10years

Alcoholic Liver Disease

Alcohol is toxic to the liver and excessive and prolonged use of alcoholic beverages causes liver disease.  Alcoholic liver disease is the commonest form of chronic liver disease in western society.  The quantity and duration of alcohol consumed are the most important factors in developing liver disease. 

There is no convincing evidence that the form of alcohol whether it be wine, beer or spirits makes any material difference.  Generally the threshold of alcohol considered likely to produce liver injury is 60 to 80 grams per day in men (10 grams of alcohol is equivalent to approximately one middie of beer, 100ml of wine or 30ml of spirits) and 20 to 40 grams per day in women for 10 years.  It is important to note that individual variations do occur and lesser amounts may produce significant problems.

It has been consistently observed that women are at greater risk of developing alcohol-induced liver disease than men even when factors such as body weight are considered.  Finally persons with chronic Hepatitis C are known to develop more advanced alcoholic liver disease than if alcohol was the only factor involved.

Symptoms - The symptoms of alcoholic liver disease are often minimal or absent in early disease.  Alcoholic fatty liver is a condition where the liver accumulates fat in response to the toxic effects of alcohol.  An enlarged liver accompanied by tenderness may result though often there are no symptoms and it is detected because of blood test abnormalities on routine screening.  90% to 100% of heavy drinkers develop fatty liver. 

Alcoholic hepatitis is a more serious condition though its severity can range from a mild up to a life threatening illness.  Symptoms include loss of appetite, nausea and vomiting, abdominal discomfort and jaundice (yellow discolouration of the skin and eyes).  More severe symptoms include those of liver failure requiring hospital admission.  Cirrhosis can develop as a result of chronic liver damage from alcohol.  As cirrhosis progresses, symptoms of liver failure occur including fluid retention in the abdomen and legs, easy bruising, gastrointestinal bleeding and confusion.  Patients with alcoholic cirrhosis have a small risk of developing liver cancer.

Treatment - The most important treatment for patients with alcoholic liver disease is abstinence from all alcohol.  In many cases the liver is able to regenerate and the patient's symptoms may improve or totally resolve.  There are therapies available to assist patients to remain abstinent when there is an alcohol dependence problem.  Psychosocial supports via Drug and Alcohol counsellors or programs such as Alcoholics Anonymous are very important. 

Despite abstinence, symptoms of liver decompensation may persist and need to be addressed individually. For end-stage liver failure, liver transplantation is an option if the patient has proven that they can remain abstinent for a prolonged period of time. Malnutrition is common in patients with alcohol related problems and therefore an adequate diet to improve the individual's nutritional status is important.

Prevention - Prevention of alcoholic liver disease is achievable if the problem is detected early and abstinence is undertaken. 



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Amoebiasis

Amoebiasis is defined as infection with Entamoeba Histolytica.  This protozoan organism causes intestinal infection and also occasional extra intestinal infections of the liver and rarely the lungs and brain.  Under the microscope it is identical with another organism Entamoeba dispar, which does not cause any disease even though it may be present in the bowel.

Symptoms - Most people who become infected do not develop symptoms, but those that have immune suppression, malnutrition, malignancy, are of a young age or other factors making them more susceptible will develop symptoms.  These symptoms include diarrhoea, bloody motions, abdominal pain and fever and weight loss.

Treatment - Direct microscopic examination of the stools may confirm the diagnosis, however it can be difficult as the Entamoeba Dispar organism which causes no disease or symptoms looks identical.  Blood tests for antibodies to Amoebae may also be helpful in confirming the diagnosis.  Recently sophisticated immunologic tests on the stool have become available and are more accurate.  

Prevention - Avoiding water that has not been boiled or using bottled water while travelling in endemic areas is the best prevention.  Care to avoid food that has been washed in unboiled water is also necessary.  No vaccine is currently available.



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Barrett's Oesophagus

Barrett's oesophagus refers to a change in the lining tissue (mucosa) of the lower oesophagus from normal (squamous cells) to a lining composed of cells normally lining the intestine (columnar cells).  This occurs in some people as a response to chronic oesophageal reflux.

Symptoms - Barrett's oesophagus by itself produces no symptoms but may be associated with reflux symptoms (see reflux), due to irritation and sometimes ulceration of the lining of the lower oesophagus.

Treatment - Currently trials of anti reflux measures; drugs and surgery are being performed to see whether Barrett's can be "treated" and made to disappear. Some researchers are trying to remove the abnormal lining tissue - hoping to replace it with 'normal' squamous mucosa.



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Bowel Cancer (Colorectal Cancer)

Cancer of the colon and rectum - the large bowel - is the second most common cause of cancer-related death.  It is also one of the most preventable.  Approximately one in 20 people in western societies like Australia will at some time develop this condition.  This cancer can occur at any age but the vast majority of them occur in people over the age of 40.

The colon is the last part of the intestine.  It continues to absorb water and minerals from the material delivered to it by the small bowel.  The final section is called the rectum, about 15cm from the anal opening.  It acts as a storage organ.  Cancer starts in the innermost layer of the bowel wall and can grow through the other layers.  Colon cancer and rectal cancer have many features in common and can be considered together.  The treatment is somewhat different however.  Cancer can develop in any part of the colon and rectum.  Before a cancer develops there are usually pre-cancerous changes, typically a type of polyp which is a small growth in the inner layer.  Cancer usually develops slowly over months to years, invades the bowel wall and can spread to involve other parts of the body, especially the liver.

Treatment - Cancers of the colon and rectum are treated surgically.  The section of bowel containing the cancer is removed together with the associated blood vessels and lymph glands. Usually the bowel is able to be joined back together after this operation.  If the cancer has spread to the lymph glands or other organs, chemotherapy or radiotherapy may be advised. Cancers of the rectum are usually treated similarly.  Sometimes, however the bowel cannot be rejoined and it is necessary to make a colostomy.  This means the end of the bowel is brought out on the skin of the abdomen and it is necessary to wear a bag to collect the waste.  These days a permanent colostomy is rarely necessary.

Prevention - Most colorectal cancer develops in a benign polyp so finding and removing such polyps should reduce the risk of cancer.  Family members of people who have had polyps or cancer are at increased risk and need screening.  Colonoscopy is usually recommended. Similarly screening is advised for people with ulcerative colitis and certain inherited conditions. Diet plays some role in the development of polyps and cancer.  How great the role is unclear. A diet containing plenty of fruit, vegetables and cereal and low in fat seems beneficial and also reduces the risk of heart disease, diverticular disease and haemorrhoids among other benefits.



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Cirrhosis

Cirrhosis is a condition where the liver becomes irreversibly scarred with changes to the liver's architecture.  It can result from any disease which causes chronic liver injury or inflammation. Common causes of chronic liver injury in western society include alcohol and viral hepatitis.  As cirrhosis progresses the development of liver failure can occur.

Symptoms - Cirrhosis is a condition where the liver becomes irreversibly scarred with changes to the liver's architecture. It can result from any disease which causes chronic liver injury or inflammation. Common causes of chronic liver injury in Western society include alcohol and viral hepatitis.  As cirrhosis progresses the development of liver failure can occur.

Treatment - The treatment of cirrhosis is subdivided into the treatment of the underlying cause of the chronic liver disease and the treatment of the complications arising from cirrhosis such as bleeding and fluid retention. Currently there are no therapies available to reverse the scarring of the liver but this may be a possibility in the future with exciting advances being made at present at a research level.  The only effective treatment at present for end-stage cirrhosis where the liver has failed is liver transplantation.  Consultation with your general practitioner and gastroenterologist will advise you of your possible treatment options.

Prevention - Prevention of cirrhosis is possible when the diseases that cause chronic liver injury are detected early and where treatments are available.  



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Coeliac Disease

People with coeliac disease have an immune reaction to gluten, resulting in intestinal damage. The treatment is a gluten-free diet for life.  People with wheat allergy or who have been advised to follow a low-gluten diet, but who have not been diagnosed with coeliac disease should check with their doctor or dietician first before commencing a strict gluten-free diet.

Gluten is a protein found naturally in certain grains, namely wheat, barley, rye and triticale. Oats may also be contaminated with wheat and currently are not permitted on a gluten-free diet.  Many common foods in Australia are therefore a source of gluten eg. bread, pasta, biscuits, because they have ingredients made from gluten-containing grains.  Some food additives eg. malt extract, thickening agents, may also contain trace amounts of gluten.

Label reading is a vital part of shopping for gluten-free foods.  The good news is that the choice of gluten-free products has expanded significantly over the last five years and new legislation requires food manufacturers to state on their labels if any of their ingredients contain wheat or gluten.  Health food stores as well as the health food section of the major supermarkets usually display a range of commercial gluten-free foods and many ordinary foods are still suitable.

