On 18 April, we hosted a webchat all about bowel cancer. John Newlands, one of our Information Nurses from the Macmillan Support Line, answered questions on symptoms, testing and treatment.

If you’d like any further information on the subject see our bowel cancer pages, or call the Macmillan Support Line on freephone 0808 808 00 00 (Mon-Fri, 9am-8pm). And, if you haven’t done so already, you can join the  bowel cancer group in the Online Community to get support from others who are going through similar experiences.

Many thanks to John for taking part.                     

I recently found out about a friend who has bowel cancer. I know little about it – how long after diagnosis would someone typically start treatment? I realise each case is probably different.

After a diagnosis of bowel cancer, NHS treatment should start within 31 days of a decision to give treatment. The treatment would depend on the stage of the cancer - that means how far it has spread.

I am being tested at the moment as I have a number of symptoms but I am only 43 so in my mind this is fairly young for this type of cancer?

Under 45 years would be seen as being young to have bowel cancer but it is still very important to get checked out.

What is the youngest age you have seen this type of cancer?

I have nursed people in their 20s with bowel cancer - this is very rare, though. Usually people are much older.

Is that why the screening age is higher? Is there any argument or evidence for screening people at a younger age for bowel cancer?

Good question - the screening ages vary amongst the UK nations. In Scotland, it starts at age 50, and in England currently 60, but this is being extended. Below those ages, screening is available for people at high risk.

I did a bowel cancer test annually (provided by my company) for 10 years, nothing found until I was diagnosed with liver secondaries and then they found the primary in my bowel.

Was that a stool test called an FOB? This is used in the screening programme - it is very accurate but not 100%.

Can you tell us a little about the symptoms of bowel cancer?

Here are some common symptoms:

• Blood in, or on the stools (bowel motions) – the blood may be bright red or dark in colour
• A change in your normal bowel habit (such as diarrhoea or constipation) for no obvious reason, lasting longer than six weeks
• Pain in the tummy (abdomen) or back passage
• A feeling of not having emptied your bowel properly after a bowel motion
• Unexplained weight loss
• Unexplained tiredness.

The tiredness can happen if the cancer has been bleeding, causing a reduction in the number of red blood cells (anaemia).

I have secondaries in my liver so my bowel is being ignored for now but I'm worried about developing other secondaries all the time I have my primary.

If you are being treated with chemo, it will attack cancer cells in the liver, bowel and anywhere else that they may be in the body.

I've been told that when they operate on my bowel they may be able to do keyhole surgery, does this mean I won't have a stoma?

It doesn't mean you will not need a stoma if keyhole surgery is performed - it has more to do with the size and position of the tumour.

 My Auntie was diagnosed with initial peritoneal cancer. Is this the same as bowel cancer and does it carry the same prognosis? She now has metastasis in the kidney, liver and lungs.

Peritoneal cancer is not the same as bowel cancer and is managed differently. We have some information about primary peritoneal cancer on our website, which you might find helpful.

We often find that we can help people more by speaking with them directly on the phone. Our helpline is open Monday to Friday 9am until 8pm. The freephone number is  0808 808 00 00   . You can ask to talk to a cancer information nurse specialist who will be happy to provide you with a specific answer to your question.

She now has to have a stoma because her bowel has more or less gone

I think you mean the peritoneal cancer has moved to the bowel, but management after surgery will be different - give us a call and we can discuss it in more detail.

Thank you very much for that, I will give them a call. I feel I need to be as informed as I can be on this, because I am her main carer now.

You can also find lots of information for carers on our website.

Two days ago, I had an endoscopy. It was so, so painful. The doctor said they couldn’t get around all of my intestine and that’s why it hurt. They took some biopsies of the wall and a polyp they found. Should I be worried? Please be honest.

A colonoscopy is the camera exam of the lower bowel. Sometimes there can be polyps which are not cancer, but it is important to get the results back.

They told me it could take up to 3 months to get a result, though.

