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NTCLINICAL UPDATE The importance of improving awareness of colorectal cancer AUTHOR Claire Jagot, is press and public relations officer, Diagnosing colorectal cancer Colon Cancer Concern. The symptoms of colorectal cancer depend upon the ABSTRACT Jagot, C. (2004) The importance of improv- stage of the disease and the part of the colon or rectum ing awareness of colorectal cancer. Nursing Times; 100: affected. They may include the following: 14, 30–31. ● A recent or persistent change of bowel habit, such as The function of the bowel and the incidence of bowel feeling the need to go to the toilet more frequently or cancer are issues that we do not want to think about. having looser stools; Embarrassment around the symptoms, ignorance, and ● Passing blood or mucus from the rectum; fear, are barriers that need to be overcome in order to ● Extreme tiredness or fatigue without an obvious cause; reduce the number of people affected by the disease. ● Unexplained pain or a lump in the abdomen. Colon Cancer Concern’s awareness campaign aims to The main tests used in the diagnosis of the disease are start members of the public talking about this killer flexible sigmoidoscopy, colonoscopy, and barium enema. disease and acting upon their concerns. Ultrasound and computerised tomography (CT) scans can also be used in further investigations of the disease, usu- Colorectal cancer is the UK’s second most common cause ally for staging the cancer rather than in diagnosis. of cancer death but if caught early, it is one of the most As yet in the UK there is no national screening pro- treatable forms of cancer. Some 35,000 people are diag- gramme for colorectal cancer. However, the NHS is cur- nosed with colorectal cancer every year in the UK and rently carrying out pilot studies to examine the best 16,000 of this number will die from the disease (Cancer method of screening the public to increase detection of Research UK, 2003). the disease in its earlier stages. It remains the disease that people do not want to talk about. Therefore, this year Colon Cancer Concern (CCC), Treatment the UK’s leading bowel cancer charity, is undertaking the The most common form of treatment for colorectal can- most comprehensive awareness campaign in the history cer is surgery. Here the surgeon will remove the portion of the disease and the charity. of the colon or rectum containing the cancer, together with a healthy margin of tissue either side of the tumour What is colorectal cancer? and the surrounding lymph nodes to help reduce the Colorectal cancer, otherwise known as large bowel or chances of the disease spreading or recurring. colon cancer, can develop within any part of the colon or Some patients will have to undergo a course of chemo- rectum. It is a disease that most people in this country therapy following surgery. Radiotherapy is used more know little or nothing about yet it will affect one in 20 of commonly to treat cancer of the rectum and can be given us in our lifetime (Cancer Research UK, 2003). prior to and/or following surgery. Although the exact cause of colorectal cancer is unknown, there are several factors that make people Reducing the risk of colorectal cancer more at risk: By making a few simple lifestyle changes, people can ● Colorectal cancer can develop in men and women of help to reduce their risk of developing colorectal cancer. any age but it tends to be a disease of late middle age; These changes include: ● In the UK, about 75 per cent of cases occur in people ● Being aware of their bowel pattern, so people know over the age of 55 (Cancer Research UK, 2003); what is normal for them; ● In the UK, 5–10 per cent of all people diagnosed with ● Trying to avoid constipation, as this slows down the colorectal cancer have a family history of the disease. passage of waste products through the digestive system; NT CLINICAL is an essential Often if there is a history of colorectal cancer within a ● Eating a healthy diet that is low in fat and high in resource for extending family, the disease appears at an earlier age – under the fibre, including at least five portions of fresh fruit and age of 45 (Cancer Research UK, 2003); vegetables a day; your knowledge base. You ● People who have an inflammatory bowel disease, ● Drinking plenty of fresh fluids, water in particular; can achieve your such as Crohn’s disease or ulcerative colitis, or those who ● Exercising regularly to keep healthy. continuing professional have had polyps removed in the past, may be at an These key facts highlight the importance of under- development PREP increased risk; standing why raising awareness needs to be taken seri- ● Consuming a diet that is high in fat and low in vegeta- ously. Colorectal cancer can affect anyone. It is a common requirements by reflecting bles, combined with an inactive lifestyle, can increase disease but simple lifestyle changes can reduce the risk on these articles. the risk of developing the disease. and it is highly treatable. 