If you have newly-diagnosed coeliac disease, here are the basic recommendations to follow for the gluten-free diet.

  • Replace gluten-containing foods with gluten-free alternatives.
  • Eat a variety of foods from the different food groups for nutritional adequacy.
  • See a dietician for individualised diet counselling. This is particularly important if you also have other related nutritional concerns such as weight loss, lactose intolerance, iron deficiency or low bone mineral density.
  • Consider joining the Coeliac Society of Australia which provides invaluable support, information and practical advice to people with coeliac disease.  



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Constipation

Constipation is when there are less than 3 bowel movements per week.  Constipation is hardly ever harmful.  If you pass only two bowel movements per week but are reasonably comfortable, no specific treatment is required.  Constipation is a very common complaint, especially in women, children and the elderly.

Symptoms - Less than three bowel movements per week.  There are many causes of constipation, with poor dietary fibre and fluid intake being amongst the most common. 

If there has been a change in bowel habit, especially if you are over 50 years, you should discuss this with your doctor who may suggest a test for bowel cancer such as colonoscopy or barium enema (x-ray).  Sometimes blood tests are performed to look for thyroid problems, or high calcium levels.

Treatment - Increasing the fibre in the diet clearly makes people have more frequent bowel movements.  Fibre is contained within cereals, breads, fruit and vegetables and also in simple supplements such as psyllium.  Increasing fibre should be done slowly, otherwise bloating and gas may be more of a problem.  Fibre only works if you are having enough liquid with it.  You should have 6-8 glasses per day. 

Caffeinated beverages such as tea, coffee, and some soft drinks actually make you lose more fluid and should therefore be limited.  Try taking a water bottle to work or when travelling! Regular gentle exercise may also help the bowels work.  Simple advice: When you have the urge to open your bowels, you should try to make time to go to the toilet at that time.  Putting it off can make constipation worse.  You should avoid straining as this can cause further problems.  Your bowel is naturally more active in the early morning and after meals and so you should consider attempting to have a bowel movement at these times.

Prevention - A diet high in fibre, along with a good liquid intake is important in preventing constipation.  It is important to consume more fluids when exercising or travelling.  Some medications that cause constipation should be avoided such as calcium tablets and iron tablets.



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Crohn's Disease

Crohn's disease is an inflammatory disease of the digestive tract which can involve any part of the gut from the mouth to the anus, although it commonly involves the small bowel (ileum) and colon (large bowel).  The disease often is a patchy one with segments of normal bowel. The bowel wall becomes swollen, thickened and often ulcerated producing narrowing and sometimes perforation.

Treatment - Treatment may be medical (with drugs and diet), or by surgery when the disease fails to respond to drugs or when complications such as perforation or abscess occur. Drug treatments include cortiesteroid (cortisone), immunosuppressants, antibiotics, and aminosalicylic acid compounds.

Prevention - The cause of the disease is unknown and no preventive measures are known.



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Cryptosporidiosis

A postradiation cryptosporidiosis is an infection with the protozoan organism cryptosporidium. Although there are 20 different species of cryptosporidium, only one causes infection in humans - cryptosporidium parvum.   Infection occurs following ingestion of contaminated food or water.  It was first recognised as a cause of diarrhoea in 1976.

Symptoms - After a 7 day incubation period diarrhoea and abdominal cramping may occur. The illness is often mild in those people with a normal immune system.  Severe and protracted diarrhoea with wasting and abdominal cramping is seen with immune suppression.  Patients with HIV AIDS may also have the infection in the bile ducts and gall bladder.

Treatment - The diagnosis is usually made by examination of the stools microscopically or by examination of biopsy material taken from infected parts the gastrointestinal tract at the time of endoscopy.  Although drugs such as paromomycin and azithromycin have been tried in those patients with HIV AIDS, the effects have only been temporary and the organism and the diarrhoea it causes continue long term, often with marked weight loss.

Prevention - Boiling or filtering water may be helpful in the immune suppressed, together with avoidance of oral contact with water from lakes, streams and public swimming pools.  However these measures are unproven.



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Diverticulosis

Diverticulosis is the presence of small pouches (diverticula) that bulge out through weak spots in the wall of the bowel.  The pouches can occur anywhere in the digestive tract but most commonly in the large bowel, especially the sigmoid and descending colon.  Diverticulitis is inflammation or infection of these pouches.

Symptoms - Most people with diverticulosis have no symptoms.  Mild cramps, bloating and constipation may occur but these symptoms are common and occur with other conditions also. Diverticulitis causes abdominal pain and tenderness especially in the left side of the abdomen. Depending on the severity of the inflammation fever, nausea and vomiting may occur.  Rarely, complications such as abscess formation, perforation of the bowel and peritonitis can occur. These complications can be serious and always require treatment, usually in hospital.  Rarely, bleeding can occur from a weakened blood vessel in a diverticulum.  The bleeding can be profuse but often stops by itself without treatment.

Treatment - Increasing the intake of dietary fibre (cereals, fruit and vegetables) may improve constipation and reduce symptoms of diverticulosis.  It may also reduce the risk of developing complications like diverticulitis.  In addition a fibre supplement may be advised.  Some doctors used to advise avoiding food with small seeds and nuts because of the fear that these may get caught in the diverticula.  Most doctors now believe that these foods are more beneficial than harmful.  If diverticulitis develops, treatment is aimed at eradicating the infection and inflammation.  Usually antibiotics are prescribed together with a liquid diet to rest the bowel.  If the attack is severe or doesn't respond to antibiotics by mouth, admission to hospital for intravenous antibiotics may be necessary.  Most attacks settle down with treatment and with attention to diet don't recur.  Once the attack settles further investigation is usually required to make sure that the diagnosis was correct and that there is no other serious problem in the bowel.  Bowel cancer can sometimes cause very similar symptoms and would need further treatment.

Prevention - Eating a healthy diet containing sufficient grains, fruit and vegetables from an early age should reduce the chance of developing diverticular disease.  Diverticular disease is common in developed countries where low fibre diets are common.  The disease is rare in the countries of Africa and Asia where people eat high fibre diets.



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Faecal Incontinence

If there is a change in the way the bowels are functioning it should be discussed with your doctor.  Sometimes testing to check for bowel cancer should be performed, especially if you are over 50, or have any bleeding from the bowel.  Tests of the anal sphincter are relatively simple and easy.  A simple, small measuring tube is placed in the anal canal and tests the strength of the muscles, the sensation and the nerve function.  An ultrasound scan of this region may also be very useful to detect if the muscle is damaged.

Treatment - When the stool is loose, it is important to try things to bulk or firm up the stool. Adding some fibre to the diet, such as contained in breakfast cereal, fruit and vegetables should be tried in the first instance.  If you prefer, you can take a supplemental fibre such as psyllium, available in supermarkets, chemists and health food stores.  In a few patients, increasing the fibre will lead to ongoing loose stools, and sometimes trying to actually reduce the fibre in the diet may help.  Medications are available over the counter to treat faecal incontinence.

Prevention - Effort should me made to avoid excess straining.  Pelvic floor exercises in women may also be helpful.



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Fatty Infiltration of Liver

Fatty infiltration of the liver is an accumulation of fat within liver. It is the commonest cause of abnormal liver blood tests which is sometimes associated with inflammation and scarring within liver, however it rarely progresses to cirrhosis and liver failure.

Treatment - Treatment is dependent on cause eg. a low fat diet; reduction in alcohol consumption; improvement in the control of diabetes.



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Focal Nodular Hyperplasia

FNH is a much more common tumour than liver cell adenomas.  FNH is more common in women but the gender difference is less striking than that of liver cell adenoma.

Symptoms - The vast majority of patients with FNH do not have symptoms referable to their liver lesions.  However, pain sometimes occurs and this may be due to bleeding.



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Gallstones

Gallstones are collections of crystals made up of cholesterol, bile salts or bile pigments. These crystals solidify within the gallbladder or bile ducts in certain people and may result in the symptoms described below.  Gallstones range in size from microscopic crystals to large stones the size of a golf ball. They occur commonly in western societies, with their frequency in the population increasing with age. Approximately 10-15% of the population of developed nations has gallstones. 

Cholecystitis is inflammation of the gallbladder that usually occurs due to obstruction of the flow of bile by a gallstone. The symptoms associated with this condition are described in detail below.

Symptoms - Many gallstones do not cause any symptoms at all and are detected incidentally on tests done for other reasons.  These stones do not usually require any treatment unless they become symptomatic at a later date.  When a gallstone moves out of the gallbladder into the bile ducts this can lead to symptoms such as upper abdominal pain (which commonly radiates around the abdomen and up into the shoulder blades), nausea, vomiting, fever, night sweats, jaundice, dark coloured urine, and light coloured faeces.  If the gallstone passes out of the bile duct into the duodenum spontaneously, these symptoms resolve without any specific medical intervention.  

