Cancer, whatever the form, can often strike without warning. A diagnosis can send shock waves through a whole family and put lives on hold. Treatment and management become top priorities as patients figure out their next step. A positive diagnosis becomes much easier to handle when doctors detect cancer early. This is the aim with current EU guidelines on colorectal cancer, more commonly known as colon or bowel cancer.
Bowel cancer is remarkably common to contract, but also easy to overlook. Therefore, medical organisations across Europe need the best practices and guidelines.
Bowel Cancer Is A Common Cancer Across Europe
The prevalence of colorectal cancer is partly due to the fact that it can affect both men and women, and also down to the age range of patients. In the UK alone, someone faces a diagnosis of bowel cancer every 15 minutes. There were 152,000 deaths in EU member states in 2012 alone. These are startling facts for those that haven’t really considered the issue before.
We put on suntan lotion to prevent skin cancer. We have horrific images on cigarette packages to deter smokers and reduce lung cancer rates. There are special awareness months for breast and testicular cancer. Yet, there isn’t much press and awareness with bowel cancer or the screening options available to the public. That is why European screening procedures need to reach the general public.
Screening and General Guidelines For Europe
There has been an increase in colorectal or bowel cancer screening tests in the EU in recent years. This increase relates to clear plans for screening in 23 member states. Screening is then available for 72% of the target population of those 50-74. 50-74 is the target age range under current guidelines and refers to the male and female population.
However, the actual age range does vary depending on the country involved. For example, just 7 of these states begin at 50, with most starting at 55. Austria is an anomaly, with a range of 40-80. In the UK, England, Wales and Northern Ireland start at 55, but Scotland at 50. Then there is the interval between screenings. About every 2 years is the norm in population-based programmes, but it is yearly in Austria and Latvia.
In most cases, these are publicly funded screenings to ensure free provision to this broad group. Patients receive notifications via invitations to participate.
There are three stages to the guidelines depending on the age of the patient in question.
The first stage is a one-off screening process, which is commonly referred to as bowel scope screening. The bowel scope screening process is the first interaction in this process and typically occurs at either age 50 or 55. The second stage is the at-home testing kit sent out to patients. Patients usually receive the kit every 2 years. Again, the time scale can vary depending on the country. This postal service continues until around the age of 75. From there, it is up to patients whether they continue to request the kit from their healthcare provider.
Let’s take a closer look at these two screening methods, their pros and cons and the tertiary step should patients receive a positive result.
Source: Cancer Research UK
What is Bowel Scope Screening?
Official descriptions of the bowel scope process make it sound pretty intense and confusing. The NHS talks about the “flexible sigmoidoscopy” and the need to search for “adenomas and polyps in the sigmoid colon, rectum and anus”.
The more basic definition here is that technician will use a bendable endoscope – a camera device – to look at the walls of the entire bowel region. They do so to search for lumps and growths on the surface. Some of these growths will be benign polyps. Others may be more harmful cancerous growths.
The technician can then use the tool to take samples of the growths for further testing. This biopsy will determine the nature of the growth, as well as any need for further testing or treatment.
The Pros and Cons of Bowl Scope Screening under these Guidelines
The obvious benefit here is that patients get the chance to undergo a pretty thorough screening of the bowel. Medical professionals can look out for signs of cancer or any other abnormalities in a professional setting. The results could help to determine current risk factors and other issues in the colorectal area.
Questionable results may lead to biopsies and further testing. The downside is that the procedure is a one-time deal. The idea is to look for signs early and then that is it. This is a problem for those that develop issues after the event. There is also the risk that if the doctors miss something, there is no second chance. This approach may seem harsh. Yet, funding and availability are always an issue with publicly funded healthcare solutions.
Situations Where Bowel Scope Screening is Not an Option
A bowel scope screening procedure is not an option for anyone with complications in this area of the body. For example, those that have had bowel surgery in the past or those with conditions such as ulcerative colitis or Crohn’s disease. The procedure is also not recommended for those with heart problems. Candidates in this category include those that have endured heart surgery in the past 3 months, those awaiting surgery and those that cannot walk more than 100 yards without resting.
Source: Stanford Health Care
What Is The Faecal Occult Blood Test?
Faecal occult blood test kit is another name that sounds a lot worse than it is. The basic premise here is that users take small samples of their poo – from three different days – and smear them on the testing cards provided. It sounds unpleasant, but it is actually quick and simple. FOBT at-home kit is on offer to all men and women, typically between 60 to 74, with a new invitation every 2 years.
Pros And Cons of the Faecal Occult Blood Test (FOBT)
Again, there are upsides and downsides to this approach. The positive side is that this frees up healthcare provisions via a DIY approach. Patients don’t have to worry about booking appointments for embarrassing tests. The negative side is that the at-home kit relies on non-professional users collecting samples.
