Bowel cancer affects over 20,000 people per year in the UK. The majority of patients are over 50, but 10% are under the age of 50 - some even in their late teens and early twenties. In many cases, bowel cancer occurs without any obvious cause, but the following factors may be implicated: family history; ulcerative colitis; diet; obesity.

Curability
Bowel cancer may spread through the wall of the bowel to invade adjacent organs and via the blood stream or the lymphatic system. However, when bowel cancer is diagnosed early, then there is an excellent chance of being completely cured.

Symptoms
The vast majority of patients with bowel symptoms do not have serious conditions. The following symptoms however deserve more close attention:

• Persistent change in bowel habit particularly to increased frequency of going to the toilet and or increased looseness of the stools particularly when this is associated with bleeding from the back passage.
• Persistent change in bowel habit without bleeding from the back passage in patients over the age of 60.
• Bleeding from the back passage persistently without any symptoms of piles e.g soreness, itchiness and pain around the back passage, lumpiness in this area or prolapse of piles.
• Other higher risk symptoms and signs include unexplained anaemia and any 'masses' or lump(s) that can be felt in the tummy

Screening for Bowel Cancer
Currently, there is no national screening programme for bowel cancer. This will change in the future, but the details of who will be screened, and how this is to be carried out, are under discussion. The tests are likely to be Faecal Occult Blood testing (looking for blood in the stools) and/or flexible sigmoidoscopy (an examination using a flexible telescope to examine the lining of the bowel). If bowel cancer is suspected, patients will then be referred for a colonoscopy (an examination with a longer flexible telescope to inspect inside the entire length of the large bowel).

Certain people can already be screened for bowel cancer e.g. if bowel cancer runs in your family:

If you have:

• One close relative under 45 affected (brother, sister, parent or child) - talk to your GP about screening. It's usually recommended around 10 years before the age at which your relative developed the disease.
• Two or more close relatives from the same side of the family, and the younger those relatives, the more you need to discuss screening with your GP
• A less strong family history - say one grandparent who died in their 70s or 80s - you are probably at no increased risk. Talk to your GP if you are worried.

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A polyp is a protrusion in the lining of the bowel caused by an abnormal production of cells. It may be a tiny raised area (A); it may look like a grape (B) or take the form of many tiny projections clustered together (C). Polyps are very common (occurring in 15-20% of the population) and most are NOT cancerous.



Polyps are important however, as, if they are not removed, they may eventually become a cancer in the colon (large bowel) or rectum (back passage), although this takes many years.

Symptoms of polyps

Most people are unaware of having polyps as they produce no symptoms and they are often an incidental finding. Some polyps can, however, produce a small amount of bleeding or an excess production of mucus (slime) with bowel motions. Polyps are usually found as a result of bowel investigations - such as a sigmoidoscopy or barium enema. If they are found colonoscopy is required to view the whole of the large bowel.

Treatments for polyps

The most common method of removal is by:

1. Snaring the polyp whilst you have a colonoscopy (snaring is like cutting the polyp off with a cheese wire and is painless).
2. Hot biopsying removes the polyp by touching it with an electric probe (this is also painless).
3. An operation to remove part of the bowel if the polyp is large.

Some people will require further colonoscopies because polyps can recur. The British Society of Gastroenterology has recently issued guidelines with regards to polyp surveillance.

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Haemorrhoids (piles) are swollen blood vessels in the back passage. One in three people experience haemorrhoids at some time.

The most usual cause is straining to open the bowels, and piles are more common during or after pregnancy. They can cause bleeding and discomfort and many protrude outside the anal canal. There are a number of different treatment options.

Injections for Piles

This involves injecting a small amount of a chemical called phenol near the haemorrhoid causing it to shrivel up. This treatment will usually take 4-6 weeks to be effective, so you should not expect immediate relief. Many people require more than one injection, but again you should be able to get back to your normal life almost immediately.

'Banding' of Piles

This involves using a small instrument to put a tight elastic band over the haemorrhoid. This band cuts off the blood supply so that the haemorrhoid should drop off within 3-7 days. You should be able to get back to your normal life straight away. You may be seen again in 6-12 weeks to check that the banding has been successful. Sometimes the banding needs to be repeated, but this is generally a superior treatment compared to injections.

Prevention

Increase the amount of fibre and water in your diet. Fibre is not completely digested and absorbed by the body, so it provides bulk to the stools. This helps the movement of waste through the bowel resulting in stools that are easier to pass.

Haemorrhoidectomy

Surgical removal is the best method for the permanent removal of haemorrhoids. This becomes necessary when simpler treatments such as banding or injections fail, and where there is a degree of prolapse or protrusion. This may be performed using general anaesthetic or a spinal block and usually requires at least an overnight stay, and often longer.

Stapled Haemorrhoidectomy ('PPH' - Procedure for Prolapse and Haemorrhoids)

This is a relatively new surgical which enables patients recover from haemorrhoid surgery faster and with less pain when compared to conventional haemorrhoidectomy. Using a special stapling device, PPH 'lifts up' or repositions the anal canal tissue, and reduces blood flow to the internal haemorrhoids. These haemorrhoids, then, typically shrink within four to six weeks after the procedure. The PPH procedure results in less pain than traditional haemorrhoidectomy because it is performed above the "pain" line inside the anal canal, whereas traditional haemorrhoidectomy procedures are performed below this line. I will discuss the suitability of this operation with you at the time of your consultation.