However, if the stone becomes blocked inside the bile ducts, these symptoms may be prolonged and may recur at intervals of days, weeks or months.  One potential complication of the passage of a gallstone down the biliary tree that may occur is a condition known as pancreatitis.

Pancreatitis is inflammation of the pancreas gland caused by an elevation of pressure within the pancreatic duct, which may occur when a gallstone becomes impacted at the opening of the biliary tree into the duodenum.  This is associated with severe abdominal pain that may radiate through to the back, and over the entire abdomen.  It is diagnosed on blood tests, and by ultrasound or computerised tomography (CT) scanning, and requires hospital treatment. It is a potentially very serious condition and requires urgent medical attention. Prolonged obstruction to bile flow may also result in inflammation of the gallbladder itself known as cholecystitis.

Symptoms of cholecystitis are similar to those described above, and the diagnosis is usually confirmed on ultrasound or nuclear medicine scanning of the gallbladder.  Cholecystitis usually requires admission to hospital for intravenous fluids, antibiotics and possible surgery to treat the disorder.

Treatment - During an episode of biliary colic where a gallstone is passing down the common bile duct, patients will often require significant amounts of pain relieving medication to relieve their symptoms of discomfort.  Patients experiencing these symptoms should seek medical advice.  Simple analgesics such as paracetamol may provide limited relief.  More commonly smooth muscle relaxants such as hyoscine butyl bromide (Buscopan) are used orally or as an intravenous injection to relieve the pain.  On some occasions it may be necessary for patients to be given narcotic analgesics such as pethidine if pain is not controlled by other measures.  If there is evidence of infection within the biliary tree, patients may require oral or intravenous antibiotics.

Prevention - Most gallstones are made of cholesterol.  Diets that are high in cholesterol or saturated fats, and low in fibre, may predispose to formation of gallstones.  Dehydration and constipation also appear to play a role in predisposing to bile salts precipitating to form gallstones and should therefore be avoided.  



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Gastric Cancer

Gastric cancer is a tumour of the stomach.  There are different types of tumours of the stomach and these may be either benign or malignant. Benign stomach tumours include simple metaplastic polyps and small leiomyomas which have no potential to spread elsewhere. On the other hand, malignant tumours (cancers) have the potential to spread beyond the stomach and may be lethal.  The most common type of malignant tumour of the stomach is an adenocarcinoma.  Other rarer types include carcinoid tumours and gastric lymphomas.

Symptoms - Gastric cancer can be hard to detect early.  Often there are no symptoms in the early stages and, in many cases, the cancer spreads before it is found.  When symptoms do occur they are often vague and people usually ignore these symptoms.  However, gastric cancer can cause the following: indigestion or heart burn; discomfort or pain in the upper abdomen; nausea and vomiting; diarrhoea or constipation; bloating of the stomach after meals; loss of appetite; weakness and fatigue; and bleeding (vomiting blood or having blood in the stool). Any of these symptoms can be caused by other problems and therefore may be confused with the symptoms of gastric cancer.

Treatment - Treatment for gastric cancer depends on the size, location and extent of the tumour.  The treatment options also depend on the stage of the disease and the patient's general health.  Cancer of the stomach is often difficult to cure unless it is found in the early stage before it has begun to spread.  However, advanced cancer can be treated and certainly the symptoms can be relieved.  Treatment of stomach cancer may include surgery, chemotherapy and/or radiation therapy. 

Surgery is the most common treatment for stomach cancer and the operation to remove a stomach tumour is called a gastrectomy.  The surgeon may remove part (sub total or partial gastrectomy) or all (total gastrectomy) of the stomach as well as some of the tissue around the stomach.  After removing the stomach the surgeon reconnects the remaining part of the stomach or the lower part of the oesophagus to the small intestine.  The lymph glands are also usually removed and the histopathologist will examine these to see if the tumour has spread beyond the stomach.  

Other options for treating gastric cancer include chemotherapy which is the use of drugs to destroy cancer cells.  

Prevention - There are a number of possible causes of gastric cancer. These include dietary factors, genetic factors and possibly infection by helicobacter pylori.  There is evidence to link helicobacter pylori infection with the early changes associated with gastric cancer and some data to suggest that helicobacter pylori should be eradicated to prevent gastric cancer.



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Gastro-Oesophageal Reflux Disease

Irritation and damage to the lining of the oesophagus due to the reflux or regurgitation of gastric juices (acid and pepsin) or bile (bile reflux).  The condition usually relates to weakness of the lower oesophageal sphincter (reflux valve) and reduced oesophageal peristalsis (or contractions).  This tends to produce heartburn and indigestion. Reflux is very common - up to 40% of the population experience some degree of heartburn occasionally.  The condition may vary greatly in its severity and frequency.

Symptoms - Usually produces heartburn or 'acidity', felt in the chest often radiating to the throat.  Occasionally reflux produces belching and food regurgitation and an acid taste in the mouth (waterbrash).  When severe reflux may interfere with normal swallowing, or produce painful swallowing.

Treatment - Reflux tends to be aggravated by certain foods and drinks - spicy food, fat, acidic foods, alcohol and coffee.  There is much individual variation, but dietary modification may help.  

Prevention - Dietary observance, weight loss, position and posture - elevation bed head and surgery may help.  Chronic reflux may be associated with the development of Barrett’s oesophagus, in which there is a change in the lining tissue of the lower oesophagus.  It is thought that this ‘metaplastic’ tissue may have a malignant (cancerous) potential.



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Giardia Lamblia

This is a larger organism than a bacteria or virus and it colonises the duodenum and upper small bowel. 

Symptoms – Giardia Lamblia causes a wide variety of symptoms, varying from no symptoms at all to marked diarrhoea and malabsorption of nutrients in extreme cases.  The diarrhoea may be intermittent and accompanied by a good deal of gas and wind.  Weight loss may occur in severely affected people.

Treatment - It can be diagnosed by examination of the stool (bowel motion), although this may be unreliable.  It can also be diagnosed by taking samples from the upper small bowel (duodenum) at endoscopy.  

Prevention - As the organism is spread by contaminated water, a clean water supply is essential.  If travelling overseas in areas of high risk, using a filter or boiling the water may be effective.



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Gilbert's Syndrome

Gilbert’s syndrome is due to a congenital defect in clearance by liver of bilirubin (a waste product in bile).  The condition is harmless.

Symptoms - Does not cause any symptoms apart from occasional jaundice. Fasting results in a sharp increase in bilirubin level in blood and may bring out jaundice.

Treatment - No treatment necessary.



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Helicobacter Pylori

This is a bacterium that was first discovered by an Australian, Dr. Barry Marshall, in 1983.

Symptoms - Apart from causing duodenal and gastric ulcers (which it does only in a minority of people infected), it also causes gastritis or inflammation of the stomach wall.  Gastritis looks like a severe rash on the inside lining of the stomach when it is viewed by endoscopy.  An ulcer is a defect or shallow crater and is a more serious problem than gastritis, as it can be complicated by bleeding or perforation.

Helicobacter Pylori can cause pain in the upper abdomen if it has caused an ulcer, but it can also cause indigestion, excessive burping and bad breath.  It can be diagnosed by three main methods- a breath test which requires a person to breathe into a tube after fasting for hours;  A blood test; or an endoscopy for direct visual inspection of the stomach, together with a sample taken directly from the stomach to analyse for the bacteria.  Portocaval has the advantage of not only checking for the presence of the bacteria but also it can tell if the bacteria has caused any damage such gastritis or ulcer.

Treatment - Because it is a bacterium and not a virus, it can be treated with antibiotics. However it is sometimes difficult to eradicate and usually needs at least three medications taken for one or two weeks to get rid of the organism.  Even with three different medications, upper to 20% of people will not eradicate the organism.  

Prevention - Currently there is no effective vaccine and no easy way of preventing infection, which appears to the spread by person to person close contact.



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Hepatic Adenomas

Liver cell adenoma is an uncommon benign liver tumour that was found very rarely prior to the introduction of the oral contraceptive 40 years ago.

Symptoms - These tumours do not usually cause symptoms but may cause discomfort or pain in the right upper abdomen and rarely may cause life-threatening bleeding into the peritoneal cavity.

Treatment - Surgical removal is frequently recommended for these tumours to eliminate the risk of bleeding and to prevent the development of liver cell cancer.



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Hirschsprung's Disease

A disease affecting the nerve cells of the colon, resulting in constipation.  It usually presents in infancy and childhood as the child is unable to have normal bowel movements.

Symptoms - Symptoms include constipation, bloating, distended abdomen and vomiting.



