Bowel cancer

Bowel cancer | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in adults Bowel cancer Bowel cancer About bowel cancer Signs and symptoms of bowel cancer Causes of bowel cancer Diagnosing bowel cancer Treating bowel cancer Living with bowel cancer Preventing bowel cancer About bowel cancer Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon or rectal cancer. Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer. Bowel cancer is one of the most common types of cancer diagnosed in the UK. Signs and symptoms The 3 main symptoms of bowel cancer are blood in the stools (faeces), changes in bowel habit such as more frequent, looser stools and abdominal (tummy) pain . However, these symptoms are very common and most people with them do not have bowel cancer. For example, blood in the stools is more often caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is usuallythe result ofsomething you have eaten. As almost 9out of 10 people with bowel cancer are over the age of 60, these symptoms are more important as people get older. They are also more significant when they persist despite simple treatments. Most people who are eventually diagnosed with bowel cancer have one of the following combinations ofsymptoms: a persistent change in bowel habit that causes them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools a persistent change in bowel habit without blood in their stools, but with abdominal pain blood in the stools without other haemorrhoid symptoms, such as soreness, discomfort, pain, itching or a lump hanging down outside the back passage abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss The symptoms of bowel cancer can be subtle and dont necessarily make you feel ill. When to seek medical advice Read about the symptoms ofbowel cancer , and when you should see your GP to discuss whether any tests are necessary. Your doctor will probably carry out a simple examination of your tummy and bottom to make sure you have no lumps. They may alsoarrange for a simple blood test to check foriron deficiency anaemia. This can indicate whether there is any bleeding from your bowel that you havent been aware of. In some cases, your doctor may decide it is best for you to have a simple test in hospital to make sure there is no serious cause for your symptoms. Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age. Read more about diagnosing bowel cancer Whos at risk? Its not known exactly what causes bowel cancer, but there are a number of things that can increase your risk. These include: age  almost9 in 10 cases of bowel cancer occur in people aged 60 or over diet  a diet high in red or processed meats and low in fibre can increase your risk weight  bowel cancer is more common in people who are overweight or obese exercise  being inactive increases the risk of getting bowel cancer alcohol and smoking  a high alcohol intake and smoking may increase your chances of getting bowel cancer family history  having a close relative (mother or father, brother or sister) who developed bowel cancerunder the age of50 puts you at a greater lifetime risk of developing the condition Some people have an increased risk of bowel cancer because they have another condition that affects their bowel, such as severe ulcerative colitis or Crohns disease , over a long period of time. Read more about the causes of bowel cancer and preventing bowel cancer Bowel cancer screening Bowel screening is offered to men and women aged 50 to 74 across Scotland to help find bowel cancer early when it can often be cured. Bowel screening involves taking a simple test at home every 2 years. The test looks for hidden blood in your poo, as this could mean a higher chance of bowel cancer. Read more about screening for bowel cancer Treatment Bowel cancer can be treated using a combination of different treatments, depending on where the cancer is in your bowel and how far it has spread. The main treatments are: surgery the cancerous section of bowel is removed; it is the most effective way of curing bowel cancer, and is all that many people need chemotherapy  where medication is used to kill cancer cells radiotherapy  where radiation is used to kill cancer cells biological treatments  a newer type of medication that increases the effectiveness of chemotherapy and prevents the cancer spreading As with most types of cancer, the chances of a complete cure depends on how farithas advanced by the time it is diagnosed. Read more about how bowel cancer is treated and living with bowel cancer Signs and symptoms of bowel cancer The 3 main symptoms of bowel cancer are blood in the stools (faeces), a change in bowel habit, such as more frequent, looser stools, and abdominal (tummy) pain . However, these symptoms are very common. Blood in the stools is usually caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is often the result ofsomething you have eaten. In the UK, an estimated 7 million people have blood in the stools each year. Even more people have temporary changes in their bowel habits and abdominal pain. Most people with these symptoms do not have bowel cancer. As the vast majority of people with bowel cancer are over the age of 