Bowel cancer is the third most common cancer in the UK, with approximately 34 900 new cases diagnosed per annum. It is the second most common cause of cancer death, with approximately 16 100 deaths per annum. Bowel cancer is more common on the left side of the colon than on the right with approximately 63% of cases occurring in the colon, 29% in the rectum and 8% in the recto-sigmoid junction. The lifetime risk of being diagnosed with bowel cancer is around 1 in 20 for women and 1 in 18 for men.
Staging, survival rates and cancers detected at screening
Five year survival rates according to the Dukes’ stage of classification are shown in Table 1.
Table 1 Five year survival rates by Dukes’ stage
|Dukes’ stage||Five year overall survival|
Table 2 .Cancers detected at screening by stage
|Unstaged polyp cancers 16.8%||Dukes’ stage A 25.2%|
|Dukes’ stage B 26.0%||Dukes’ stage C 25.2%|
|Dukes’ stage D 1.5%||Other unstaged cancers 5.3%|
- Diet and lifestyle
- Family history
- Genetic conditions
Nausea, weight loss, abdominal pain and anorexia may be experienced in more advanced disease.
Individual symptoms may be poor predictors of bowel cancer; however, the use of a combination of signs and symptoms is more sensitive and specific.
- Aged ≥ 40 years who report rectal bleeding with a change of bowel habit towards looser stools and/or increased stool frequency persisting for six weeks or more
- Aged ≥ 60 years who report rectal bleeding persisting for six weeks or more without a change in bowel habit and without anal symptoms
- Aged ≥ 60 years who report a change in bowel habit to looser stools and/or more frequent stools persisting for six weeks or more without rectal bleeding
- Of any age with a right lower abdominal mass consistent with involvement of the large bowel
- Of any age with a palpable rectal mass (intraluminal and not pelvic; a pelvic mass outside the bowel would warrant an urgent referral to a urologist or gynaecologist
- Men of any age with unexplained iron deficiency anaemia and a haemoglobin level of ≤ 11g/100 ml
- Women who are non-menstruating with unexplained iron deficiency anaemia and a haemoglobin level of ≤ 10 g/
These trials demonstrated a reduction in bowel cancer specific mortality in the screened groups, using biennial screening, annual screening or a combination of the two and with follow up periods ranging from 11 to 18 years.
A meta-analysis of these four trials reported a 16% reduction in bowel cancer specific mortality with screening.
- The colonoscopy procedure
- Polyp management
- Accuracy of colonoscopy
Operating from the new state-of-the-art, multi-disciplinary facility equipped with only the most advanced medical technology,
As one of only two such robots in the Western Cape, Dr Kavin operates from a hospital boasting Robotic Surgery capabilities,
As a surgeon with adept skill in minimally invasive techniques, Dr Kavin opts for laparoscopic keyhole surgery whenever possible.
Dr Bruce Kavin is a General Surgeon with particular expertise in Endocrine, Colorectal and Gastrointestinal Surgery and Surgical Oncology.