Saving lives: detecting bowel cancer early with FIT testing

Screening tests for bowel cancer are an effective way of detecting this type of cancer early. The earlier bowel cancer is detected, the higher the chances of receiving successful treatment. In the UK, the NHS offers a particular type of bowel cancer screening test called a faecal faecal immunochemical test (FIT) test, every two years to all adults aged 60 to 74 years old. This programme is expanding to make it available to everyone aged 50 to 59 years too.

The faecal immunochemical test (FIT) is a newer, more advanced type of screening for bowel cancer. The test can be easily carried out at home, following a simple step-by-step guide.

Here, King Edward VII’s Hospital consultant in gastroenterology, Dr Edward Seward explains why bowel cancer screening is so important, and how you can be tested with the FIT test.

Who is most affected by bowel cancer?

Bowel cancer, also known as colorectal cancer, is one of the most common cancers in people living in the UK.

Those who are aged 60 and older are more at risk of developing bowel cancer. According to the NHS, one in 20 people in the UK will develop bowel cancer. For every 20 cases of bowel cancer, 18 of them will be in people aged 60 and above.

If a close relative (parent or sibling) developed or develops bowel cancer before they’re 50 years old, it can also increase your chances of developing bowel cancer.

Having a bowel condition, such as Crohn’s disease or ulcerative colitis, with extensive or severe symptoms, can also increase your risk of the disease.

If you’re concerned about bowel cancer, then it’s important to speak to your GP.

What are the signs and symptoms of bowel cancer?

There are three main symptoms of bowel cancer:

• Regular blood in your stools.
• Changes in your bowel habits — either becoming constipated, or more commonly, having frequent diarrhoea.
• Pain and/or bloating in your lower abdomen after eating.

You may also lose your appetite or lose a significant amount of weight in a short time, without dieting. Blood loss can also make you anaemic, even if you don’t see the blood in your poo.

These symptoms do not necessarily mean that you have bowel cancer. Often, they can be attributed to something else. For example, finding blood in your stools can mean that you have haemorrhoids (piles). Having stomach pain and diarrhoea could mean that you’ve eaten something that hasn’t agreed with you and constipation could mean that you’re lacking fibre in your diet, or you’re dehydrated.

However, if you’re experiencing these symptoms on a regular or persistent basis and simple treatments such as laxatives for constipation haven’t worked, then it’s important to speak to your GP.

If you start to experience the following symptoms, it could mean that you have a bowel obstruction, which can be caused by a bowel cancer tumour preventing food and waste moving along the digestive tract:

• Severe pain in the lower abdomen after eating.
• Vomiting.
• Bloating or swelling in the lower abdomen.
• Rapid weight loss.
• A bowel obstruction is a serious medical condition that requires urgent treatment — if you’re experiencing what you think could be a bowel obstruction, seek medical help or visit your nearest A&E immediately.

What are the causes of bowel cancer?

Bowel cancer usually develops inside small, fleshy lumps called polyps that can form on the lining of the inner part of the bowel. Having polyps doesn’t definitely mean that you have bowel cancer, as only some polyps turn into cancerous lumps.

Despite extensive research, doctors and scientists are still unsure of the exact cause of polyps and bowel cancer. But there are a number of factors that can increase your risk of developing bowel cancer.

These include:

• Eating a diet high in processed meats (ham, sausages, bacon, burgers, pâté etc) and red meats (beef, lamb, pork etc). The NHS has valuable advice on how much meat is too much, and how to cut down on processed and red meats.
• Not eating enough fibre, which is required for moving food along the digestive tract and for regular bowel movements. Aim to eat wholegrain (not white) bread, cereals, pasta and rice, plus plenty of fruit and vegetables to increase your fibre intake.
• Being very overweight or obese, especially if you’re male. 11% of bowel cancers are linked to carrying excess weight.
• Living a sedentary life with little physical activity or exercise.
• Drinking excessive amounts of alcohol, and not having three or four alcohol-free days a week.
• Smoking.

How does the FIT screening test for bowel cancer work?

A FIT test only requires one sample. Instructions for collection and everything you need is contained within the kit.

The FIT test still detects minute traces of blood, but only detects human haemoglobin, a protein found in blood. The FIT test comes complete with full, easy to follow instructions and is packaged and posted back to the laboratory. The FIT test is analysed by a machine, reducing human error and making it a more advanced test.

How can I get a FIT testing kit?

FIT testing is now available on the NHS. Everyone aged 60 to 74 years who is registered with a GP will automatically be sent a FIT test every 2 years. This programme is expanding to include everyone from the ages 50 to 59 years. If you are not eligible to receive an NHS FIT test, speak to your GP for advice.

What happens after I get my results?

The vast majority of people get a normal result from bowel screening tests. This means that there was no blood detectable in your stool sample. You won’t need to do anything until you receive your next bowel screening kit in two years’ time (or you order another one privately), unless you begin to develop symptoms of bowel cancer, in which case you should speak to your GP.

If you receive an abnormal result, it means that blood was found in your stool sample. It does not necessarily mean you have bowel cancer but you will be invited for have a further test called a colonoscopy.

A colonoscopy procedure involves a specialist doctor passing a long, thin tube through your bottom and into your large bowel. You will be sedated throughout the procedure. The tube has a small camera attached to the end, and your doctor will be able to view the inside of your bowel on a TV screen, where they’ll be looking for the presence of polyps.

If polyps are found, during the same procedure, your doctor will be able to remove them for further testing. Most polyps are not cancerous.

If cancerous cells are detected, then you will be contacted for further scans and tests to enable doctors to put you on the best course of treatment.

The success of your treatment will depend on the severity of your cancer and full support will be given by your medical team throughout.

More information

• If you’re experiencing symptoms of bowel cancer, speaking to your GP is a good place to start. (Don’t have a GP?)
• If you’re worried about bowel cancer, or you’ve had an abnormal FIT  test, the King Edward VII Hospital’s Urgent Bowel Cancer Service allows you to speak to a world-class colorectal specialist within 48 hours.