60, these symptoms are more important as people get older.These symptomsare also more significant when they persist in spite of simple treatments. Most patients with bowel cancer present with one of the following symptom combinations: a persistent change in bowel habit, causing them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools a persistent change in bowel habit without blood in their stools, but with abdominal pain blood in the stools without other haemorrhoid symptoms, such as soreness, discomfort, pain, itching, or a lump hanging down outside the back passage abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss The symptoms of bowel cancer can be subtle and dont necessarily make you feel ill. When to seek medical advice Read about the symptoms ofbowel cancer , and when you should see your GP to discuss whether any tests are necessary. Your doctor will probably perform a simple examination of your tummy and bottom to make sure you have no lumps, as well asa simple blood test to check for iron deficiency anaemia . This can indicate whether there is any bleeding from your bowel you havent been aware of. In some cases, your doctor may decide it is best to have a simple test in hospital to make sure there is no serious cause for your symptoms. Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age. Read more about diagnosing bowel cancer Bowel obstruction In some cases, bowel cancer can stop digestive waste passing through the bowel. This is known as a bowel obstruction. Symptoms of a bowel obstruction can include: severe abdominal pain, which may initially come and go not being able to pass stools when you go to the toilet noticeable swelling or bloating of the tummy vomiting A bowel obstruction is a medical emergency. If you suspect your bowel is obstructed, you should see your GP quickly. If this isnt possible, go to the accident and emergency (A&E) department of your nearest hospital. Read further information: Beating Bowel Cancer: symptoms Bowel Cancer UK: symptoms of bowel cancer Cancer Research UK: bowel cancer symptoms Causes of bowel cancer Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour. Most cases of bowel cancer first develop inside clumps of cells on the inner lining of the bowel. These clumps are known as polyps . However, if you develop polyps, it does not necessarily mean you will get bowel cancer. Exactly what causes cancer to develop inside the bowel is still unknown. However, research has shown several factors may make you more likely to develop it. Age Your chances of developing bowel cancer increase as you get older. Almost9 out of 10 cases of bowel cancer in the UK are diagnosed in people over the age of 60. Family history Having a family history of bowel cancer can increase your risk of developing the condition yourself, particularly if a close relative (mother, father, brother or sister) was diagnosed with bowel cancer below the age of 50. If you are particularly concerned that your familys medical history may mean you are at an increased risk of developing bowel cancer, it may help to speak to your GP. If necessary, your GP can refer you to a genetics specialist, who can offer more advice about your level of risk and recommend any necessary tests to periodically check for the condition. Diet A large body of evidence suggests a diet high in red and processed meat can increase your risk of developing bowel cancer. For this reason, the Department of Health advises people who eat more than 90g (cooked weight) a day of red and processed meat cut down to 70g a day. Read more about red meat and bowel cancer risk There is also evidence thatsuggests a diet high in fibre could help reduce your bowel cancer risk. Read more about eating good food and a healthy diet Smoking People who smoke cigarettes are more likely to develop bowel cancer, other types of cancer, and other serious conditions, such as heart disease . Read more about stopping smoking Alcohol Drinking alcohol has been shown to be associated with an increased risk of bowel cancer, particularly if you regularly drink large amounts. Read about alcohol for information and tips on cutting down Obesity Being overweight or obese is linked to an increased risk of bowel cancer, particularly in men. If you are overweight or obese, losing weight may help lower your chances of developing the condition. Inactivity People who are physically inactive have a higher risk of developing bowel cancer. You can help reduce your risk of bowel and other cancers by being physically active every day. Read more about health and fitness Digestive disorders Some conditions affecting the bowel may put you at a higher risk of developing bowel cancer. For example, bowel cancer is more common in people who have had severe Crohns disease or ulcerative colitis for many years. If you have one of these conditions, you will usually have regular check-ups to look for signs of bowel cancer from about 10 years after your symptoms first develop. Check-ups will involve examining your bowel with a colonoscopea long, narrow flexible tubethat containsa small camerathat is inserted into your rectum. The frequency of the colonoscopy examinations will