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Ulcerative colitis is a form of inflammatory bowel disease that affects the lining of the large bowel (colon) and back passage (rectum). Approximately 100,000 people in Britain have ulcerative colitis.

What Are The Symptoms?
Most of the time, most sufferers feel well with no symptoms i.e. the disease is inactive (in remission). The disease may flare up from time to time and become active (relapse). The main symptoms are:

• Frequent and urgent need to pass blood and mucus (slime from your back passage)
• Diarrhoea
• Abdominal pain
• Lethargy

How Is Ulcerative Colitis Diagnosed?
It is essential to examine the lining of the back passage and colon usually with a flexible sigmoidoscope or colonoscope.

How Is Ulcerative Colitis Treated?
For most patients, the disease can be controlled by anti-inflammatory medications or other drugs such as steroids. If only the rectum is inflamed, treatment may just be with enemas, rectal foams or suppositories.

When Is Surgery Necessary?
With ulcerative colitis most people never need an operation. However, the colon may have to be removed if:

• A very severe attack of ulcerative colitis fails to respond to intensive medical treatment
• Repeated attacks cause ill-health
• Pre-cancerous changes ('dysplasia') are found in the colon

What Operations Are Available For Ulcerative Colitis?
For some patients a proctocolectomy with an ileal pouch is suitable. This involves removal of the entire large bowel and the formation of a pouch to replace the rectum. The pouch is made from a segment of the small bowel and joined to the anus. The operation is often done in stages. A part of the remaining small bowel (ileum) is brought through the abdominal wall onto the tummy as a spout (ileostomy). When the pouch has healed the bowel is then reconnected i.e. the spout is put back into the abdomen.

For patients who do not have a good working anal muscle, the most suitable operation is proctocolectomy. This is where the whole colon and rectum are removed and a permanent ileostomy is formed. The ileostomy bag does not show even through bathing costumes and should not interfere with any activities, including sexual intercourse.

Other operations include ileorectal anastomosis or loop ileostomy. In each case, the choice of operation has to be made on an individual basis by the patient and surgeon.

Can Inflammatory Bowel Disease Lead To Cancer?
Yes, but the risks are greater in patients with ulcerative colitis if their disease affects most of the colon and has been present for many years. Patients at risk may be advised to have regular colonoscopy examinations to detect dysplasia. If dysplasia is found, the person is usually advised to have the colon removed.

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The gall bladder is a small organ located beneath the liver that stores and secretes bile. When we eat, bile is added to the food as it passes along the gut. The gallbladder contracts and pushes bile out through the bile duct and into the gut. Bile breaks the fatty material of food into tiny fragments that can be more easily absorbed by the intestine.

What are Gallstones?

Gallstones develop inside the gallbladder. The risk of gallstones increases with age, weight, female gender and family history, but many people form stones without any known risk factors.

Gallstones may trigger an attack of cholecystitis (inflammation of the gall bladder) or pancreatitis (inflammation of the pancreas gland), with the following symptoms:

• Severe abdominal pain
• Fever
• Malaise
• Nausea
• Vomiting
• Laparoscopic Cholecystectomy

Cholecystectomy is the operation to remove a troublesome gallbladder. This is now almost always done laparoscopically i.e. using keyhole surgery and a thin telescope-like instrument that provides interior views of the body. This is done using only 3 - 4 small cuts on the tummy. Most commonly the patient can go home the day after surgery and experiences far less pain than traditional open gallbladder surgery.

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What is a hernia?

A hernia occurs when the abdominal wall weakens (e.g. in the groin) and then bulges or tears. The inner lining of the abdomen then pushes through the weakened area to form a lump, which may move in and out. Not infrequently, a loop of bowel can get stuck causing a very painful lump to appear - the so-called 'strangulated' hernia, which requires emergency surgery. Hernias usually occur because of a natural weakness in the abdominal wall or from excessive strain on the abdominal wall. Approximately 80% of all hernias are located near the groin (inguinal hernia). Hernias may also be found below the groin (femoral hernia), through the navel (umbilical hernia), and along a previous incision (incisional hernia).

Open (Traditional) Inguinal Hernia Surgery

Surgical repair of a hernia is called a herniorrhaphy. The surgeon will push the bulging part of the intestine back into place and most often will reinforce the defect with a synthetic mesh material. Surgery can be done on a day case basis. The operation usually lasts about 30 mins, and can be done under either local (i.e. with the patient awake) or general anaesthesia. Usually the patient can go home the same day, but should avoid driving for 10 days.

Laparoscopic (Keyhole) Inguinal Hernia Surgery

Laparoscopic hernia repair is performed under general anaesthesia. Unlike open surgery, 3 - 4 tiny cuts are made on the tummy to allow the surgeon to repair the hernia from within using a long thin telescope attached to a camera. The defect is covered with a synthetic mesh material that is anchored securely to the abdominal wall from inside.

What are the advantages of laparoscopic hernia repair?

Patients experience much less postoperative pain, heal faster, and many are able to resume full normal activities in as little as two days (compared to 3 - 4 weeks).

Laparoscopic inguinal hernia operations result in a much lower risk of chronic groin pain than open mesh techniques with very similar recurrence rates. The National Institute for Clinical Excellence has therefore recently revised its guidelines to allow use of this technique for primary unilateral inguinal hernia repairs, and not just bilateral or recurrent inguinal hernias.

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