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Bowel Cancer Awareness Month: Q & A with Dr Madhavi Kasi


According to the Cancer Council, bowel cancer is the fourth most commonly diagnosed cancer in Australia.

But it’s also one of the most treatable types of cancer when detected early.

Dr Madhavi KasiThat’s why Bowel Cancer Awareness Month in June is so important.

Bowel Cancer Awareness Month is all about educating our communities about the signs and symptoms of bowel cancer, while encouraging those who are eligible to participate in the National Bowel Cancer Screening program.

We asked St Andrew’s Gastroenterologist and Hepatologist, Dr Madhavi Kasi to answer some frequently asked and important questions about bowel cancer signs, symptoms and screening. Here’s what she said.

1. What is bowel cancer and how is it diagnosed?

The bowel is part of the digestive system of the body and is made up of two parts, the small bowel and large bowel. The large bowel includes the colon and rectum. Cancer that affects the large bowel is typically called bowel cancer. You may also hear it being called colorectal cancer, colon cancer or rectum cancer, depending on where it is found. Cancer that affects the small bowel is called small bowel cancer.

Most bowel cancers develop from polyps. These are non-cancerous growths that might develop into cancer, but not all will develop into cancer. If your doctor finds any polyps, these can be removed to lower the risk of bowel cancer.

Bowel cancer is diagnosed by colonoscopy often following a positive bowel cancer screening test or following symptoms.

2. What are the symptoms and are there any signs we should we be on the look-out for?

  • Bleeding from your bottom.
  • Blood in your bowel movements (poo).
  • Change in your bowel habits. You might be going more or less often, or have diarrhoea or constipation that might come and go.
  • Losing weight but you’re not sure why.
  • Feeling very tired all the time but you’re not sure why.
  • Pain or a lump in your tummy.

Having these symptoms doesn’t always mean you have bowel cancer, but it’s still important to find out what’s causing them.

3. What are the main risk factors or causes of bowel cancer?

We don’t know what causes most bowel cancers, but we do know that some factors increase your risk of getting the disease. Some of these are things you can’t do anything about, for example, age and genetics. But you can make changes to your lifestyle to lower the risk of getting bowel cancer. For example, by avoiding processed meats and limiting red meat in your diet, by eating plenty of fibre from wholegrains, pulses, vegetables and fruit, and by maintaining a healthy body weight.

You are more at risk of getting bowel cancer if you have one or more of the following risk factors:

  • Aged over 45
  • A strong family history of bowel cancer
  • A history of non-cancerous growths (polyps) in your bowel
  • Longstanding inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
  • Type 2 diabetes
  • An unhealthy lifestyle.

This doesn’t mean that you will definitely get bowel cancer. Equally, if you don’t have any risk factors, it doesn’t mean you can’t get bowel cancer.

4. At what age does bowel cancer screening start and what’s involved?

A screening kit will be sent to you in the mail if you’re within the age range for screening (45-75) and are registered with a GP. Your kit will be sent directly to your mailbox/doorstep, and will automatically be mailed every two years after your last screening test is completed.

The screening kit includes a stool test called FOBT. It can detect tiny amounts of blood in your poo that can be a sign of bowel cancer.

5. What course of action do you recommend for people who have a family history of bowel cancer?

The risk of developing bowel cancer may be higher if you have a family history of the disease. A close relative is a parent, sibling or child. Doctors may also call these relatives 'first-degree relatives'.

You have a 'high familial bowel cancer risk' if you have three close relatives who've had bowel cancer in your family. If your family fits into this category, you should have a colonoscopy to test for bowel cancer every five years from the age of 40 until 75.

You have a 'moderate familial bowel cancer risk' if you have a close relative who was diagnosed with bowel cancer under the age of 50 or two close relatives who have had bowel cancer at any age. This means you should have a colonoscopy when you’re 55 and also take part in the National Bowel Cancer Screening Program.

You have an 'average familial bowel cancer risk' if you have no family history of bowel cancer or a low-risk family history (for example a parent diagnosed with bowel cancer when older than 50). This means you'll be invited to take part in the National Bowel Cancer Screening Program.

6. What is your number one message for the community this Bowel Cancer Awareness Month?

Bowel cancer can affect anyone, whatever your age, gender, ethnicity or where you live. The earlier bowel cancer is spotted, the more treatable it’s likely to be. Participation in the National Bowel Cancer Screening Program is highly recommended as it will help to spot bowel cancer before symptoms start, when it’s more treatable.

Dr Madhavi Kasi is a gastroenterologist with subspecialty training in hepatology. She has special interests in all liver conditions including viral hepatitis, autoimmune and complex liver diseases, general gastroenterology conditions including coeliac disease and complex reflux disease, functional gastrointestinal disorders, and colonoscopy for bowel cancer screening.

More information about family history

  • A close relative (parent, sibling or child) diagnosed with bowel cancer before the age of 50 years
  • Two or more close relatives diagnosed with bowel cancer at any age (for example your parent, and their sibling or parent)
  • A relative with a known genetic (inherited) condition linked to bowel cancer, such as Lynch syndrome or familial polyposis

The genetic conditions include Lynch syndrome, FAP (Familial Adenomatous Polyposis) and MAP (MUTYH Associated Polyposis). People with these conditions have a much higher chance of developing bowel cancer and they are more likely to be diagnosed at a younger age. Many of these cancers can be prevented if doctors know about the genetic condition as early as possible.

Around 5-10% of all bowel cancer cases are thought to be caused by a change in a known gene. The changed gene can be passed down through a family. If you have the changed gene, you may have a higher risk of getting bowel cancer at some point in your life. We don't yet know all of the genes that are involved in these cases.