There are additional issues for disabled users that require assistance from carers. Also, around 98% of users get a normal result from this kit. The consistency here suggests a lot of missed diagnoses given the high rates of bowel cancer.
What happens if there is blood present in the sample?
Negative issues aside, these faecal stool samples should help to determine risk factors. So, what do users need to do next if the results are positive?
If there is blood in the sample, patients may need a referral to the hospital to undergo a colonoscopy. This is pretty similar to the bowel screening at age 50-55. Technicians use a flexible camera to look inside the bowel and determine the cause of the blood. Again, the reason could be harmless polyps. But, any growth with an uncertain origin should undergo a biopsy for a clearer result.
The pros and cons of current services for bowel cancer screening via colonoscopy.
The colonoscopy really is the best approach available right now. The cameras provide a great insight into what is actually going on, with the right tools for further testing. The downsides for the patient are waiting times between referrals and procedures, as well as the discomfort of the technique. The colonoscopy isn’t pleasant to prepare for but it could end up saving a patients life if it detects the problem.
Source: Dr. Meghan Davis
New Colonoscopy Procedure Tool May Improve Detection Rates
The best way to improve the experience for patients, as well as the detection rates, is to improve the abilities. A better endoscope device can at least offer the assurance that the procedure is worth the effort. There is a project underway right now here in Europe to make sure that those improved endoscopes are a reality.
The Piccolo project is part of the EU’s Horizon 2020 scheme and looks at the potential of improved optical tech in cancer detection. The better the camera and imaging during bowel screening, the better the chance of a diagnosis. This new camera uses a more compact shape, improved resolution and 3D imaging to search for cancerous growth.
The added benefit here is that imaging may provide a better idea of the nature of any growth in the area. Therefore, technicians may leave obvious benign polyps alone and only biopsy those that cause concern. The sophistication of the tech means that there may also be potential applications with other cancers. The prototype should be complete by the end of 2018, with trials commencing in 2020.
Potential Developments In Nanotechnology & Bowel Cancer Detection
Nanotechnology – more specifically nanobots – may also be able to help. Over in the US, the National Cancer Institute’s (NCI) Alliance for Nanotechnology in Cancer sees potential in nanobots and gold. The idea is that the bots deliver nano-particles of gold into the colorectal region. These particles bind to cancer cells, allowing them to shine brightly on the camera of the colonoscopy endoscope.
Others want to combine the colonoscopy camera with nano-shells of photosynthesisers. The idea here is that these elements react to the light of the camera and release oxygen into cancerous cells. The drawback here is that while the nano-particles are minuscule, the procedure still requires that invasive endoscope.
Screening is essential for positive diagnoses, but not perfect.
Unfortunately, issues with the blood tests mean that patients may have cancerous cells that are not detected. The answer to this problem is to educate people on the risks and signs of bowel cancer. Ideally, any educational activities will also target younger audiences so they can make necessary changes in time. There is also a need to help those that may opt out of the screening.
Ultimately, it is a patient’s choice to undergo testing or not. Some may have anxiety over medical testing. Others prefer not to tempt fate and only contact a doctor when they see symptoms. Still, it is important to address issues of communication and accessibility in vulnerable groups. These groups include those in poverty, elderly patients with degenerative illnesses and other minorities.
The Risks Of Developing Bowel Cancer
The first step to take with prevention is to know the risks involved with developing bowel cancer. Many of these risks are the result of our diets. For example, those that don’t eat enough fibre run the risk of dietary distress and cancerous growth. In fact, an intake of less than 23g per day results in approximately 12% of UK cases.
Then there is the dietary risk associated with processed meat. Many dieticians advise lowering meat consumption, especially processed pork products. Anyone with concerns about risk factors and preventative measures should talk to their GP. The same is true for any concerns with anything else in this guide.
Signs that you may have bowel cancer or some other condition in need of medical attention.
It also helps to know the signs of bowel cancer. This includes frequent changes in bowel habits, obvious examples blood on/in the stools, abdominal pain or lumps in the abdomen. It is also important to note that this bleeding is typically a concern when seen without other haemorrhoid symptoms. As we saw above, blood from piles is a red herring in some faecal test samples.
The Situation Has Improved With Bowel Cancer Screening in Europe
The current European guidelines for colorectal cancer screening and education have potential. Increases in screening and treatment on diagnosis are a positive step forward. There are also advantages to the accessible nature of the tools and kits within universal healthcare. Yet, there are still patients that may fall through the cracks because of risks of missed growth and at-home measures.
There is room for bowel cancer screening procedures to develop further in Europe. As more member states adopt the methods in the target population, they can save more lives. With time, funding and better resources the screening processes can only improve. It is unlikely that Brits will get gold-detecting nanobots on the NHS anytime soon. But, smarter cameras are a more achievable dream to aim for.