increase the longer you live with the condition, and will also depend on factors such as how severe your ulcerative colitis is and if you have a family history of bowel cancer. Genetic conditions There are two rare inherited conditions that can lead to bowel cancer. They are: familial adenomatous polyposis (FAP)  a condition that triggers the growth of non-cancerous polyps inside the bowel hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome  an inherited gene fault (mutation) that increases your bowel cancer risk Although the polyps caused by FAP are non-cancerous, there is a high risk that, over time, at least one will turn cancerous. Most people with FAP will have bowel cancer by the time they are 50. As people with FAP have such a high risk of getting bowel cancer, they are often advised by their doctor to have their large bowel removed before they reach the age of 25. Families affected can find support and advice from FAP registries such as The Polyposis Registry provided by St Marks Hospital, London. Removing the bowel as a precautionary measure is also usually recommended in people with HNPCC because the risk of developing bowel cancer is so high. Read further information: Bowel Cancer UK: Risk factors Bowel Cancer UK: Diet Diagnosing bowel cancer When you first see your GP, they will ask about your symptoms and whether you have a family history of bowel cancer. They will then usually carry out a simple examination of your abdomen (tummy) and your bottom, known as a digital rectal examination (DRE). This is a useful way of checking whether there are any lumps in your tummy or back passage. The tests can be uncomfortable, and most people find an examination of the back passage a little embarrassing, but they take less than a minute. If your symptoms suggest you may have bowel cancer or the diagnosis is uncertain, you will be referred to your local hospital initially for a simple examination called a flexible sigmoidoscopy. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of bowel cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected bowel cancer, read the NICE 2015 guidelines on suspected cancer: recognition and referral . Flexible sigmoidoscopy A flexible sigmoidoscopy is an examination of your rectum and some of your large bowel using a device called a sigmoidoscope. A sigmoidoscope is a long, thin, flexible tube attached to a very small camera and light. It is inserted into your rectum and up into your bowel. The camera relays images to a monitor, and can also be used to take biopsies , where a small tissue sample is removed for further analysis. It is better for your lower bowel to be as empty as possible when sigmoidoscopy is performed, so you may be asked to carry out an enema a simple procedure to flush your bowels at home beforehand. This should be used at least two hours before you leave home for your appointment. A sigmoidoscopy can feel uncomfortable, but it only takes a few minutes and most people go home straight after the examination. More detailed tests Most people with bowel cancer can be diagnosed by flexible sigmoidoscopy. However, some cancers can only be diagnosed by a more extensive examination of the colon. The two tests used for this are colonoscopy and computerised tomography (CT) colonography. Colonoscopy A colonoscopy is an examination of your entire large bowel using a device called a colonoscope, which is like a sigmoidoscope but a bit longer. Your bowel needs to be empty when a colonoscopy is performed, so you will be advised to eat a special diet for a few days beforehand and take a laxative (medication to help empty your bowel) on the morning of the examination. You will be given a sedative to help you relax during the test, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. This is not usually painful, but can feel uncomfortable. The camera relays images to a monitor, which allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer. As with a sigmoidoscopy, a biopsy may also be performed during the test. A colonoscopy usually takes aboutan hour to complete, and most people can go home once they have recovered from the effects of the sedative. After the procedure, you will probably feel drowsy for a while, so you will need to arrange for someone to accompany you home. It is best for elderly people to have someone with them for 24 hours after the test. You will be advised not to drive for 24 hours. In a small number of people, it may not be possible to pass the colonoscope completely around the bowel, and it is then necessary to have CT colonography. Find out more about whata colonoscopy involves CT colonography CT colonography, also known as a virtual colonoscopy, involves using a computerised tomography (CT) scanner to produce three-dimensional images of the large bowel and rectum. During the procedure, gas is used to inflate the bowel using a thin, flexible tube placed in your rectum. CT scans are then taken from a number of different angles. As with a colonoscopy, you may need to have a special diet for a few days and take a laxative before the test to ensure your bowels are empty when the test is carried out. This test can help identify potentially