That is a long time. It's usually a few weeks. You could try the patient advice and liaison team at the hospital to see if this can be speeded up.

My friend has been diagnosed with bowel and secondary liver cancer and is not feeling any discomfort or pain. Is this normal? Treatment has not started yet.

Sometimes people can have a bowel cancer that has spread without any pain. Other symptoms can be weight loss, yellow skin (jaundice) or tiredness

Does or should the speed of treatment depend on the type and stage of the cancer that's found?

Specifically for bowel cancer no - sometimes a cancer that is blocking the bowel needs emergency surgery, sometimes more investigations need to be done before treatment starts.

I have Crohn’s disease and I think I’ve just had a touch of food poisoning - starved all day yesterday, now I have eaten again and cant’ keep out of the bathroom. Is this something I should be worried about?

I'm sorry, I cannot comment on specific symptoms. If you are worried, you should contact your GP.

Just wondering, has anyone found that they have tingling and numbness in their fingers and/or feet because of chemotherapy treatment? Has anyone found anything that helps reduce the numbness?

This tingling after chemo can be due to nerve damage called peripheral neuropathy. We have some information on treatments for peripheral neuropathy on our web site. It often improves in time, usually a few months but can be a longer term problem - see our information on long term effects.

I get wobbly sometimes - tripping over, tripping down steps etc - is this likely to be a side effect of chemo or antibodies?

It could be peripheral neuropathy. Sometimes physiotherapy can help and maybe an occupational therapist.

After cancer removal and stoma is formed can a cancer grow in the bowel that is left dangling attached to the anus?

Any visible tumour, plus a margin of healthy tissue, is removed at time of surgery but if microscopic disease is left behind this can come back in the future. This is called a local reoccurrence.

Is it true that you can't take any vitamin tablets of any sort or manuka honey while you're on chemo treatment or are the doctors just being over-cautious when they say it might interfere with the chemotherapy?

Memorial Sloan Kettering has good information on complementary therapy at http://www.msk.org/cancercare(search for ‘about herbs’).

I am having chemotherapy and radiotherapy for small cell lung cancer. Can the cancer move down to my bowel?

Bowel secondaries are unusual from lung cancer but it can happen.

How long is the first set of chemo sessions? And is this to cure or to manage?

Chemo can be given in many different ways, before surgery to shrink down, after surgery as an extra treatment or where surgery cannot be done as the main treatment, so it really depends what the stage of the cancer is - that's how far it has spread

I have tried to find more info on the 'paliative chemo' that my Auntie is having but can't remember the name. Are there lots of different types ?

Yes there are a lot of different types of chemotherapy, used for different things and with different side effects.

• Fluorouracil as an injection or through a drip, often with another drug called folinic acid
• Irinotecan with fluorouracil and folinic acid
• Oxaliplatin with fluorouracil and folinic acid
• Oxaliplatin and capecitabine
• FOLFOX – a combination of folinic acid (leucovorin), fluorouracil and oxaliplatin given into a vein
• Capecitabine (Xeloda) tablets
• Fluorouracil (5FU) into a vein
• FOLFIRI – a combination of folinic acid (leucovorin or calcium folinate), fluorouracil and irinotecan
• Irinotecan into a vein
• Tegafur and uracil (Uftoral) capsules

It is apparently a mild one because of her other health issues (severe rheumatoid arthritis). They make it up directly before using it. It is definitely only a palliative one.

This sounds like 5FU as it is effective but has less side effects.

Sorry, none of those are ringing bells.

If you find out you can call us or email and we can tell you about the drug. We also produce factsheets on each drug that we can send you. There are more details about individual drugs on our website.

If the treatment doesn't work and there are lots more mets after her next scan or they haven't shrunk any further, is the prognosis poor or is that not always the case? 

The choices would be either changing to a different type of chemo (if she wants to continue) or palliative care to control symptoms. Prognosis is difficult to predict - it would be a good thing to discuss with the specialist, or again you can give us a call.