[Cat purring]

My name is Amen Sibtain, I'm a consultant clinical oncologist

and my NHS practice is at St Bartholomew's hospital in London.

So the term 'bowel cancer' normally refers to colon cancer or rectal cancer.

The bowel itself actually is the entire digestive tract,

running from the stomach down to the anus, where the poo comes out of,

and that's split into the large bowel and the small bowel.

So when we talk about colon and rectum cancer, we're talking about large bowel cancer,

and that's normally shortened to just bowel cancer.

The signs and symptoms are, a change in bowel habit that is not getting better after a few weeks

on standard treatments that your GP may give you,

bleeding from the bottom, usually mixed in with the stool

or if there's bleeding when one wipes oneself with loo paper.

It's important to qualify that bleeding from the bowel isn't an automatic sign of bowel cancer.

There are a lot of other causes, but it is a persistent change in bowel habit that's probably the most important.

Other things to watch out for are abdominal pain,

a loss of appetite and weight loss are also factors to look for.

Some people may be embarrassed about talking about something that we don't normally talk about every day,

so it's obvious to feel some embarrassment.

But be reassured that doctor will not be embarrassed

and is used to dealing with this all day every day.

The first diagnostic test is a technique that looks at the lining of the bowel

and that's usually a flexible sigmoidoscopy.

Then if there is something suspicious there, they can take a biopsy there and then.

That is a sample of any suspicious lump and that is sent off for analysis.

If nothing can be seen, but there is still a high degree of suspicion

that there may be something going on further up the bowel, further up the colon,

a full colonoscopy is done, which usually requires a separate visit.

The patients have to clear out their bowel before attending and they're given some sedation.

The process takes about 20 to 25 minutes in total and this is an excellent way of looking at the inside of the bowel,

right from the rectum, at the bottom, all the way round to the right hand side of the bowel.

So if all of the tests show the tumour is confined to the bowel itself and has not spread anywhere else,

the main treatment is surgery, and the surgery involves removal of the relevant part of the bowel

along with things called lymph nodes.

Nowadays if the tumour has only spread to the liver and there is no sign of any spread anywhere else,

and it is seen to be technically possible to remove part of the liver along with the bowel,

then that can be done and can be curative.

If there is spread elsewhere one has to think about what symptoms the patient is having.

If there are major symptoms from the tumour itself in the bowel,

then surgery still may be done to prevent or relieve those symptoms.

But if the disease has spread then the main treatment is chemotherapy.

For information, help, or if you just want a chat,

call the Macmillan Support Line on 0808 808 00 00 or visit macmillan.org.co.uk