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The importance of improving awareness of colorectal cancer.

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Colorectal cancer is the UK’s second most common cause of cancer death but if caught early, it is one of the most treatable forms of cancer. Some 35,000 people are diagnosed with colorectal cancer every year in the UK and 16,000 of this number will die from the disease (Cancer Research UK, 2003).

Abstract

VOL: 100, ISSUE: 14, PAGE NO: 30

Claire Jagot, is press and public relations officer, Colon Cancer Concern

 

Colorectal cancer is the UK’s second most common cause of cancer death but if caught early, it is one of the most treatable forms of cancer. Some 35,000 people are diagnosed with colorectal cancer every year in the UK and 16,000 of this number will die from the disease (Cancer Research UK, 2003).

 

 

It remains the disease that people do not want to talk about. Therefore, this year Colon Cancer Concern (CCC), the UK’s leading bowel cancer charity, is undertaking the most comprehensive awareness campaign in the history of the disease and the charity.

 

 

What is colorectal cancer?
Colorectal cancer, otherwise known as large bowel or colon cancer, can develop within any part of the colon or rectum. It is a disease that most people in this country know little or nothing about yet it will affect one in 20 of us in our lifetime (Cancer Research UK, 2003).

 

 

Although the exact cause of colorectal cancer is unknown, there are several factors that make people more at risk:

 

 

- Colorectal cancer can develop in men and women of any age but it tends to be a disease of late middle age;

 

 

- In the UK, about 75 per cent of cases occur in people over the age of 55 (Cancer Research UK, 2003);

 

 

- In the UK, 5-10 per cent of all people diagnosed with colorectal cancer have a family history of the disease. Often if there is a history of colorectal cancer within a family, the disease appears at an earlier age - under the age of 45 (Cancer Research UK, 2003);

 

 

- People who have an inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, or those who have had polyps removed in the past, may be at an increased risk;

 

 

- Consuming a diet that is high in fat and low in vegetables, combined with an inactive lifestyle, can increase the risk of developing the disease.

 

 

Diagnosing colorectal cancer
The symptoms of colorectal cancer depend upon the stage of the disease and the part of the colon or rectum affected. They may include the following:

 

 

- A recent or persistent change of bowel habit, such as feeling the need to go to the toilet more frequently or having looser stools;

 

 

- Passing blood or mucus from the rectum;

 

 

- Extreme tiredness or fatigue without an obvious cause;

 

 

- Unexplained pain or a lump in the abdomen.

 

 

The main tests used in the diagnosis of the disease are flexible sigmoidoscopy, colonoscopy, and barium enema. Ultrasound and computerised tomography (CT) scans can also be used in further investigations of the disease, usually for staging the cancer rather than in diagnosis.

 

 

As yet in the UK there is no national screening programme for colorectal cancer. However, the NHS is currently carrying out pilot studies to examine the best method of screening the public to increase detection of the disease in its earlier stages.

 

 

Treatment
The most common form of treatment for colorectal cancer is surgery. Here the surgeon will remove the portion of the colon or rectum containing the cancer, together with a healthy margin of tissue either side of the tumour and the surrounding lymph nodes to help reduce the chances of the disease spreading or recurring.

 

 

Some patients will have to undergo a course of chemotherapy following surgery. Radiotherapy is used more commonly to treat cancer of the rectum and can be given prior to and/or following surgery.

 

 

Reducing the risk of colorectal cancer
By making a few simple lifestyle changes, people can help to reduce their risk of developing colorectal cancer. These changes include:

 

 

- Being aware of their bowel pattern, so people know what is normal for them;

 

 

- Trying to avoid constipation, as this slows down the passage of waste products through the digestive system;

 

 

- Eating a healthy diet that is low in fat and high in fibre, including at least five portions of fresh fruit and vegetables a day;

 

 

- Drinking plenty of fresh fluids, water in particular;

 

 

- Exercising regularly to keep healthy.

 

 

These key facts highlight the importance of understanding why raising awareness needs to be taken seriously. Colorectal cancer can affect anyone. It is a common disease but simple lifestyle changes can reduce the risk and it is highly treatable.

 

 

One of the ironies surrounding colorectal cancer is that the number of deaths could so easily be reduced if people acted on their symptoms earlier and helped identify the disease in its early stages. If caught early, colorectal cancer is one of the most treatable forms of cancer. However, embarrassment, ignorance, and the fear that surrounds the disease stop some people from acting upon their symptoms in time.

