Bowel cancer

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Unit 612

June 2024

Bowel cancer

The purpose of this activity is to provide you with an understanding of how to manage people presenting with bowel cancer symptoms, with a focus on early detection, treatment and supportive care.

The incidence of and mortality from colorectal cancer is increasing in developed countries like Australia. Alarmingly, there appears to be a significant increase in early-onset colorectal cancer, defined as a diagnosis of colorectal cancer under the age of 50 years. Early-onset colorectal cancer is more often left-sided (descending colon or rectum) and more advanced at the time of diagnosis compared with later-onset disease.

The reasons for the worldwide increasing incidence of early-onset colorectal cancer are unclear although obesity and factors such as a sedentary lifestyle have been implicated. While some patients with early-onset disease have a strong family history, the majority do not have a family history or identifiable genetic variants. As a consequence, general practitioners have a critical role to play in identifying higher-risk patients (such as those with a strong family history), encouraging the uptake of bowel cancer screening in their patients and facilitating an earlier diagnosis of colorectal cancer.

With the implementation of population-level screening and recent advances in treatment for people with bowel cancer, an increasing number of Australians are living with bowel cancer. Cancer survivors stand to benefit from excellent survivorship care coordinated through general practices. Moreover, general practice teams, with their focus on holistic, person-centred care, are well placed to manage patients with palliative care needs by providing care, support and access to specialist palliative care services.

Here we present five cases that deal with the investigation and management of people presenting with bowel cancer symptoms, with a focus on early detection, treatment and supportive care.

Learning outcomes

At the end of this activity, participants will be able to:

  • identify and assist individuals who are at risk for familial bowel cancer
  • list the red flag symptoms and signs for bowel cancer that require referral
  • implement, in their practice setting, strategies to increase patient uptake of bowel cancer screening
  • describe the management of patients who have recently received treatment for bowel cancer, including the care of stomata
  • outline the assessment and management of patients with bowel cancer who have supportive and palliative care needs.

Case studies

Below is a list of the case studies found in this month's edition of check. To see how these case studies unfold and gain valuable insights into this months topic, log into gplearning to complete the course. 

Tom, a carpenter aged 35 years, is eager to explore preventive measures, including screening for polyps associated with colorectal cancer. Additionally, he is interested in accessing genetics services to gain insights into his risk factors for developing colon cancer.

Carrick, aged 66 years, presents to your practice for the first time with a three-month history of tiredness and altered bowel habits. His past medical history includes ischaemic heart disease, hypertension, hypercholesterolaemia and diabetes mellitus. He had two coronary stents inserted 18 months ago. Medications include sitagliptin, metformin, rosuvastatin, perindopril, bisoprolol and clopidogrel. Initial blood tests indicate evidence of microcytic hypochromic anaemia.

Ben, a business executive aged 27 years, presents to you for the first time with a six-week history of crampy abdominal pain. One week earlier, he had presented to the hospital emergency department with cramping and vomiting. He was discharged after receiving intravenous fluid and analgesia, with a presumptive diagnosis of gastroenteritis. 

Linh, aged 60 years, was diagnosed with low rectal adenocarcinoma three months ago. Based on the clinical findings of scans and biopsies before the start of treatment, the tumour has grown into the outer lining of the bowel wall and there are cancer cells in up to three nearby lymph nodes, but the cancer has not spread to other parts of the body (cT3N1M0 in the tumour, nodes, metastasis staging notation). She has a history of hypertension, for which she takes valsartan.

Mo, aged 68 years, was diagnosed with metastatic colon cancer one year ago. At diagnosis he had a solitary transverse colon lesion, intra-abdominal lymphatic spread and multiple small liver lesions. Mo’s case was discussed at the oncology multi-disciplinary meeting where it was agreed that his cancer was not resectable and he began six months of chemotherapy. 

CPD

This unit of check is approved for 10 hours of CPD activity (two hours per case). The 10 hours, when completed, including the online questions, comprise five hours’ Educational Activities and five hours’ Reviewing Performance.
 
Educational
Activities
5
hours
Measuring
Outcomes
0
hours
Reviewing
Performance
5
hours

Complete check online

To enroll in this check unit online: 

  1. Log into myCPD home page
  2. Select 'Browse' and search for 818389
  3. Select the course and register

Please note: If you're not a member of the RACGP or don't have a check subscription, click here.

TOPICS

Gastrointestinal healthPalliative care

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