by Dr Rimma Grant
Bowel cancer is the 4th most common cancer in the UK with around 40,000 patients diagnosed each year. The key to an improved survival rate is early detection. Around a quarter of new diagnoses will occur via the home screening programme but the majority will be detected following a review and presentation in primary care. Bowel cancer is more commonly detected in patients over the age of 50 but cases in younger patients are rising, so knowing when to investigate and refer is an essential skill in primary care.
Risk factors for bowel cancer
- Increasing age
- Family history of bowel cancer
- Obesity
- Increased alcohol intake
- Smoking
- A diet high in processed meat
Common bowel symptoms
Rectal bleeding-This would include any bleeding such as seeing blood on the toilet paper and mixed with the stool or in the toilet bowl.
Change in Bowel Habit
This would be anything which the patient would say is different to ‘their usual pattern’, including an increase in stool frequency, new urgency, tenesmus and also new constipation.
Less obvious symptoms but should always be prompt a clinician to think ‘Could this be Bowel Cancer?’
- Anaemia
In particular in older patients. Always consider bowel pathology when presented with a new anaemia. Remember anaemia itself is a not a diagnosis…always consider what could be causing anaemia. Patients may present with fatigue as their only symptom, in which case always consider blood test investigations which would look for a potential underlying anaemia.
- Weight loss and or a loss of Appetite
If a patient presents with unintentional weight loss, always consider an underlying cancer diagnosis. This may not always present with associated bowel symptoms.
- Abdominal pain and or bloating
There are many causes to abdominal pain and bloating. As part of the investigations and history taking, always document regarding any associated bowel changes or weight loss. Even in the absence of these still consider bowel specific testing.
What is the role of the GP?
Early detection and prevention is vital in primary care. Always offer patients a stool FIT test with any suspicious symptom, including just vague abdominal pain symptoms. This has a high sensitivity for detection of bowel cancer and is an easy non-invasive test for patients to do at home. Patients should be fully informed on the FIT test implications and stool tests which are not returned within a couple of weeks should be chased by the surgery. A negative stool test should not prevent any referral to secondary care if the clinician has high suspicions of underlying pathology.
Patients should feel comfortable presenting to the GP with any bowel new symptoms. Depending on the history consider performing a rectal examination. This should always be offered with a history of rectal bleeding. A new anal mass or lesion would need an urgent suspected cancer referral to secondary care and this can be carried out without waiting for other test results.
Ordering and organising blood tests especially with vague symptoms. I call these ‘MOT’ tests for patients. Focus on a Full Blood Count (FBC), haematinics (remember a low iron could be present but an overall normal FBC which would prompt referral), renal, liver, thyroid, coeliac screen, Ca125 in women if abdominal pain and bloating are present. Further stool tests such as a faecal calprotectin should also be tested.
Always offer a review appointment. Not every bowel symptom is cancer…but the symptoms that don’t resolve should always be reviewed and a referral made to secondary care, even in the absence of abnormal tests.
How can I reduce my risk?
A good diet, regular exercise, not smoking and reducing alcohol intake is important to lower the bowel cancer risk. If in doubt….don’t ignore your symptoms and see your GP. Early detection saves lives.
Dr Rimma Grant, an experienced GP and expert witness, provides independent opinions in cases involving delayed diagnosis or mismanagement of bowel cancer. With a strong background in primary care and medico-legal reporting, she offers clear, evidence-based assessments for both claimant and defendant cases.
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