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Irritable Bowel Disease (IBD)

A general term for any disease characterised by inflammation of the bowel.  Examples include ulcerative colitis and Crohn's disease.  Symptoms include abdominal pain, diarrhoea, fever, loss of appetite and weight loss.  Inflammatory bowel disease should not be confused with Irritable Bowel Syndrome (IBS). 



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Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is a disorder of the intestine that affects motility and causes abdominal pain, bloating and irregular bowel movements (constipation and/or diarrhoea).  It used to be known in the past as spastic colon or colitis or irritable colon.  IBS should not be confused with irritable bowel disease (IBD).  IBS is one of the commonest gastrointestinal disorders. 



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Lactase Deficiency

Lactose is a dietary carbohydrate or sugar which is split into its two component single-sugars (glucose and galactose) by lactase, an enzyme found in the lining of the small intestine.  Unless lactose is successfully broken down by lactase, it cannot be effectively absorbed across the small bowel lining into the body.  It is then wasted, passing down through the small intestine and reaching the colon or large bowel.  Here the unabsorbed lactose causes diarrhoea and is fermented by the normal bacterial flora in the colon.  The generated gas contributes to pain, bloating, cramping and flatulence.

Symptoms - The symptoms, namely abdominal pain, cramping, diarrhoea, bloating and flatulence, overlap with those of irritable bowel syndrome and can be difficult to distinguish. 

Treatment - There are a variety of ways in which lactase deficiency can be diagnosed. These include assessment of lactase levels in endoscopic biopsies of the small bowel, an oral lactose tolerance test (where blood levels of glucose are measured at times after ingesting a given amount of lactose) and a breath test.

Avoiding milk products usually alleviates symptoms.  If dairy products are being restricted then consideration needs to be given to calcium supplementation to help prevent osteoporosis (weak bones) in the future.



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Liver Cysts

Cysts are spaces occurring in organs that may contain only air or may be filled with liquid or solid contents.  Most cysts that occur in the liver are filled with clear fluid.

Symptoms - They usually do not cause any symptoms.  However, when small cysts become large they can cause abdominal discomfort or pain.  They are usually hereditary and totally benign.  Cysts may be due to parasites particularly amoebic and hydatid cysts.

Treatment - Ultrasound or CT scans of the abdomen are used to evaluate liver cysts.  Simple (hereditary) cysts are common and do not require treatment unless they are causing symptoms.  If treatment is required, the cysts can be drained through a needle placed in the cyst under radiological control.  Rarely cysts need to be surgically repaired.



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Non-ulcer Dyspepsia

Non ulcer dyspepsia is a term often used to indicate the presence of dyspeptic symptoms for which no cause can be found after standard gastrointestinal investigations.  Another term for this condition is "functional dyspepsia" - this is a more useful term, as it highlights that the symptoms are very likely due to a disturbance of stomach or upper bowel function, rather than physical disease.

The diagnosis is based on the presence of specific symptoms, and ruling out other conditions. Common tests to rule out the presence of a stomach ulcer include upper gastrointestinal endoscopy, and to exclude gall stone disease ultrasound scanning of the abdomen.

Treatment - The precise causes of functional dyspepsia are not known.  Certain dietary changes and medications may, however, lessen the symptoms.  For example, some symptoms can be reduced by avoiding spicy or fatty food.  If fullness after eating, or bloating or nausea occurs it may be helpful to eat six small low fat meals per day.  Some patients also find that the symptoms lessen if they avoid drinking coffee or alcohol or stop smoking.  Medications are not generally helpful for the condition. Some patients, however, find that medications used for stomach ulcers can help, while other patients find that medications to improve the emptying of the stomach may help.

Prevention - Because the causes of non ulcer dyspepsia have not been clearly established, preventive measures are not known.However, some factors such as chronic stress can affect the muscular actions and sensitivity of the stomach, so that it is overly reactive when food enters and needs to be digested.  When there are specific foods which can provoke the symptoms these can be identified and the symptoms improved by avoiding or reducing these type of foods in the diet.



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Pancreatitis

Pancreatitis is inflammation of the pancreas.  The two main forms of this condition are "acute" and "chronic".  Both are relatively common reasons for people to consult gastroenterologists or present to hospital emergency departments.

Treatment - Acute pancreatitis - one of the main problems in treating an established episode of acute pancreatitis is the lack of effective medications for the condition.  If gallstones are involved, a special form of endoscopy called ERCP (Endoscopic Retrograde Cholangio-Pancreatography) is often helpful, as a relatively non-invasive way of clearing the offending gallstones form the ducts.  Otherwise, treatment consists of resting the pancreas, by fasting, and maintaining hydration and nutrition intravenously.  Chronic pancreatitis - the management of chronic pancreatitis revolves around attempts to control the pain and efforts to correct the disordered absorption which causes the diarrhoea, by using capsules of pancreatic enzymes taken with meals.  ERCP and surgery sometimes play a role.

Prevention - Avoidance of excess alcohol intake.



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Peptic Stricture

A peptic stricture is a narrowing of the normal diameter of the oesophagus (gullet) due to (usually) longstanding gastro-oesophageal reflux, corrosive gastric acid and pepsin, (a digestive juice), and sometimes by bile reflux causing scarring and 'fibrosis' of the lower oesophagus.

Symptoms - Peptic strictures usually cause difficulty with swallowing (dysphagia), sometimes causing a lump of food acutely blocking the oesophagus (food bolus obstruction), slow or painful swallowing.  This may also produce a cough or an inhalation of food into the windpipe or lungs and sometimes food regurgitation.

Treatment - Peptic strictures usually require to be stretched by a rigid dilator or balloon.  This can be performed through the mouth at the time of an endoscopy.  Ongoing treatment to prevent further acid reflux is very important.  Occasionally surgery is required to treat the narrowed area.

Prevention - Peptic strictures can be prevented by the treatment of GORD (gastro-oesophageal reflux disease).



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Primary Hepatocellular Carcinoma

Cancer arising from within the liver.

Treatment - Treatment include: surgical resection, liver transplantation, alcohol injection into tumour, radiofrequency ablation, chemotherapy.

 


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Ulcerative Colitis

Ulcerative colitis is a chronic disease of the colon (large bowel) caused by in inflammation of its lining (mucosa).  Ulcerative colitis may involve just the rectum proctitis or a variable section of the bowel, usually in a continuous fashion.  Its cause is unknown.  It does not affect other parts of the gut.

Symptoms - People with ulcerative colitis complain of diarrhoea, usually with the passage of blood and mucus with the stool.  Cramp-like pain and an urgency to go to the toilet are common symptoms.  Bowel frequency is increased.

Treatment - Medical treatment includes the use of corticosteroids, (cortisone), administered as enemas or suppositories or as tablets or intravenous form.  Salazopyrin is an aspirin like drug which is useful, especially in preventing relapse.  Immunosuppressants are also commonly used.  Surgery is occasionally needed when the disease cannot be controlled by drugs or when cancer risk is heightened.

Prevention - Regular colonoscopic screenings may be necessary to minimize risk of cancer developing, or finding it at an early stage.  Surgery can usually be performed to avoid a colostomy and effectively 'cures' patients of the disease.



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Viral Hepatitis

Viral hepatitis is an inflammation of the liver resulting from a viral infection.  Numerous viruses can cause liver disease as part of their infection of humans. 

There are however six viruses currently known that, when causing disease in humans, primarily affect the liver.  These viruses have been named Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D (delta hepatitis), Hepatitis E and Hepatitis G.  These viruses are not related to each other and whilst they can cause similar symptoms, have different patterns of disease.  Hepatitis G has not been proven to cause symptoms or liver disease in humans and its relevance is still under investigation.

Symptoms - Viral hepatitis can affect the liver in two major ways.  Acute hepatitis can cause symptoms ranging from being asymptomatic and in apparent to rarely, serious life threatening illness depending on the individual virus and circumstances.  Hepatitis A and E only cause acute hepatitis and do not cause chronic liver disease.  Hepatitis B, C and D however can cause hepatitis in a proportion of patients that continues and is classified as chronic.  The symptoms of acute viral hepatitis are similar despite being caused by different viruses.

Prodromal symptoms may precede the onset of jaundice (yellow discolouration of the skin and sclera) by 1-2 weeks.  These symptoms can be variable and include loss of appetite, nausea and vomiting, fatigue, muscle and joint pains, headache and fever.  Dark urine and clay-coloured stools may be noticed from 1-5 days prior to the onset of noticeable jaundice.  With the onset of jaundice, prodromal symptoms usually diminish though the liver can become tender and enlarged.  As the jaundice resolves, a recovery phase where minor liver test abnormalities and liver enlargement are still evident, occurs that can last several months.  A substantial proportion of patients with viral hepatitis never become jaundiced.  The most serious complication of acute viral hepatitis is ‘fulminant hepatitis’.  Fortunately this is a rare event.  It is primarily seen in Hepatitis B and D but can occur with the other viral types.