cancerous areas in people who are not suitable for a colonoscopybecause ofother medical reasons. A CT colonography is a less invasive test than a colonoscopy, but you may still need to have colonoscopy or flexible sigmoidoscopy at a later stage so any abnormal areas can be removed or biopsied. Read further information: Bowel Cancer UK: Diagnosis Cancer Research UK:Getting diagnosed Macmillan Cancer Support:Symptoms of bowel cancer Further tests If a diagnosis of bowel cancer is confirmed, further testing is usually carried out to check if the cancer has spread from the bowel to other parts of the body.These tests also help your doctors decide on the most effective treatment for you. These tests can include a: CT scan of your abdomen and chest this will check if the rest of your bowel is healthy and whether the cancer has spread to the liver or lungs magnetic resonance imaging (MRI) scan  this can provide a detailed image of the surrounding organs in people with cancer in the rectum Staging and grading Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer. Staging refers to how far your cancer has advanced. Grading relates to how aggressive your cancer isand howlikely it isto spread. This is important, as it helps your treatment team choose the best way of curing or controlling the cancer. A number of different staging systems are used by doctors. stage 1  the cancer is still contained within the lining of the bowel or rectum stage 2  the cancer has spread beyond the layer of muscle surrounding the bowel and may have penetrated the surface covering the bowel or nearby organs stage 3  the cancer has spread into nearby lymph nodes stage 4  the cancer has spread beyond the bowel into another part of the body, such as the liver There are 3 grades of bowel cancer: grade 1  a cancer that grows slowly and has a low chance of spreading beyond the bowel grade 2  a cancer that grows moderately and has a medium chance of spreading beyond the bowel grade 3  a cancer that grows rapidly and has a high chance of spreading beyond the bowel If you are not sure what stage or grade of cancer you have, ask your doctor. Treating bowel cancer Ifcolon cancer is at a very early stage, it may be possible to remove just a small piece of the lining of the colon wall. This is known as local excision. If the cancer spreads intomuscles surrounding the colon, it will usually be necessary to remove an entire section of your colon.This is known as a colectomy. There are 2 ways a colectomy can be performed: an open colectomy  where the surgeon makes a large cut (incision) in your abdomen and removes a section of your colon a laparoscopic (keyhole) colectomy  where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of colon During surgery, nearby lymph nodes are also removed. It is usual to join the ends of the bowel together after bowel cancer surgery, but very occasionally this is not possible and a stoma is needed. Both open and laparoscopic colectomies are thought to be equally effective at removing cancer and have similar risks of complications. However, laparoscopic colectomies have the advantage of a faster recovery time and less postoperative pain. It is becoming the routine way of doing most of these operations. Laparoscopic colectomies should be available in all hospitals that carry out bowel cancer surgery, although not all surgeons perform this type of surgery. Discuss your options with your surgeon to see if this method can be used. Surgery for rectal cancer There are a number of different types of operation that can be carried out to treat rectal cancer, depending on how far the cancer has spread. Some of the main techniques used are described below: Local resection If you have a very small, early-stage rectal cancer, your surgeon may be able to remove it in an operation called a local resection (transanal resection). The surgeon puts an endoscope in through your back passage and removes the cancer from the wall of the rectum. Total mesenteric excision In many cases, however, a local resection is not possible. Instead, a larger area of the rectum will need to be removed. This area willinclude a border of rectal tissue free of cancer cells, as well as fatty tissuefrom around the bowel(the mesentery). This type of operation is known as total mesenteric excision (TME). Removing the mesentery can help ensure all the cancerous cells are removed, which can lower the risk of the cancer recurring at a later stage. Depending on where in your rectum the cancer is located, one of two main TME operations may be carried out. Low anterior resection Low anterior resection is a procedure used to treat cases where the cancer is in the upper section of your rectum. The surgeon will make an incision in your abdomen and remove the upper section of your rectum, as well as some surrounding tissue to make sure any lymph glands containing cancer cells are also removed. They will then attach your colon to the lowest part of your rectum or upper part of the anal canal. Sometimes they turn the end of the colon into an internal pouch to replace the rectum. You will probably require a temporary stomato give the joined section of bowel time to heal. Abdominoperineal