive of bowel cancer, if they receive a positive result from an at-home screening test, known as a faecal immunochemical test (FIT), they should see their GP or specialist to investigate the reason why blood was found in the stool sample
Step by step instructions.
What is the process for getting tested?
1. Label the container with your name, date of birth and collection date.
2. Pass urine into the toilet before passing stool into a clean, dry container or onto layers of toilet paper. The stool must not touch the toilet water or contain any urine.
3. Unscrew the top of the sample tube and remove the sampling stick. Scrape the end of the sampling stick across multiple areas of the stool surface as shown.
4. Only a very small amount of stool is needed on the sampling stick.
5. Put the sampling stick back into the tube. Make sure that the top of the tube clicks into place to ensure it is closed. Place the container in the green bag provided.
6. Place the green bag with the container and the completed request form in the clear bag.
7. Drop your sample off within 24 hours of collection at any Ampath Care Centre or participating pharmacy.
Results
Your results and a reference letter will be available on your login account at www.bowelscreen.co.za within a week of you submitting your samples.
What do your results mean?
Negative test result: A negative test result means that no blood was found in your samples and you don’t need to take any further action for now. A negative result does not mean that you don’t have bowel cancer or that you will never develop bowel cancer. This is because some bowel cancers don’t bleed, or only bleed sometimes. Bowel screening tests can detect up to 85% but not all bowel cancers. If you are having symptoms, please make an appointment with your doctor. After getting a negative result, it is recommended to repeat a test every two years or if you develop abdominal symptoms.
Positive test result: If your results are positive. This means blood has been detected in one or more of your samples. Bleeding may be caused by several conditions including polyps, haemorrhoids, or inflammation, and may not necessarily be cancer-related. However, the bleeding needs to be investigated. Bowel Screen South Africa encourages you to contact your closest Netcare, Life Healthcare or Mediclinic hospital to schedule an appointment with a specialist gastroenterologist, general surgeon or your general practitioner to discuss and investigate the cause of your bleeding. A specialist doctor may advise you to have a procedure called a colonoscopy. This procedure is the best way of finding the cause of the blood found in your bowel motion. Your specialist doctor will be able to provide you with information about colonoscopy, its benefits and risks, and answer any questions you may have.
Inconclusive test result: If your test result is inconclusive, it does not mean anything is wrong. It just means the lab was not able to analyse your sample. This could happen for a variety of reasons.
How is bowel cancer treated?
Just as everyone is different, so is their bowel cancer treatment plan, which will be tailored to the patient’s individual circumstances. Treatments can include surgery, chemotherapy, radiation or a combination of these. Screening for loss of expression of mismatch repair protein (MMR) is recommended following surgery if you are under age 50. Everyone diagnosed with bowel cancer age 70 or younger should have their tumour screened for Lynch syndrome to determine if they carry the genetic mutation. If they do, they and their family members should receive a referral to a Specialist and to discuss screening and surveillance.
The process to collect a stool sample is simple. You just need to follow the step-by-step guide provided in the kit. Once you have collected the sample, place the sample container in the box. Then, deliver the sample to the nearest Ampath Lab. After delivering the sample, come back to our website after a week to see your results.
A positive result indicates the presence of blood in the stool, requiring further investigation. You will be referred to a specialist, and if deemed appropriate, a colonoscopy will be scheduled within 30 days.
While some discomfort is normal, we provide an easy-to-use guide and kit to make the process as comfortable as possible. The convenience of collecting the sample at home is a key feature of our service.
A negative result means no blood was detected in the samples, but it doesn’t guarantee the absence of cancer. Regular screening is crucial, and any persistent symptoms should be discussed with a healthcare professional for further evaluation.
• You’ve had blood in your poop for over 1 week.
• You have a lot of pain in your bottom.
• You have pain or a lump in your stomach.
• You have heavy bleeding.
• Your poop has been softer, thinner, or longer than normal for at least a week.
• You have no idea why you’re bleeding (in other words, you’re not bleeding because of constipation, diarrhoea, or something you know about)
• You have bleeding along with fever, chills, fainting, weakness, or vomiting.
A test for faecal occult blood test for human blood in your poop
Yes, you can. The test that is done in the lab, which looks for microscopic traces of blood in your poo.
The pathology labs generally complete the testing with a few days and these tests will be available on to you on our website thereafter.
Bowelscreen South Africa will publish the results on our website, which will be available on your customer profile.
There are many reasons for why you will get a positive result, and this may not mean that you have bowel cancer.
Many of these symptoms are also caused by common, non-life-threatening illnesses such as haemorrhoids, inflammatory bowel disease, etc. Please contact your GP/Specialist for more advice.
Generally, you will be at a higher risk of contracting bowel cancer, if this is so.
You should test, if you feel that you are at risk of having cancer, or if you feel you may have blood in your poo.
It is recommended that you should test once every year, if you in the high-risk category.
Our test kit is used by all pathology labs and ensures that the sample is clinically tested in the lab, to ensure that it is reliable.
If your test result is inconclusive, it does not mean anything is wrong. It just means the lab was not able to analyse your sample. This could happen for a variety of reasons. If you are still concerned it is advisable to repeat the test, alternatively contact Bowel Screen South Africa for advice.
Please check with your specific medical aid.
Yes, you do – you can claim back the costs from your medical aid if they provide for this.
It is advisable to keep the sample cool, and not frozen. Use the cool pack supplied to keep the sample at an acceptable temperature.
As long as the sample is kept cool and not allowed to dry out, it does not matter for up to 24 hours.
The courier will notify you when the sample will be collected.
Yes you can. Make sure that it is an Ampath Lab as we are contracted to Ampath and the sample is kept cool.
The result is very accurate and reliable.
You will have to see a specialist who will advise you of the way forward.
Please follow the instructions that are supplied carefully.
No, please continue as normal.
No, wait for your menstruation to stop first before taking the test sample.
Yes, Haemorrhoids (piles), Anal Fissures (a tear in the lining of the back passage or the skin around it), polyps (small growths in the bowel), irritable bowel syndrome (IBS), Diverticular Disease or Inflammatory Bowel Diseases such as Ulcerative Colitis or Crohn’s Disease.