Patients usually present with signs of liver failure.  The mortality rate is high but patients who survive may have a complete recovery.  Liver transplantation may be required.  Depending on the type of viral hepatitis, the virus may persist after acute infection and cause chronic hepatitis. Chronic hepatitis may be associated with no symptoms but sometimes can cause non-specific symptoms such as fatigue and decreased appetite.  If chronic hepatitis persists and causes increasing liver damage, cirrhosis may develop. 

Patients may then have symptoms related to significant liver damage such as fluid retention manifested by abdominal or ankle swelling, gastrointestinal bleeding, bruising or confusion.  In a small proportion of patients, progressive liver failure develops which finally leads to death if no treatment such as a liver transplant can be performed.

Treatment - The treatment of viral hepatitis depends on whether it is an acute or chronic infection, the type of virus involved and the symptoms of the patient.  There is no specific treatment for acute viral hepatitis.  Most patients do not require hospital care.  Treatment is mainly supportive and rest is important.  If severe symptoms develop, hospitalisation may be required and in some cases, if fulminant hepatitis occurs, a liver transplant may be necessary.

Chronic hepatitis occurs with Hepatitis B and Hepatitis C.  There are now specific therapies available for treatment of these viruses.  Patients with chronic hepatitis B or C require full evaluation by their medical practitioner and probable referral to a specialist gastroenterologist or liver clinic.

Prevention - Prevention of viral hepatitis can be subdivided into general and specific measures. General measures are important such as hygiene and avoiding infected water or foods by travellers to areas where hepatitis A or E are endemic.  Hepatitis B and C are commonly spread via the injection of illicit drugs.  Vaccination is a specific way to prevent viral infection. Vaccines are available for Hepatitis A and B. 

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Real Life Stories

Peter F's story (41, NSW)

1

Buying a $40 FOBT kit is so much cheaper when compared to your life. I was diagnosed with bowel cancer at the age of 40 after finally getting around to using an FOBT kit. I had purchased the kit in June 2012 and it sat in my cupboard until I finally used it in early September. The results came back positive....

Lynette's story (73, VIC)

1

I was diagnosed with bowel cancer at 72 – just two weeks shy of my 73rd birthday. I’d experienced a little bit of rectal bleeding, but initially thought it was nothing and would go away. When it didn’t, I visited my GP who recommended a colonoscopy....

John S' story (65, NSW)

1

I was diagnosed with stage one bowel cancer at the age of 62. Everything seemed to happen so quickly. I took part in the Rotary Bowelscan program in April and in early June received notification that my test results were positive. I saw my GP on 6 June and she booked a colonoscopy for 7 July. Just four days later I was having an x-ray and CT scan, which revealed a 4cm tumour on my sigmoid colon. By the end of July I had seen a surgeon, who recommended an operation to remove the tumour and outlined my treatment options....

Barbara's story (60, NSW)

1

I had a bowel cancer test in November 2006 which came back all clear, therefore when symptoms started occurring in February 2007 I ignored them, at the age of 57, blamed my new job, the change of lunch hours etc. Initially the symptoms were changes in my bowel habits, rectal bleeding with froth and bubbles. Eventually the symptoms started to get serious, with some stomach pain, a heaviness in the back passage and generally feeling uncomfortable. In September 2007 I couldn’t ignore any of this any longer....

Milly's story (30, VIC)

1

I believe it is important for all of us to fight to be healthy. After experiencing years of diarrhoea and stomach pain, Mum was diagnosed with bowel cancer at age 55. After a urinary infection that persisted, Mum’s doctor suggested an ultrasound where ‘masses’ were discovered on her bowels. She was then referred for an abdomen scan....

Geoffrey's story (70, NSW)

1

Six years ago at 64, I began to notice blood in my stool and reported it straight away to my GP, who referred me to a colorectal surgeon.  A colonoscopy revealed cancer and an operation was recommended as my best option. I’d estimate that from the moment I noticed the blood to finally being operated on took no more than six weeks, which isn’t very long to come to terms with the fact of bowel cancer.  I was given an ileostomy during surgery, which also took some getting used to....

Sinead's story (31, NSW)

1

I was only 26 when I went to my doctor concerned about changes in my bowel habits and feeling very tired. My doctor put it down to stress which frustrated me because I felt I wasn’t being listened to. I went to the ED and remember crying saying, “I know there is something wrong with me”. Coming from a medical background (registered nurse) I demanded to speak with a gastro specialist. The doctor who came along spoke and listened to me as human being, he was empathetic and asked the right questions. He s...

David G's story (51, NSW)

1

I was diagnosed with bowel cancer (first stage) at the age of 51 as a result of a routine check-up with my GP. Previously I had no symptoms or warning signs of the cancer. During a check-up with my GP I asked about the Government Screening Kit which I had received but ignored. My GP handed me another kit and recommended I do it. I undertook the stool test which came back positive. My GP recommended I have a colonoscopy as soon as possible - it was booked and undertaken two weeks later. Three weeks later I went in for s...

Felicity's story (38, VIC)

1

In August 2010 my life changed forever.  Nothing can prepare you for a bowel cancer diagnosis at just 38 years old.   I had been given what I thought was a routine colonoscopy to investigate the cause of my iron deficiency, which my doctor thought was probably due to an ulcer. But as I lay in bed in the recovery room after being told they had found a tumour, I remember thinking: ‘I’m too young.  I have a husband and two young boys.  This can’t be happening to me’.  ...

Sandy's story (38, NSW)

1

Was it not for me having a totally random check-up back in 1999, I would not be alive today.  Still to this day I’m not quite sure what got me to go and have a check up as I was fit and healthy, but what happened next still amazes me. My Gastroenterologist calls me the “luckiest girl in the world” as having that check up saved my life.  Being told at 28 years old that had I not come in for a check-up I would have only had a couple of years to live was a huge wake up call for me.   So to me...

Stacey B's story (29, WA)

1

I went to my GP in early 2009 complaining of tiredness and lethargy, rectal bleeding and a change in my bowel habits.  But because of my age and the fact that I had recently given birth, I was given only a blood test and told that further investigation wouldn’t be necessary.  The blood test showed low iron levels so my tiredness was put down to that....

Ron's story (60, VIC)

1

I’d had rectal bleeding and unusual bowel habits for six to eight weeks before going to see my GP in 2008. I was 60 at the time. My GP gave me an internal examination but found nothing. Nonetheless, he was insistent that I see a specialist and made the call while I sat in his surgery, getting me an appointment for the very next day.  I had a colonoscopy within the week and was diagnosed with stage III bowel cancer.  I had a CT scan the next day, then an ultrasound for tumour staging....

Hollie's story (24, WA)

1

Despite experiencing horrible stomach pains and bloating and visiting a few different GPs about my symptoms, I was told I had IBS and female problems. My mother has Crohns so I finally found a GP who would send me for a colonoscopy to test me for this. After being on the waiting list for a while I finally had a colonoscopy in April 2011; however, it had to be abandoned due to the extreme pain I suffered during the procedure. I was scheduled to have another colonoscopy as they had found a polyp during the first procedure. Th...

Cherie's story (24, WA)

1

I was diagnosed with bowel cancer at the age of 24. Over the period of a few months, I noticed that the urge to go to the toilet was becoming more frequent but I assumed that was because I was pregnant. The other key symptom was severe pain in my tailbone area. I would later find out that this was where the tumour was, though at the time it was also attributed to pregnancy....

Carol's story (63, QLD)

1

The main symptom that led to my diagnosis of bowel cancer was a change in my bowel habits, which I discussed with my GP. I was referred to a gynaecologist who diagnosed a uterine prolapse, which affects the working of the bowel, and was sent to a physiotherapist who put together an exercise program for me to help with the problem. When I went back to the gynaecologist after 12 months as requested, I was still having bowel problems so he recommended a colonoscopy....

Adam's story (25, NSW)

1

I was diagnosed with stage 3 bowel cancer two years ago at the age of 23.  I had been experiencing a range of symptoms for about five years, including rectal bleeding, mucous in my stools, diarrhoea, stomach pain and cramps to changes in my bowel habits.    Coincidentally, my mother was also having these problems, so we were both seeing a doctor to try to discover their cause....

Carolyn's story (45, VIC)

1

When I was diagnosed with stage III bowel cancer in 2006, I was 45 years old. I am a wife and a mother of three (now 23, 20 & 16 years old) and an office manager.  I had no family history of bowel cancer and I led a healthy lifestyle before my diagnosis, although I was told further along the process that I carry the HNPCC gene, which is a strong indicator of the disease. ...