resection Abdominoperineal resection is used to treat cases where the cancer is in the lowest section of your rectum. In this case, it will be necessary to remove the whole of your rectum and surrounding muscles to reduce the risk of the cancer regrowing in the same area. This involves removing and closing the anus and removing its sphincter muscles, so there is no option except to have a permanent stoma after the operation. Bowel cancer surgeons always do their best to avoid giving people permanent stomas wherever possible. Stoma surgery Where a section of the bowel is removed and the remaining bowel joined, the surgeon may sometimes decide to divert your stool away from the join to allow it to heal. The stool is temporarily diverted by bringing a loop of bowel out through the abdominal wall and attaching it to the skin  this is called a stoma. A bag is worn over the stoma to collect the stool. When the stoma is made from the small bowel (ileum) it is called an ileostomy , and when it is made from thelarge bowel (colon) it is called a colostomy . A specialist nurse, known as a stoma care nurse, can advise you on the best site for a stomaprior to surgery. The nurse will take into account factors such as your body shape and lifestyle, although this may not be possible where surgery is performed in an emergency. Inthe first few daysafter surgery, the stoma care nurse will advise on the care necessary to look after the stoma and the type of bag suitable. Once the join in the bowel has safely healed, which can take several weeks, the stoma can be closedduring further surgery. In some people, for various reasons, rejoining the bowel may not be possible or may lead to problems controlling bowel function, and the stoma may become permanent. Before having surgery, the care team will advise you about whether it may be necessary to form an ileostomy or colostomy, and the likelihood of this being temporary or permanent. There are patient support groups available that provide support for patients who have just had or are about to have a stoma. You canget moredetails fromyour stoma care nurse, or visit the groupsonline for further information. Ileostomy and Internal Pouch Support Group provides a unique visiting service for anyone wishing to speak with someone who has been through similar surgery Learn more about coping with a stoma after bowel cancer Side effects of surgery Bowel cancer operations carry many of the same risks as other major operations, including bleeding, infection, developing blood clots, or heart or breathing problems. The operations all carry a number of risks specific to the procedure. One risk is that the joined-up section of bowel may not heal properly and leak inside your abdomen. This is usually only a risk in the first few days after the operation. Another risk is for people having rectal cancer surgery. The nerves that control urinationand sexual function are very close to the rectum, and sometimessurgery to remove rectal cancer can damage these nerves. After rectal cancer surgery, most people need to go to the toilet to open their bowels more often than before, althoughthis usually settles down within a few months of the operation. Radiotherapy There are 2 main ways radiotherapy can be used to treat bowel cancer. It can be given before surgery to shrink rectal cancers and increase the chances of complete removal, or be used to control symptoms and slow the spread of cancer in advanced cases (palliative radiotherapy). Radiotherapy given before surgery for rectal cancer can be performed in 2 ways: external radiotherapy  where a machine is used to beam high-energy waves at your rectum to kill cancerous cells internal radiotherapy (brachytherapy)  where a radioactive tube is inserted into your anus and placed next to the cancer to shrink it External radiotherapy is usually given daily, 5 days a week, with a break at the weekend. Depending on the size of your tumour, you may need 1 to 5 weeks of treatment. Each session of radiotherapy is short and will only last for 10 to 15 minutes. Internal radiotherapy can usually be performed in one session before surgery is carried out a few weeks later. Palliative radiotherapy is usually given in short daily sessions, with a course ranging from 2 to 3 days, up to 10 days. Short-term side effects of radiotherapy can include: feeling sick fatigue diarrhoea burning and irritation of the skin around the rectum and pelvisthis looks and feels like sunburn a frequent need to urinate a burning sensation when passing urine These side effects should pass once the course of radiotherapy has finished. Tell your care team if the side effects of treatment become particularly troublesome. Additional treatments are often available to help you cope with the side effectsbetter. Long-term side effects of radiotherapy can include: a more frequent need to pass urine or stools blood in your urine and stools infertility erectile dysfunction If you want to have children, it may be possible to store a sample of your sperm or eggs before treatment begins so they can be used in fertility treatments in the future. Chemotherapy There are 3 ways chemotherapy can be used to treat