Bowel Cancer

1.0 Introduction
What comes in your mind when you explore a patient with certain mutation
in intestine? Well! It can be Bowel Cancer. It is also known as Colorectal
Cancer because it is a cancer of either rectum or colon or sometimes it
spread in both portions. It often begins as a Polyp-a tissue growth in colon
or rectum.[1] [Polyps are abnormal growths of tissue that can be found in
an organ that have blood vessels]

The chance of changing into a cancer depends on the kind of polyp. The 2
main types of polyps are:
Adenomatous polyps (adenomas): These polyps sometimes change into
cancer. Because of this, adenomas are called a pre-cancerous condition.
Hyperplastic polyps and inflammatory polyps: These polyps are more
common, but in general they are not pre-cancerous.[2]
So the Purpose of this essay is to make people aware about bowel cancer.

2.0 Overview of Bowel Cancer and

Determinants:
Colorectal cancer begins when healthy cells in the lining of the colon or
rectum change and grow out of control, forming a mass called a tumor. A
tumor can be cancerous or benign. A cancerous tumor is malignant,
meaning it can grow and spread to other parts of the body. A benign tumor
means the tumor can grow but will not spread. These changes usually take
years to develop. Both genetic and environmental factors can cause the
changes. However, when a person has an uncommon inherited syndrome
changes can occur within months to years.[3] It includes the stages of
infection or tumor, nodes and Metastasis stage generally known as TNM
Stage. In addition there are Numbering stage and Duke’s stage but the
most commonly used is TNM one.

Tumor (T).
There are 4 stages:

 T1 means the tumor is only in the inner layer of the bowel

 T2 means the tumor has grown into the muscle layer of the bowel wall
 T3 means the tumor has grown into the outer lining of the bowel wall
 T4 means the tumor has grown through the outer lining of the bowel
wall.

Node (N)
There are 3 possible stages:

 N0 means there are no lymph nodes containing cancer cells

 N1 means that 1 to 3 lymph nodes close to the bowel contain cancer
cells
 N2 means there are cancer cells in 4 or more nearby lymph nodes

Metastasis (M)
There are 2 stages

 M0 means the cancer has not spread to other organs

 M1 means the cancer has spread to other parts of the body

MYH-associated polyposis, or hereditary nonpolyposis colon cancer

run in your family, that raises the risk for colon cancer (and other
cancers), too. People who eat a lot of fat and cholesterol and little fiber
may be more likely to develop colorectal cancer. You may be more
likely to get colorectal cancer if you drink a lot of alcohol, smoke, don't
get enough exercise, and if you are overweight. Diabetes. People with
diabetes are more likely to develop colorectal cancer than other
people. [4]

3.0 Rationale to Bowel Cancer:

A study published in February 2012 in New England Journal of Medicine
found that patients who received colonoscopies and had noncancerous or
pre-cancerous growths (polyps) removed, were half more likely to die from
colon cancer than people in the general population who were not screened
or used less effective screening methods. 5Men and women are equally
likely to die from colon cancer,6 but men are more likely to be diagnosed
with colon cancer than women of the same age. 7 Black men and black
women are at higher risk for developing colon cancer and dying from it than
are white men and white women of the same age.89Being overweight or
obese increases men’s risk of colon cancer more than it does women’s
(see Obesity and Cancer: What You Should Know). In the U.S., nearly one
in ten cases of colon cancer is estimated to be caused by excess body
fat.10 [5]

Estimated number of new cases of colorectal cancer diagnosed in 2017

16,682 = 9,127 males + 7,555 females

Estimated % of all new cancer cases diagnosed in 2017

12.4%

Estimated number of deaths from colorectal cancer in 2017

4,114 = 2,136 males + 1,978 females

Estimated % of all deaths from cancer in 2017

8.6%

Chance of surviving at least 5 years (2009–2013)

69%

People living with colorectal cancer at the end of 2012 (diagnosed in the 5 year
period 2008 to 2012)

52,630

New cases of colorectal cancer

Colorectal cancer was the third most commonly diagnosed cancer in
Australia in 2013. It is estimated that it will become the second most
commonly diagnosed cancer in 2017 (Table 1). This is because the
incidence of prostate cancer (which was the most commonly diagnosed
cancer in 2013) is expected to continue to decline.

In 2013, there were 14,962 new cases of colorectal cancer diagnosed in

Australia (8,214 males and 6,748 females). In 2017, it is estimated that
16,682 new cases of colorectal cancer will be diagnosed in Australia (9,127
males and 7,555 females).

In 2013, the age–standardised incidence rate was 58 cases per 100,000

persons (68 for males and 49 for females). In 2017, it is estimated that the
age–standardised incidence rate will remain at 58 cases per 100,000
persons (67 for males and 49 for females). The incidence rate of colorectal
cancer is expected to generally increase with age for both males and
females (Figure 1).

