Bowel cancer proforma

What is bowel (colorectal) cancer, in simple terms?

Cancer arising in the colon or rectum (parts of the large intestine), usually starting from a precancerous polyp that mutates into an invasive tumour (adenocarcinoma - cancer of the gland cells).

What does the colon normally do?

Absorbs water and nutrients, stores and excretes faeces, and secretes GI hormones and mucus.

What does the rectum normally do?

Temporarily stores and excretes stool.

How common is bowel cancer globally?

3rd most diagnosed cancer worldwide and the 2nd leading cause of cancer-related death.

Where in the colon is cancer most commonly found?

The sigmoid colon (55% of colon cancer cases).

What are the three molecular pathways to bowel cancer?

1) Adenoma-carcinoma sequence (APC gene mutation), 2) Serrated pathway (KRAS/BRAF mutations), 3) Inherited pathways (e.g. Lynch syndrome, familial adenomatous polyposis).

Why is population screening important for bowel cancer?

Early-stage disease is often symptom-free, so screening catches polyps/early cancer before symptoms appear, reducing mortality.

Name the main screening/diagnostic tests for bowel cancer.

FOBT (faecal occult blood test), FIT (faecal immunochemical test), tumour marker testing, and colonoscopy.

FOBT vs FIT - key difference?

FOBT is cheaper and non-invasive but less accurate; FIT is more sensitive/specific but can be thrown off by non-cancerous bleeding or non-bleeding tumours.

What red-flag symptoms (over age 20) warrant referral for bowel cancer testing?

Persistent abdominal pain/gas, changed bowel habits, changed stool shape, blood/mucus in stool, unexplained anaemia, unintentional weight loss, or an abdominal mass.

What are the 4 stages of bowel cancer based on?

Depth of tumour growth into the bowel wall and whether it has spread to lymph nodes or distant organs.

Describe Stage 1 bowel cancer.

Cancer grows through the mucosa/submucosa into the muscularis externa of the bowel wall; no lymph node involvement.

Describe Stage 2 bowel cancer.

Cancer extends through the muscle layer and, in advanced sub-stages, through the outer bowel wall into nearby tissue/organs; no lymph spread.

Describe Stage 3 bowel cancer.

Cancer has spread into nearby lymph nodes; sub-stages reflect depth of invasion and number of nodes involved.

Describe Stage 4 bowel cancer.

Metastatic disease - spread to distant organs (often liver/lungs) or the peritoneum.

What is the overall 5-year survival rate for bowel cancer in Australia?

Roughly 71-72%.

How does survival rate change by stage?

About 98% at Stage 1 down to only 13-15% at Stage 4 - early detection dramatically improves prognosis.

Why is early-stage bowel cancer often missed?

It's frequently asymptomatic, so many patients aren't diagnosed until an advanced stage.

What are common early/general signs and symptoms of bowel cancer?

Hematochezia (blood/mucus in stool, often jam-like), abdominal mass, and intestinal obstruction (abdominal pain, nausea, vomiting, altered bowel habits).

What symptoms appear in late-stage bowel cancer?

Unintentional weight loss, anaemia, and cachexia (severe wasting).

How do symptoms differ by tumour location?

Right-sided colon cancer -> abdominal mass; left-sided colon cancer -> rectal bleeding and obstruction; rectal cancer -> altered bowel movements.

What psychological symptoms are associated with bowel cancer?

Anxiety, depression, and body image concerns.

What is the underlying cause (etiology) of bowel cancer?

A mutation of the gland cells lining the bowel (making it an adenocarcinoma), usually arising from a pre-existing polyp.

What genetic factors increase bowel cancer risk?

Having a relative with CRC roughly triples risk (~20% of cases); inherited syndromes like FAP and Lynch syndrome (mismatch repair gene mutations) are recognised causes.

How does diet contribute to bowel cancer risk?

High fat/animal protein and low fibre diets increase bile secretion and bile acid breakdown, raising intestinal carcinogen levels and altering gut bacteria.

Which pre-existing bowel conditions raise CRC risk?

Colorectal polyps/adenomas, ulcerative colitis (3-5% develop CRC), and Crohn's disease; 15-40% of colon cancers arise from pre-existing polyps.

List the key risk factors for bowel cancer.

Age over 45-50, family history/inherited conditions (Lynch, FAP), IBD (Crohn's/ulcerative colitis), obesity and inactivity, smoking/heavy alcohol use, and a diet high in red/processed meat and low in fibre.

What are the main treatment approaches for bowel cancer?

Surgery (main treatment), plus chemotherapy, immunotherapy, radiotherapy (mainly rectal cancer), and molecular targeted therapy.

Differentiate neoadjuvant, adjuvant, and palliative chemotherapy.

Neoadjuvant: given before surgery (often with radiotherapy) to shrink the tumour; Adjuvant: given after surgery to kill remaining cells; Palliative: used in late-stage disease to improve quality of life and prolong survival.

What are common complications of bowel cancer?

Local/distant tumour spread (liver, lungs, peritoneum), bowel obstruction or perforation, chronic blood loss/anaemia, surgical complications (infection, altered bowel function, stoma), and treatment side effects (neuropathy, immunosuppression, fatigue, nausea).

Give an example of a treatment contraindication.