Trevor's story (40, QLD)

1

Life was quite normal, albeit very busy with a young family and a very time consuming career.  Things changed for me one night when I experienced severe stomach pains after eating a chicken sandwich and immediately self-diagnosed myself with "food poisoning."  The next morning I was severely sick and started to vomit. At this stage I thought I was getting better as I had got it all out of my system....

Peter's story (62, QLD)

1

I was first diagnosed with a hernia, which seemed to explain the changes in my bowel habits and the stomach pains I had been experiencing. But in the lead up to the Easter long weekend in 2009, I started feeling pretty unwell. We had family arriving so I didn’t really want to make a fuss – we were meant to be enjoying Good Friday together, after all – but I felt much worse as the day went on and started vomiting....

Brent R's story (32, VIC)

1

I’ve seen the effects of bowel cancer first hand and know I never want to go through it. My Dad was diagnosed with bowel cancer in February 2000. He was just 49 years old. He had had some rectal bleeding and back pain so went to the GP who sent him for a colonoscopy. After this plus scans and blood tests, Dad was diagnosed with bowel cancer which had spread to the liver. He had successful surgery to remove the cancer from the bowel but when the surgeons opened him up to remove the tumour from his liver, they discovere...

Eve's story (51, VIC)

1

I have been a vegetarian for over 30 years, have never smoked and have drank very little alcohol – so to get bowel cancer has been such a rude awakening. I feel I no longer have the security of my health and I worry that the cancer could come back at any time… I first started feeling something was wrong in January 2008. I suffer from many auto immune problems, including Sjogren’s syndrome which causes irritable bowel type symptoms (this threw my GP off the scent and complicated the situation even more)....

Hazel's story (58, SA)

1

If you have any irregularities in your bowel movements, don’t ignore it. See your GP straight away and don’t be embarrassed! The whole experience of being diagnosed with bowel cancer has been emotionally devastating for me. In February 2010, I noticed blood in my faeces and made an appointment to see my GP. I’d had bleeding from haemorrhoids before but this was different. I had also been experiencing an urgency to open my bowels for a few years which I had put down to my history of haemorrhoids....

Paula's story (54, WA)

1

I was diagnosed in 2008 when I was 54. I had been complaining to doctors for years about various symptoms but I was never sent for tests – not even a bowel screen – until I started bleeding from the rectum. I’ve been an athlete for more than 26 years, competing in marathons, triathlons, even an IronMan event. When you run a lot, diarrhoea is quite common, so everyone – including doctors – kept telling me that my various symptoms were the result of an intense training schedule. I knew things wer...

John's story (40, QLD)

1

I started experiencing a change in my bowel habits, stomach pains and rectal bleeding in February 2010 so I saw my GP and was sent for blood tests to investigate the cause of the problems. The results came back normal. However, a month later when the bleeding persisted I was referred for a colonoscopy in mid April. The colonoscopy revealed a 4cm tumour on my sigmoid colon....

Sandra's story (49, SA)

1

In 2008 I had lap band surgery to help reverse obesity. Since having the surgery, I have had routine blood tests every six months. Prior to one check-up appointment, I noticed a speck of blood in the toilet so during my consultation with my GP (and after she had written a referral for my bariatric specialist) I told her about the blood in the toilet. Straightaway she added this piece of information to the referral just to be sure....

Janice's story (29, NSW)

1

 My father was a fit and healthy man. He ate well, never smoked, almost never drank to excess and played a lot of sports. As a result of old work and football injuries, he suffered from chronic knee and back pain for many years. He also suffered frequent digestive upsets, which he rationalised to be a side-effect of the anti-inflammatory medication he needed to take for his pain....

Helen's story (65, NSW)

1

Unlike many people, I had a lot of symptoms before I was diagnosed with bowel cancer.     I saw my doctor many times about the ongoing pains in my stomach, back and bottom and the mucous in my bowel motions but was told I was probably suffering emotional strain or irritable bowel syndrome.     I was given blood tests but they never revealed anything significant.  It felt like doctors gave me the run-around for nearly a year until I finally found one who took me seriously. ...

Vicki's story (57, NSW)

1

Some people are known for their sense of humour, some for their compassion, others for their courage.  Anyone who knew bowel cancer victim Vicki Morris will tell you she was all of this and more. Vicki’s husband Peter writes:  Cancer is one of those things that you think happens to someone else and it is a shock when it comes to your own household.  It doesn’t need to be a death sentence, but the odds are difficult to beat. It takes someone exceptional to deal with it as bravely as Vicki did....

Lisa's story (41, NSW)

1

I had rectal bleeding and abdomen pain for a year and a half before finally going back to my GP to tell her I thought the diagnosis of piles was wrong! At one point, there was so much blood and mucous that I thought I had haemorrhaged. My GP finally referred me to another doctor who gave me a colonoscopy in January 2008, where he discovered a tumour and a number of polyps, which were removed....

Aly's story (57, VIC)

1

It’s hard not having control and not knowing what is happening. I first went to my GP in Nov 2011 after a government bowel screen test sent back a positive result for blood in the stools. My GP recommended a colonoscopy, which I had in late February 2012. I was shocked to find out I had rectal cancer. There was no indication and no family history of bowel cancer either....

Ian's story (65, QLD)

1

“It’s an unusual birthday present, but it is probably the best gift I have received.” Ian, a retired merchant seaman, never thought the simple act of emptying his post box would ultimately save his life. At 65, Ian, like many Australians, was unaware the risk of developing bowel cancer increased with age. He was physically fit and believed he was in good health. As an active fisherman determined to make the most of his retirement, bowel cancer was the last thing on Ian’s mind....

Mary-Anne's story (49, NT)

1

When I was diagnosed with bowel cancer on 23 June 2011, I didn’t even ask what stage the cancer was at – I just wanted to know what I had to do to fight it. My initial symptoms were rectal bleeding, a change of bowel habit and stomach pain. Eighteen months prior, I had started bleeding and had a colonoscopy which showed nothing. The last colonoscopy five years prior to that had showed a polyp and an unknown growth, neither of which were diagnosed as a cancer. There is no family history of bowel cancer on eith...

Eve's story (22, SA)

1

In 2005 when I was 14, my father was diagnosed with stage 3 bowel cancer.  Dad was just 38 at the time and given a low chance of surviving five years.  That was eight years ago and he is still with us, happy and healthy today.   Finding out dad had bowel cancer was a complete shock.  Following his diagnosis, he underwent surgery and half of his large intestine was removed.  He then was prescribed Xeloda as chemotherapy and, like most cancer patients, experienced a lot of difficulty with the treatme...

Mary's story (43, VIC)

1

Unlike many people, I had severe symptoms for some time before I got my diagnosis. For four weeks during the time of seeing my doctor and being diagnosed I had very bad stomach pains and was completely unable to eat.  My condition continued to deteriorate all the time – the stomach pain came and went, becoming sharper and more intense as time passed, and I was generally very sick. By the end of this 4 week period, I was unable to walk.   During this time I saw four GPs, each of whom had a different opinion...

Brian's story (53, VIC)

1

I was diagnosed with bowel cancer in May 2011 after experiencing changes to my bowel habits over approximately 2 months, which was followed by abdominal pain.  This led me to my GP who thought the stomach upsets were nothing serious so prescribed a reflux medication and sent me on my way.    I soon returned to my GP after experiencing rectal bleeding, when he then referred me for a faecal occult blood test immediately. ...

Jo's story (45, NSW)

1

I was diagnosed with bowel cancer at 44 years old.   I went to see my GP after about twelve months of changed bowel habits and intermittent rectal bleeding, which I assumed was caused by haemorrhoids.  The pain I had been experiencing on and off had become quite bad, so I wanted to talk to my GP about other treatment options.  I was given a colonoscopy as part of this visit – and that’s when they discovered the tumour in my rectum....

Damien's story (26, VIC)

1

When I was first diagnosed with bowel cancer I did not have enough time to feel ‘sad’ or ‘worry’ too much. I am naturally an optimistic person and an ‘action man’. “I can get through this!” I thought to myself. Prior to my diagnosis at age 26, I had been experiencing dull pains in my pelvic area for 3 to 4 years, extending up through to my belly button and around to the right side of my body....

Margaret's story (50, VIC)

1

I was diagnosed with bowel cancer in 2007 at the age of 50. I had been noticing changes in my bowel habits for some time but it wasn’t until my abdomen was severely distended and I lost the use of my bowels that I was admitted to hospital. I was on holiday in Port Douglas at the time, so I was taken to Mossman Hospital....