 

 

Recent research has indicated that 84 per cent of the UK population does not act on their symptoms by going to talk to their doctor, even when they have concerns. Furthermore, most people in this country know little or nothing about colorectal cancer and some do not even know where their colon is. Some avoid going to their GP because they are fearful of the diagnostic tests they will have to undergo. Sometimes people may be even more fearful of the tests than they are of the disease itself (Cancer Research UK, 2003).

 

 

Dave Miners, a patient with CCC who recently appeared on BBC Breakfast, sums things up perfectly: ‘I am absolutely convinced that we don’t talk about bowel cancer because of the English reticence; the British stiff upper lip. Bowels are something that we don’t want to talk about or think about but we must if we are going to tackle this dreadful disease.’

 

 

CCC’s awareness campaign
Colon Cancer Concern believes that its upcoming awareness campaign will help to overcome this reticence and make colorectal cancer a subject that people are comfortable discussing.

 

 

The campaign aims to reach an estimated audience of 17 million people. It is being launched during Bowel Cancer Awareness Month (April 2004) and has been made possible, in part, by National Lottery funding of over £200,000.

 

 

Focusing on public awareness, the campaign will target GPs’ waiting rooms, pubs, gyms, councils and large employee workplaces - in order to reach as wide an audience as possible.

 

 

Eye-catching slogans, such as ‘Don’t blush. Look before you flush’, will be sure to capture the public’s attention as the campaign is rolled out throughout the year. CCC’s 45-foot trailer, which will act as its ‘mobile surgery’ for the campaign, will be touring the country and is somewhere the public can visit to learn about the disease and talk to nurses or CCC representatives.

 

 

CCC is also relying on the help of staff in GP surgeries, councils and workplaces to help spread its messages by putting up posters, distributing leaflets, and utilising the intranet and other resources.

 

 

Flagship campaigns that are aimed at achieving the media attention and coverage the disease deserves include the following:

 

 

- The launch of Bowel Cancer Awareness Month at the House of Lords on 1 April;

 

 

- Men’s Health Week in June;

 

 

- CCC’s pub campaign in September.

 

 

CCC’s regional campaigns, such as those in Scotland in September, will also enable local media coverage and awareness throughout the UK.

 

 

Implications for nurses
While this campaign is a public awareness campaign, CCC recognises that it would not be possible without the support of health care professionals.

 

 

Partnership with nurses is essential to the campaign’s successful roll-out as they play a vital role in offering information about the disease and responding to the reaction that is likely to be generated by the public.

 

 

Nurses need to be able to respond to concerns that members of the public may have and to filter through those individuals whose concerns require more attention. Specialist nurses working on the charity’s trailer will also be on hand to talk to the public during awareness visits.

 

 

Any health care professional - whether working with CCC on the campaign or reacting to increased public awareness - will be supported by CCC’s infoline, which is staffed by colorectal, oncology and stoma nurses. As well as being a source of information, advice and support for patients, the infoline is also there to provide more in-depth information if required (Box 1).

 

 

Working with government
The government’s commitment to a national screening programme and to improving treatments and services, through the NHS Bowel Cancer Programme, is a sign that colorectal cancer is, at last, receiving the recognition that it deserves.

 

 

However, it is also an indication that more still needs to be done. Survival rates of colorectal cancer are low in the UK in relation to other European countries. There is currently only one first-line drug available for most bowel cancer patients in the UK - fluorouracil. In comparison a number of drugs to treat bowel cancer are available in other European countries.

 

 

Colon Cancer Concern will be working with and lobbying the government to ensure that colorectal cancer is kept high on the political agenda and that recent screening and treatment commitments are not forgotten.

 

 

It is important to keep up the momentum of campaigning to raise awareness and improve services at this level as this complements the charity’s efforts to raise awareness ‘on the ground’ and helps to ensure that patients are able to obtain access to the treatment and services that they deserve.

 

 

This article has been double-blind peer-reviewed.

 

 

FURTHER READING
Borwell, B. (2002)
Bowel cancer in the older person. Gastrointestinal nursing; November, 32-33.

 

 

CancerBACUP (2000)Understanding Cancer of the Colon and Rectum. London: CancerBACUP.

 

 

De Snoo, L. (2002)Colorectal Cancer. Cancer Nursing Practice; 1: 10, 32-38.

 

 

Jones, D.J. (2000)ABC of Colorectal Diseases. London: BMJ Publishing Group.

 

 

Porrett, T., Daniels, N. (1999)Essential Coloproctology for Nurses. London: Whurr Publishers Ltd.

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