What’s new in beating bowel cancer with Mr Romi Navaratnam

April is bowel cancer awareness month and as the forth most common cancer and the second biggest cancer killer in the UK, 1 in 15 men and 1 in 18 women will be diagnosed with the disease in their lifetime.

Mr Romi Navaratnam leading Gastrointestinal Consultant at The GI Unit discusses what’s new in beating bowel cancer, from when you should seek medical advice to the importance of bowel cancer screening and the advanced surgical treatment options now available.

Bowel cancer can affect anyone of any age but it is more commonly seen in people over the age of 60. Every year almost 42,000 people are diagnosed with the disease. However, there are more than 2,500 new cases of bowel cancer diagnosed in people under the age of 50.

Bowel cancer remains a very common cancer with a poor prognosis if identified at an established stage. Identification of early disease improves long-term prognosis. This is particularly relevant in patients where there is a strong family history of colonic problems, or where they are experiencing symptoms.

When to visit your GP or GI (Bowel) Specialist

• If you notice an alteration in bowel habits. This could include either constipation, diarrhoea or a combination of both.
• Mucus discharge from the bottom or the presence of rectal bleeding.
• A persistence of the above symptoms should result in a referral to your GP or a GI (bowel) specialist.
• Individuals with a first degree relative diagnosed with bowel cancer, or large colonic polyps, below the age of 60, should also seek advice.

Bowel Cancer Screening

Bowel cancer screening has a proven history in the USA and Europe, where the incidence of colorectal cancer is falling. In the USA, screening starts at 45. There appears to be a slight increase in diagnosis in the younger population, and this may be related to increased public awareness.

The aim of effective bowel cancer screening is to identify asymptomatic patients with pre cancerous polyps or very early cancers and successfully remove them, thus improving long term outcomes.

Diagnostic options:

Stool analysis

FIT faecal immunochemical testing (FIT), is more accurate than any of its predecessors. However its sensitivity has limitations. False negatives can be obtained in the presence of rectal bleeding, anaemia (low blood count) or ironically with an advanced bowel cancer. If the test results are positive, colonoscopy is mandatory.

Colonoscopy

Colonoscopy remains the most accurate tool for diagnosing polyps or early pre cancerous lesions. The establishment of an immediate diagnosis is a strong means of reassurance. The risk of a complication is very low (1:1100) and is even less in experienced hands. Therapeutic procedures such as banding of haemorrhoids and polyp removal can be undertaken simultaneously.

Flexible sigmoidoscopy

Flexible sigmoidoscopy is a less accurate examination than colonoscopy. At best only 50% of the colon is examined, but may have a role in the younger patient under 35. A proportion of individuals require additional colonoscopy at a later date.

Virtual colonoscopy (VC)

Virtual colonoscopy involves similar pre operative laxative preparation to conventional colonoscopy and the introduction of a tube into the anus. No sedation is provided. It is particularly useful in the establishment of coincidental pathology outside of the colon, especially in frail patients.

It is less accurate than colonoscopy, for early or subtle flat lesions. Any lesion identified on VC, e.g. polyps requires colonoscopy thereafter, for their removal.

What is the most accurate diagnostic method?

The most accurate diagnostic tool remains colonoscopy, which is a very well tolerated procedure in experienced hands. Virtual colonoscopy is reserved primarily for elderly patients.

Treatment options

 If any pathology is identified, which cannot be immediately dealt with at colonoscopy, this may require advanced endoscopic techniques such as endoscopic mucosal resection (EMR) or laparoscopic (keyhole) surgery.

There have been remarkable advances in surgical techniques which have resulted in an enhanced recovery. The use of advanced endoscopic techniques and laparoscopic keyhole surgery results in a rapid return to normal activity, with minimal lifestyle disruption.

Make an appointment

At The GI Unit we have a team of eleven specialists including Mr Romi Navaratnam that are able to offer same day appointments for bowel cancer consultations and bowel cancer screening. For enquires and appointments please email [email protected] or call  020 7078 3802.

Flexible appointment times are available.