Alison's story (46, QLD)

1

This story is about my mum’s ordeal with bowel cancer. She was diagnosed in 2005 at the age of 73, but her diagnosis had taken some time.  Her rectal bleeding was initially thought to be haemorrhoids, and the GP gave her a cream to treat the condition, but the bleeding persisted and, when she finally had a colonoscopy two months later, they found advanced bowel cancer....

Robert's story (61, NSW)

1

When I was diagnosed with Bowel Cancer I was 61 years old, fit and healthy (at least I thought I was).  I was working in the entertainment industry with a part time job as a spruiker (sales motivator) and also did freelance work in the entertainment industry as a DJ/MC for various events. Approximately 6 years ago, during a prostate check at the local GP, my doctor found a mass on my appendix, protruding into my bowel, fortunately this was benign, however I still required a resection to the right side of my large bowel...

Sharon's story (47, QLD)

1

My journey with bowel cancer came as a surprise to me, even though I have an extensive family history of the disease due to Lynch Syndrome (a type of inherited cancer of the digestive tract). My mother, brother and uncle have all had bowel cancer and survived to tell the tale. I suppose I thought it wouldn’t happen to me as I have always been healthy, eaten lots of fruit and veggies plus I’m quite a positive person....

Kylie's story (36, QLD)

1

I had been seeing bright red blood in my stools for between four and six weeks before I saw a doctor.   Because a similar thing had happened after my children (now four and six years old) were born, the experience wasn’t totally unfamiliar to me.  I felt otherwise OK and my energy levels were normal. Nothing felt unusual or different. I had a sigmoidoscopy on my doctor’s orders on 19 April 2010 and they found a growth which they biopsied....

Chelsea's story (38, WA)

1

It was very frightening to realise I might die and leave my two small children (aged 1 and 4 at diagnosis) without their mum after being diagnosed with Stage 3 rectal cancer at the age of 37 in April 2012. I noticed occasional rectal bleeding and after about six weeks I went to my GP. She didn’t think it was urgent but recommended a colonoscopy. After a six week wait and a substantial increase in rectal bleeding, the colonoscopy showed a tumour in my mid to low rectum, plus two polyps in my bowel. Over the next few...

Ella's story (35, ACT)

1

At the age of 35 I started experiencing rectal bleeding so my GP recommended I have a colonoscopy. The colonoscopy confirmed three growths located within my bowel. After seeing my GP it all happened within weeks, it all seemed so fast yet very professional. After being diagnosed I was required to undergo radiation and chemotherapy. Two weeks before Christmas I commenced my radiation cycle which included trips to radiology every day for 6 weeks and chemotherapy in a tablet form, which included 3 pills, twice a day....

Lorraine (50, NSW)

1

We all need to know that cancer does not discriminate. I am a healthy fit woman, with no history of bowel cancer in my family, yet it affected me. I was diagnosed with bowel cancer at the age of 50 after participating in the National Bowel Cancer Screening program. I received the positive results approximately two weeks after sending the test away....

Stephanie's story (21, QLD)

1

I woke from what was supposed to be a routine, last resort colonoscopy and was advised that my undertaking of this small procedure had saved my life. I was diagnosed with bowel cancer last year in October 2012 at the age of 21....

Alan's story (48, WA)

1

I got my Rotary bowel test kit from a chemist in 2009. The staff was giving them away so I thought I might as well do one. Two weeks later, the results of the test were sent to my GP and they were positive. I was on holiday in New Zealand when I received an email from the surgery asking me to contact my doctor as soon as possible. When I got back, I went straight to my doctor and was told I had bowel cancer....

Monica's story (85, QLD)

1

My bowel cancer diagnosis was a huge shock. I had been experiencing frequent constipation, a general change in bowel habits and some rectal bleeding, all of which my GP felt needed further investigation. I was referred for a colonoscopy and endoscopy in order to pinpoint the source of the problem....

Richard (48, NT)

1

I was diagnosed with bowel cancer in 2007. Ironically, I had just given up smoking and was trying to get fit. I was even riding my bike to work for exercise but I was feeling more and more tired. That’s when I knew something was wrong. Three months prior to my diagnosis, I had been experiencing stomach pains and eventually I ended up in the emergency department of hospital.   The doctors there thought I had Crohn’s disease and arranged for me to have a CT scan. That’s when they discovered the tumour....

Howard's story (52, QLD)

1

I was diagnosed with bowel cancer in February 2010 at the age of 51.  I was seeing a specialist at Toowoomba Hospital about my renal condition.  He asked if there were any other health problems; I mentioned the blood in my stool, which I had seen off and on for the last six years.  I didn’t think it that important, as I had had ulcerative colitis over the years.  My GP did not think it was a concern.  Also I had recently done a FOBT test as part of the National Bowel Cancer Screening...

Carolina's story (33, NSW)

1

I was six months pregnant with my first baby when I started experiencing blood in my stool. I talked to my obstetrician, who said that a little bleeding can often happen during pregnancy but that the amount I was experiencing sounded a little suspicious. She referred me to a gastroenterologist and I decided to wait until after my baby was born to book the appointment....

Gillian's story (62, VIC)

1

I was diagnosed with bowel cancer at 58 years old. I’d had dull stomach pain and occasional bleeding for several months but it wasn’t until I saw a lot of blood in the toilet that I booked an appointment with my GP.  He sent me for a colonoscopy and I was referred to a surgeon within a week. I was very shocked when I was told I had cancer, but I tried to remain positive throughout my treatment and I really think that helped me cope....

Karen's story (45, NSW)

1

In summary, over the last two years I have had three operations, two colonoscopies, six weeks of chemoadiation, four months of chemotherapy, an ileostomy, a hernia on my bowel surgery scar, gone through instant menopause and had to give up work. However, since going through bowel cancer, all my tests have been clear and my last CT is in September 2013, which will be two years since the operation....

Renay's story (41, VIC)

1

I used to think cancer was the worst thing that had ever happened to me until it became the best thing. This might sound crazy but it is true. I am a wife and mother to a now 6 year old son. I was diagnosed with bowel cancer in May 2011 at the age of 41. I had been suffering from exhaustion, stomach pain and unusual bowel habits for three or four months and finally saw my GP when the pain started getting much worse....

Joy's story (39, NSW)

1

In May 2011 Mum began losing weight and starting experiencing pain on the right side of her abdomen. A colonoscopy discovered a large mass and she was diagnosed with stage 4 bowel cancer. She was 66. Mum was treated with surgery and has since had chemotherapy. Sadly three months ago she started finding it difficult to speak. It seemed as though her nerves were not working effectively, causing her to not be able to eat or talk properly. At that point I didn’t have a good feeling about things so we went back to Mum&rsqu...

Michelle's story (35, VIC)

1

It’s not so long ago I went to the GP and told her about a few concerns I had and the symptoms that I was experiencing, which my GP considered not to be a big deal. The GP thought it was possibly haemorrhoids. I decided that I could allow myself to be more relieved, seeing as I had expressed my concerns but the GP had predominantly dismissed it being anything serious…. after all....

Eileen's story (50, NSW)

1

Even though there is a history of bowel cancer in the family, I never thought it would happen to me. My diet had been considerably healthy throughout my life and I had previously used a Rotary Bowelscan kit, which had come back clear. This all changed in July 2007 when I was diagnosed with Dukes stage 3 bowel cancer....

Stacey's story (35, SA)

1

My symptoms were fairly vague.  In January 2010 I had one incident of a very upset tummy, I had had slight rectal bleeding for about 8 months but put it down to having haemorrhoids from having had a baby in the past year, and my bowel movements had been more regular. I was actually at the GP in January 2010 about getting my moles checked for cancer when right at the end I mentioned the above symptoms.  My GP who I now thank for my life, said that at my age I should have nothing and immediately referred me to a gas...

Christine's story (54, QLD)

1

Kim was diagnosed with bowel cancer in June 2012 and passed away on 8th May 2013. We are just coming up to 6 months since his passing and I am here to share his dreadful journey. Kim was being treated for constipation, no bleeding or anything to let us know there was a problem. After 10 days he started vomiting and I took him to the hospital in Brisbane. He spent a week in hospital to clear his bowel, then a big op to remove a large cancer in his bowel that had burst through the bowel wall. He had chemo 24/7 but still h...

Rachel's story (40, QLD)

1

I had noticed some blood in the toilet for about a month but thought it was due to constipation. I was working fulltime and have four children to look after – being so busy I just carried on and didn't dwell on it. One morning, however, I thought I had diarrhoea but all I could see was a lot of old blood in the toilet bowl. I left my husband with the kids at home and took myself straight off to hospital.Staff at the hospital found evidence of bleeding with no obvious cause. The doctor said he would write a referral...