00 NT 6 April 2004 Vol 100 No 14 www.nursingtimes.net KEYWORDS ■ Public health ■ Colon cancer ■ Awareness campaign One of the ironies surrounding colorectal cancer is that CCC is also relying on the help of staff in GP surgeries, REFERENCE the number of deaths could so easily be reduced if peo- councils and workplaces to help spread its messages by Cancer Research UK (2003) Cancer ple acted on their symptoms earlier and helped identify putting up posters, distributing leaflets, and utilising the Research UK Statistics, April 2003. the disease in its early stages. If caught early, colorectal intranet and other resources. London: Cancer Research UK. cancer is one of the most treatable forms of cancer. Flagship campaigns that are aimed at achieving the However, embarrassment, ignorance, and the fear that media attention and coverage the disease deserves surrounds the disease stop some people from acting include the following: upon their symptoms in time. ● The launch of Bowel Cancer Awareness Month at the Recent research has indicated that 84 per cent of the House of Lords on 1 April; UK population does not act on their symptoms by going ● Men’s Health Week in June; to talk to their doctor, even when they have concerns. ● CCC’s pub campaign in September. Furthermore, most people in this country know little or CCC’s regional campaigns, such as those in Scotland in nothing about colorectal cancer and some do not even September, will also enable local media coverage and know where their colon is. Some avoid going to their GP awareness throughout the UK. because they are fearful of the diagnostic tests they will have to undergo. Sometimes people may be even more Implications for nurses fearful of the tests than they are of the disease itself While this campaign is a public awareness campaign, CCC (Cancer Research UK, 2003). recognises that it would not be possible without the sup- Dave Miners, a patient with CCC who recently appeared port of health care professionals. on BBC Breakfast, sums things up perfectly: ‘I am abso- Partnership with nurses is essential to the campaign’s lutely convinced that we don’t talk about bowel cancer successful roll-out as they play a vital role in offering because of the English reticence; the British stiff upper information about the disease and responding to the lip. Bowels are something that we don’t want to talk reaction that is likely to be generated by the public. about or think about but we must if we are going to Nurses need to be able to respond to concerns that tackle this dreadful disease.’ members of the public may have and to filter through those individuals whose concerns require more attention. CCC’s awareness campaign Specialist nurses working on the charity’s trailer will also Colon Cancer Concern believes that its upcoming aware- be on hand to talk to the public during awareness visits. ness campaign will help to overcome this reticence and Any health care professional – whether working with make colorectal cancer a subject that people are com- CCC on the campaign or reacting to increased public fortable discussing. awareness – will be supported by CCC’s infoline, which is The campaign aims to reach an estimated audience staffed by colorectal, oncology and stoma nurses. As well of 17 million people. It is being launched during Bowel as being a source of information, advice and support for Cancer Awareness Month (April 2004) and has been patients, the infoline is also there to provide more in- made possible, in part, by National Lottery funding of depth information if required (Box 1). over £200,000. FURTHER READING Focusing on public awareness, the campaign will target Working with government Borwell, B. (2002) Bowel cancer in the GPs’ waiting rooms, pubs, gyms, councils and large The government’s commitment to a national screening older person. Gastrointestinal nursing; employee workplaces – in order to reach as wide an programme and to improving treatments and services, November, 32–33. audience as possible. through the NHS Bowel Cancer Programme, is a sign that Eye-catching slogans, such as ‘Don’t blush. Look before colorectal cancer is, at last, receiving the recognition that CancerBACUP (2000) Understanding you flush’, will be sure to capture the public’s attention it deserves. Cancer of the Colon and Rectum. as the campaign is rolled out throughout the year. CCC’s However, it is also an indication that more still needs London: CancerBACUP. 45-foot trailer, which will act as its ‘mobile surgery’ for to be done. Survival rates of colorectal cancer are low in De Snoo, L. (2002) Colorectal Cancer. the campaign, will be touring the country and is some- the UK in relation to other European countries. There is Cancer Nursing Practice; 1: 10, 32–38. where the public can visit to learn about the disease and currently only one first-line drug available for most talk to nurses or CCC representatives. bowel cancer patients in the UK – fluorouracil. In com- Jones, D.J. (2000) ABC of Colorectal parison a number of drugs to treat bowel cancer are Diseases. London: BMJ Publishing BOX 1. FURTHER INFORMATION available in other European countries. Group. Colon Cancer Concern will be working with and lobbying ● For further information on CCC’s awareness the government to ensure that colorectal cancer is kept Porrett, T., Daniels, N. (1999) Essential campaign or its nurse education programme, call high on the political agenda and that recent screening Coloproctology for Nurses. London: 020 7381 9711. and treatment commitments are not forgotten. Whurr Publishers Ltd. It is important to keep up the momentum of cam- ● For further information on colorectal cancer, contact CCC’s infoline service on 08708 506050. paigning to raise awareness and improve services at this This article has been double-blind level as this complements the charity’s efforts to raise peer-reviewed. ● Alternatively, visit the CCC website on www. awareness ‘on the ground’ and helps to ensure that For related articles on this subject coloncancer.org.uk patients are able to obtain access to the treatment and and links to relevant websites see www. services that they deserve. ■ nursingtimes.net NT 6 April 2004 Vol 100 No 14 www.nursingtimes.net 31
"The importance of improving awareness of colorectal cancer"