Anti-angiogenic drugs (molecular targeted therapy) are avoided around surgery due to bleeding and wound-healing risk; some chemo agents are contraindicated with serious cardiac, renal, or hepatic impairment.

How does bowel cancer impact neuromusculoskeletal/movement function?

Abdominal pain, surgical incisions, and weakness limit trunk mobility and endurance; chemo-induced peripheral neuropathy impairs balance and fine motor control.

How does bowel cancer impact mental functions?

Stress, anxiety, depression, body image issues, plus chemo-related cognitive changes and fatigue affecting concentration.

How does bowel cancer impact cardiovascular/haematological/respiratory function?

Chronic tumour bleeding causes iron-deficiency anaemia, leading to fatigue and breathlessness; treatments can suppress immune function.

How does bowel cancer directly affect digestive/bowel function?

Tumour disrupts the large intestine causing changed bowel habits, obstruction risk, bleeding, altered stool consistency, and possible loss of bowel control or need for a stoma.

Why is occupational performance compromised in bowel cancer?

Everyday tasks need energy, physical comfort, cognitive focus, and time management - all disrupted by unpredictable symptoms, exhaustion, and emotional toll of a life-threatening illness.

How is bowel cancer likely to impact ADLs?

Hygiene/showering/dressing can be exhausting post-surgery; toileting is physically/emotionally demanding (urgency, stoma, incontinence); appetite may drop due to nausea or bowel-related stress.

How does bowel cancer impact work/study participation?

Severe fatigue, surgical recovery time, and chemotherapy schedules make maintaining work or study difficult.

How does bowel cancer impact leisure and social participation?

Fear of bowel urgency, unpredictable symptoms, fatigue, and body image changes often cause withdrawal from social outings, hobbies, and community events.

How can bowel cancer affect seated occupations like driving?

Pain, weakness, and stoma location/comfort can impact ability to sit, lie, or change position safely.

What is the OT's role with a bowel cancer client in hospital?

Improve independence, comfort, and occupational performance - intervention depends on cancer stage.

How do OTs address fatigue in bowel cancer clients?

Teach energy conservation strategies and adapt occupations to accommodate fatigue.

How do OTs help clients adapt daily routines?

Adjust routines for toileting, cooking, clothing, and outings to manage bowel changes, urgency, or a new stoma.

What does an OT home assessment focus on for this population?

Ensuring a safe path to the bathroom to reduce fatigue-related fall risk and support toileting.

What cognitive supports might an OT provide?

Help with memory or concentration difficulties caused by fatigue or chemotherapy side effects.

What equipment might an OT provide?

Shower chairs and grab rails to support independent ADL participation.

What other role does OT play around hospital discharge?

Supporting discharge planning and return-to-work.

What is the GP's role in bowel cancer care?

Coordinates overall care, manages general health, provides initial screening and referrals.

What is the medical oncologist's role?

Oversees treatment such as chemotherapy and targeted/immunotherapy.

What is the colorectal surgeon's role?

Performs diagnostic procedures (e.g. colonoscopy) and surgical resections/stoma formation.

What is the stoma nurse's role?

Provides education and support for stoma care and fitting.

What is the dietitian's role?

Nutritional assessment and advice for managing appetite, weight loss, and bowel symptoms.

What is the palliative care team's role?

Provides quality-of-life care and end-of-life support for the patient and family.

What is the social worker's role in this context?

Supports with finances, medical fees, and related practical concerns.

What survival rate do early-stage patients have after surgery-based treatment?

Over 90% 5-year survival for early-stage CRC treated with surgery-based treatment.

Name common chemotherapy agents used in bowel cancer.

Fluorouracil (5-FU), irinotecan, oxaliplatin, and raltitrexed.

What are FOLFOX, FOLFIRI, CAPEOX, and FOLFOXIRI?

Common combination chemotherapy regimens built from agents like 5-FU, leucovorin, oxaliplatin, irinotecan, and capecitabine.

What is molecular targeted therapy in bowel cancer?

Drugs targeting either anti-angiogenesis (blocking tumour blood supply) or anti-epidermal growth factor (blocking cancer cell growth signals).

When and why is radiotherapy used in bowel cancer?

Mainly for rectal cancer, given before and/or after surgery alongside chemo to improve local tumour control and quality of life.

What other treatment options exist beyond surgery, chemo, and radiotherapy?

Immunotherapy, hyperthermia (combined with chemo/radiotherapy), biotherapy, local cryotherapy, radiofrequency therapy, and palliative care.

How is Stage 1 bowel cancer typically treated?

Endoscopic polypectomy or local excision via colonoscopy; wide surgical excision if invasion is deeper.

How is Stage 2 bowel cancer typically treated?

Surgical resection (e.g. trans-anal resection, low anterior resection, proctectomy, abdominoperineal resection), plus adjuvant chemo (e.g. 5-FU or capecitabine) and/or radiotherapy.

How is Stage 3 bowel cancer typically treated?

Partial colectomy plus adjuvant chemotherapy such as FOLFOX or CAPOX.

How is Stage 4 bowel cancer typically treated?

Surgery if possible, palliative chemo/radiotherapy, targeted molecular therapy, and clinical trials, with a focus on quality of life.

Why does treatment approach change so much by stage?

Earlier stages aim for cure via local removal/resection, while later stages (especially Stage 4, with metastatic spread) shift toward palliative and quality-of-life focused care since cure is less likely.