bowel cancer: before surgeryused in combination with radiotherapyto shrink the tumour after surgeryto reduce the risk of the cancer recurring palliative chemotherapy to slow the spread of advanced bowel cancer and help control symptoms Chemotherapy for bowel cancer usually involves taking a combination of medications that kill cancer cells. They can be given as a tablet (oral chemotherapy), through a drip in your arm (intravenous chemotherapy), or as a combination of both. Treatment is given in courses (cycles) that are 2 to 3 weeks long each, depending on the stage or grade of your cancer. A single session of intravenous chemotherapy can last from several hours to several days. Most people having oral chemotherapy take tablets over the course of two weeks before having a break from treatment for another week. A course of chemotherapy can last up to 6 months, depending on how well you respond to the treatment. In some cases, it can be given in smaller doses over longer periods of time (maintenance chemotherapy). Side effects of chemotherapy can include: fatigue feeling sick vomiting diarrhoea mouth ulcers hair loss with certain treatment regimens, but this is generally uncommon in the treatment of bowel cancer a sensation of numbness, tingling or burning in your hands, feet and neck These side effects should gradually pass once your treatment has finished. It usually takes a few months for your hair to grow back if you experience hair loss. Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Inform your care team or GP as soon as possible if you experience possible signs of an infection, including high temperature (fever) or a sudden feeling of being generally unwell. Medications used in chemotherapy can cause temporary damage to mens sperm and womens eggs. This means that for women who become pregnant or for men who father a child, there is a risk to the unborn babys health. Itis thereforerecommended you use a reliable method of contraception while having chemotherapy treatment and for a period after your treatment has finished. Find out more about chemotherapy Biological treatments Biological treatments, including cetuximab, bevacizumab and panitumumab, are a newer type of medication also known as monoclonal antibodies. Monoclonal antibodies are antibodies that have been genetically engineered in a laboratory. They target special proteins found on the surface of cancer cells, known as epidermal growth factor receptors (EGFR). As EGFRs help the cancer grow, targeting these proteins can help shrink tumours, and improve the effect and outcome of chemotherapy. Biological treatments are therefore usually used in combination with chemotherapy when the cancer has spread beyond the bowel (metastatic bowel cancer). These treatments are not available to everyone with bowel cancer. The National Institute for Health and Care Excellence (NICE) has specific criteriathat need to be met before these can be prescribed. Cetuximab is only available on the NHS when: surgery to remove the cancer in the colon or rectum has been carried out or is possible bowel cancer has spread to the liver and cannot be removed surgically a person is fit enough to undergo surgery to remove the cancer from the liver if this becomes possible after treatment with cetuximab Cetuximab, bevacizumab and panitumumab are available on the NHS through a government scheme called theCancer Drugs Fund. All these medications are also available privately, but are very expensive. Further information isavailable from: Macmillan Cancer Support:Targeted therapies and immunotherapies for bowel cancer Bowel Cancer UK: Surgery Cancer Research UK: Treatment Bowel Cancer UK:Radiotherapy Macmillan Cancer Support:Radiotherapy Living with bowel cancer Talk to others Your GP or nurse may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP surgery will have information on these. Some people find it helpful to talk to others with bowel cancer at a local support group or through an internet chat room. Beating Bowel Cancer offers support services to people with bowel cancer. They run anurse advisory line on 08450 719 301 or 020 8973 0011 available 9am to 5.30pm Monday to Thursday, and 9am to 4pm on Fridays. You can also email a nurse at nurse@beatingbowelcancer.org . The organisation also runs a national patient-to-patient network called Bowel Cancer Voicesfor people affected by bowel cancer and their relatives. Find more support from Bowel Cancer UK and cancer support groups Your emotions Having cancer cancause a range of emotions. These may include shock, anxiety, relief, sadness and depression. Different peopledeal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you. However, you and your loved ones may find it helpful toknow aboutthe feelings that people diagnosed with cancer have reported. Read aboutthe emotional effects of cancer Recovering from surgery Surgeons and anaesthetists have found using an enhanced recovery programme after bowel cancer surgery helps patients recover more quickly. Most hospitals now use this programme.It involves giving you more informationabout what to expectbefore the operation, avoiding giving you strong laxatives to clean the bowel