In 2017, it is estimated that the risk of an individual being diagnosed with

colorectal cancer by their 85th birthday will be 1 in 13 (1 in 11 males and 1
in 15 females).

The number of new cases of colorectal cancer diagnosed increased from

6,986 (3,524 males and 3,462 females) in 1982 to 14,962 in 2013. Over the
same period, the age–standardised incidence rate increased steadily from
58 cases per 100,000 persons (67 for males and 52 for females) in 1982 to
a peak of 66 cases per 100,000 (81 for males and 55 for females) in 2000
and 2001 before decreasing to 58 cases per 100,000 in 2013[6]

4.0 Primary Prevention 1:

One very important program against the bowel cancer is NBCSP( National
Bowel Cancer Screening Program). Its details are as follow:
Bowel Cancer Australia was represented on the Australian Government's
National Bowel Cancer Screening Program Advisory Group and
Communications Working Group, which focused on the roll out of the
Program and the development of a national communications framework.In
2006, the then Minister for Health, the Hon Tony Abbott MP, announced
funding for Bowel Cancer Australia to roll-out the first ever national bowel
cancer screening campaign, It's Crunch Time™, which promoted
participation by eligible Australians in Phase I and II of the National Bowel
Cancer Screening Program.

The It's Crunch Time™ campaign featured cricket legend Max Walker AM.

In the 2014 Federal Budget, the Coalition Government announced an

additional $95.9 million over four years to accelerate implementation of the
National Bowel Cancer Screening Program to all Australians aged 50 to 74
years by 2020. The previous Labour Government had committed to full
implementation by 2034. This will ensure the Program will become
consistent with the National Health and Medical Research Council clinical
practice guidelines, which recommend screening every 1 to 2 years from
age 50.It is estimated that when fully rolled out, approximately four million
eligible Australians will be invited each year.This will significantly reduce
the burden of bowel cancer on Australians and their families[7]. By this
campaign the public are so much aware about bowel cancer and its
consequences.

5.0 Primary Prevention 2:

Several scientific organizations recommend regular screening for all adults
aged 50 years or older. Recommended screening procedures and intervals
are as follows:

 Fecal Occult Blood Test (FOBT or FIT) every year.

 Stool DNA Testing (sDNA) , Interval uncertain
 Flexible sigmoidoscopy every 5 years.
 Double-contrast barium enema every 5 years.
 Total colon examination by colonoscopy every 10 years.
 Computed tomographic colonography (virtual colonoscopy)
every 5 years.
Persons at higher risk should begin screening at a younger age and may need
to be tested more frequently.

According to the Centers for Disease Control and Prevention (CDC), screening for
colorectal cancer lags far behind screening for other cancers. As
of 2011, approximately 53.2% of men and of women aged 50 years or older
had undergone screening in the past 10 years. Use of screening for
colorectal cancer was particularly low among those respondents who lacked
health insurance, those with no usual source of health care, and those who
reported no doctor's visits within the preceding year. If caught in its early
stages, people treated for colon cancer have a 5-year relative survival rate of
90%. As many as 60 percent of deaths from colorectal cancer could be
prevented if everyone age 50 and older were screened regularly. The map
below summarizes recent screening rates.

If you live in one of the following 25 states or 4 tribal territories, you may
be eligible for free or low-cost colorectal cancer screening through the
CDC-funded Colorectal Cancer Control program..[8]

6.0 Conclusion:
From the above details and statistics we come to know about bowel cancer
which has become one of the 5 most common cancer. It can be treated in
present age due to advancement in eras of medicine and research. It can
be inherited but still cure able. One of the important test for its diagnose is
screening test which should be done at or after the age of fifty. People now
a days are so much aware about this disease by the campaigns like
NBCSP and many others. In Western countries laws and policies are
formulated for its treatment. Its true that for every disease there is a cure so
we just have to believe in ourselves and serve mankind.
Refrences:
1:http://www.nhs.uk/Conditions/Cancer-of-the-colon-rectum-or-
bowel/Pages/Introduction.aspx

2: http://www.webmd.com/colorectal-cancer/guide/colorectal-polyps-
cancer#1

3:http://about-cancer.cancerresearchuk.org/about-cancer/bowel-
cancer/stages-grades/tnm-staging

4:http://www.webmd.com/colorectal-cancer/guide/risk-factors-colorectal-
cancer

5:http://www.stopcancerfund.org/p-colon-cancer/colon-cancer-who-is-at-
risk-and-how-can-it-be-prevented/

6:https://bowel-cancer.canceraustralia.gov.au/statistics

7:https://www.bowelcanceraustralia.org/national-bowel-cancer-screening-
program

8:http://www.ncsl.org/research/health/colorectal-cancer-screening-laws-by-
state.aspx