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Preventing colorectal cancer

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Bowel cancer is the second most prevalent fatal cancer in Ireland, and currently people present with the disease at a much later stage than they should. Dr Brian O’Neill, consultant radiation oncologist at Beaumont Hospital and St Luke’s Hospital, Dublin, told IMN that this is a trend seen throughout Ireland in other cancers. “But as awareness increases throughout the country, via GPs and the Irish Cancer Society (ICS), this will improve,” he said.

“A really good example was Lollipop Day, which highlighted oesophageal cancer,” he said.

It got the message across that a swallowing problem may equal cancer, so go to the doctor quickly. “Presentations will get earlier and earlier, which is also down to the new screening programme. But I think currently in Ireland, people present at much later stages than we would like.”

When it comes to GPs raising awareness of the disease, Dr O’Neill told IMN that GPs have been creating awareness of bowel cancer for “many, many years”. He said that invitations for the National Colorectal Cancer Screening Programme, scheduled for January 2012, will also help to create awareness in the community. “It’s going to be important that people are aware of the availability of the screening programme,” he said.

Initially, men and women between 60 and 69 will receive invitations, while this will eventually widen out to between 55 and 74, which Dr O’Neill said is the complete target age group. “This is a huge improvement and an important initiative for Ireland. We’re going to see an increased number of bowel cancers at an early stage and also an increase in premalignant lesions, as well as an increase in early bowel cancers,” he said. On the issue of detecting the disease in primary care, Dr O’Neill said, GPs are not only aware of the very specific left-sided symptoms, but also the more non-specific right-sided symptoms like anaemia, tiredness or shortness of breath. Dr O’Neill advised that right-sided symptoms are the more general symptoms that people should look out for, such as anaemia, abdominal pain, abdominal mass, weight loss or rectal bleeding.

He added that apart from the direct interaction between patients and GPs in the surgery, the ICS can play a huge role in creating awareness of bowel cancer. Their campaign has also been aided by the country’s favourite googly-eyed bachelor puppets, Podge and Rodge. “The left-sided symptoms are a little more specific and include changes to bowel habit, obstruction, rectal bleeding, mucous discharge, weight loss and tenesmus,” he explained. Regarding staging, Dr O’Neill advised that, “stage one is where the tumour involves just the inner layer or the muscle of the bowel wall without any lymph nodes involved, stage two evolves beyond the muscle of the bowel wall, without involving the lymph nodes; at stage three there is involvement with the lymph node; and at stage four, it spreads to other organs.” Dr O’Neill said there have been huge and ongoing improvements over the last decade “especially with regard to patient access quickly to high quality service”, as well as for diagnosis and treatment.

“This has improved enormously over the last nine or 10 years. There has been a huge increase in consultant numbers and that’s across the board really in terms of medical oncology and radiation oncology. “Access to oncology services has become much better and faster now,” he added. New radiotherapy units at Beaumont Hospital and St James’s Hospital, Dublin, have “huge implications of importance” he told IMN, as waiting times for patients to begin radiotherapy will be cut, for both bowel cancers and other cancers. With the new screening programme will come a rise with diagnoses of cancer. So is the system ready for that? “I think that’s been planned for in terms of the hospitals that have been selected. There is capacity in those hospitals,” stated Dr O’Neill. He advised that screening won’t require an increase in colonoscopy as this service is planned for seperately.

Currently, according to figures from the ICS, there are 1,854 patients waiting three months or more for a colonoscopy. The ICS noted that these figures represent an increase of 848 compared with the figures for March last year. Dr O’Neill said, “It’s estimated that 95 per cent will get normal test results and are invited for routine screening, and around five per cent receive an abnormal result and require a colonoscopy.

The whole plan allows for five per cent getting colonoscopy.” “I think it’s going to represent a challenge, but we’ve already seen an increased number of rectal and colon cancers in cancer centres around the country, because of the National Cancer Strategy,” Dr O’Neill continued. “While it’s a challenge, the increased numbers of surgeons, radiation oncologists, and medical oncologists are key in coping with this.” Diagnosing early colon cancers has advantages for both patients and hospitals, he added. “There may not be the requirement for chemotherapy or radiotherapy. Early bowel cancers really impact on the surgical services more than they do on radiation and oncology services, which is a big advantage for patients and resources,” he said.

Bowel Cancer Awareness Month takes place throughout April. For more information visit www.cancer.ie

 

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