Andrew's story (22, VIC)

1

In April 2010, I suffered a huge amount of bleeding when I went to the toilet.  I had no warning signs – it just happened out of the blue.  It was so bad that I went straight to the emergency ward at the hospital.  I think they thought it was just haemorrhoids so I was given a DRE (digital rectal examination) and the doctor took some blood and sent me home. ...

Brent C's story (64, NSW)

1

Prior to her diagnosis in 2006, my wife’s concerns about her health were dismissed as a trivial condition because her only symptoms were occasional and very slight rectal bleeding. Each time she raised her concerns with her GP, the GP thought the bleeding was related to other things such as beetroot (we ate a lot of vegetables) or haemorrhoids. However after insisting, her GP finally ordered a colonoscopy which showed my wife had late stage bowel cancer, with metastases in the liver and lungs (stage 4)....

Richard's story (63, NSW)

1

I successfully beat prostate cancer in 2007 so being diagnosed with bowel cancer so soon after came as a real shock. I did the Rotary bowel cancer test (FOBT) in March 2009 and the results were negative. But later that year, my bowel habits began to change – mainly increased urgency and frequency – and when I twice noticed blood in my stools I decided to take the FOBT again. This time the results were positive.   I was overseas when the results came through in April 2010 so I talked to my GP in Australia...

Donna's story (45, QLD)

1

I would recommend for anyone reading this to please listen to your body, take notice of your symptoms and get it followed up with your doctor. We all need to push to get looked at when we think there is a problem, because like me, there probably is.  For a couple of years I had experienced bowel changes, which I mentioned to my GP but I was told my symptoms were related to others things. I was tested for coeliac disease as my brother is a coeliac; however, no further tests were done....

Russell's story (72, NSW)

1

Let me introduce you to an insidious silent killer.   My name is Russ and I have been a Rotarian for 42 years.  It was 1996 when I was asked to take on the role of District Chairman for Rotary Bowelscan, a project designed to raise community awareness of bowel cancer and encourage early detection.  With the participation of pharmacies around Australia, Rotary Bowelscan sells test kits designed to detect blood in the stool, which is one of the best early indicators of bowel cancer. ...

Martin's story (60, NSW)

1

My name is Martin and I’m a happily married father of three and grandfather of one, working as a General Manager in the building industry. I want people to hear my story so that they understand that bowel cancer can happen to anyone at any time. I was sent the bowel screen test kit in 2006. I took the test and the results came back negative. In mid-April 2011, I noticed blood in my stools and thankfully I acted immediately. I am normally a procrastinator, but in this instance I acted swiftly. I saw my GP straightaway...

Jane's story (41, QLD)

1

In early November 2010 I noticed some weight loss and a change in my bowel habits, including rectal bleeding. I went to the doctor in mid-November and was diagnosed with anaemia and booked in for a colonoscopy later that month. I was told on the day of the colonoscopy that I had bowel cancer. The next step was surgery, a high anterior resection, which was done in mid-December. It all happened so quickly that I didn’t really have time to dwell on what was going on, but it never occurred to me before my diagnosis tha...

Cris' story (34, QLD)

1

I was only two years old when I lost my grandmother to bowel cancer. My Grandmother and my Auntie, were both diagnosed at ages 60 and 40 years respectively. By the time my grandmother was diagnosed, the cancer was terminal. My Auntie was checked out for bowel cancer due to the high family history of the disease. I was here in Australia when she was diagnosed with bowel cancer in Brazil. She had the chance to fight it but could not stand the pain caused by the radiotherapy treatments. I was fortunate enough to be able to vis...

Gayle's story (53, QLD)

1

In 2000 I was diagnosed with pneumonia. While I was in hospital the specialist did a cancer marker test which came back really high. However the subsequent colonoscopy was not very clear as the prep had not been very effective. In September 2011 I underwent a second colonoscopy as I was experiencing continual bad diarrhoea. During the procedure a carcinoid tumour was discovered....

Dale's story (49, TAS)

1

Us men rarely go to doctors, let alone get our proper checks. But I recommend to all other men to please listen to your doctor and do exactly what they tell you. Put your faith and trust in them and you will be managed appropriately. I was diagnosed with Bowel Cancer in 2011. Passing blood made me go to my GP to have a check-up. My GP suggested doing a Digital Rectal Examination and having a colonoscopy....

Warren's story (31, ACT)

1

I am 31 years old and happily married with two children (3 years and 18 months old) and another little boy on the way, due any time now. I'm an Australian  Federal Police Officer currently attached to the Specialist Response and Security Tactical Response Team. Bowel cancer was the last thing on my mind when I started to experience small amounts of rectal bleeding. ...

Vicki S' story (36, QLD)

1

I was diagnosed with bowel cancer in 1999 at 36 years of age. Twelve months prior to my diagnosis I had visited my GP and raised concerns about weight loss, rectal bleeding, changes in my bowel habit, stomach pain and feeling tired. My GP told me it was stress-related. After numerous visits I felt like I a hypochondriac so I stopped going to the doctor to report the same symptoms and accepted it was stress (even though I didn’t feel it was stress related). I was a single mother with two young children so I told myself...

Helen's story (44, QLD)

1

My experience with bowel cancer began with a niggly pain, not unlike wind pain, that lasted for about 10 days. I had always suffered with endometriosis so I put the pain down to that. Thankfully my husband encouraged me to go and get checked out. When the doctor examined my tummy it was very painful. The doctor diagnosed me as having a burst appendix and before I knew it, I was flown out from our small town to the nearest teaching hospital. I spent three days there on intravenous antibiotics to reduce what they thought...

Steve's story (66, NSW)

1

Three weeks prior to my diagnosis I had been sent a National Bowel Screen Kit. I looked at it and thought, “I should really do that one day”. Needless to say, I left the kit on the bench and three weeks later ended up seeing my GP on a Wednesday afternoon for a prescription. At the time I complained of having had a slight pain in my abdomen. The GP asked to examine my abdomen and it was then he felt a mass....

Moya's story (69, NSW)

1

In 2007, the government sent out free bowel cancer test kits to a range of people and I did my test as soon as I received it. The results indicated blood in my samples and I was told to see my GP immediately. I wasn't overly worried at this stage because I had seen blood in my stools on and off for some time and had always put this down to taking iron tablets, which can cause dietary problems like constipation.   After my GP appointment, things started to move very quickly, with a colonoscopy, blood tests, i...

Mandi's story (29, NSW )

1

I was diagnosed with bowel cancer at 24 years old, just before I was due to leave for Europe with a group of girlfriends after finishing university. I had experienced some bleeding from my rectum only one week prior to this time, but at the time I really wasn’t too fussed about getting it looked at because I was so excited about my European adventure, and because of my age....

Bobby's story (57, NSW)

1

My message to anyone out there reading this would be to stay positive and keep moving forward. Despite what I’ve been through I feel better now than I have in a long time. Prior to my diagnosis, I hadn’t been feeling well for some time. A driving holiday to Melbourne prompted me to see a doctor. I was fine sitting down but as soon as I stood up I had to rush to a toilet. Back in Sydney my GP sent me off for blood tests and a CT scan. The results showed my tumour markers were up so things were not looking good. A...

Antonia's story (62, QLD)

1

I had not been feeling well for a couple of months, tired, lost weight, feeling sick, and then I had 2 episodes of rectal bleeding, the second worse than the first. I went to my GP, after having done some research. I wanted a referral for a colonoscopy. My GP was initially hesitant to refer me on as he thought it was possibly only haemorrhoids, I knew this wasn’t correct. I had blood tests and I was referred to a general surgeon for a colonoscopy. A week after the colonoscopy, the specialist looking after me told...

Rick's story (63, NSW)

1

I was diagnosed with advanced bowel cancer in September 2011 after seeing my GP about a very small amount of blood being present on my toilet paper. ** The GP asked me to get a home testing kit from the chemist, conduct the test and return it to him. The test showed it was a positive result so I was referred to another doctor to conduct a colonoscopy. The colonoscopy took place on September 26 and the results showed two tumours in my large bowel. I was booked in for a CT scan the next day. After the scan my doctor told...

Maureen's story (55, QLD)

1

When Maureen received a screening kit in the mail just after her 55th birthday, she had no reservations about doing the test. “It was just too simple not to do. The test was hygienic, quick to complete and extremely straight-forward,” she said. Just as well, because ultimately this unusual birthday present saved her life.  When the test returned a positive result, Maureen was not overly concerned as she had read in the accompanying booklet that the presence of blood may be due to conditions other than ca...

David B's story (65, NSW)

1

I was diagnosed with bowel cancer in 1993 at the age of 47.  I had taken a Rotary Bowelscan test (FOBT) and, when it returned a positive result in May, my GP referred me to a specialist.  I was given a colonoscopy in June and told I had a 10 per cent chance of having cancer… turns out, I was in that unlucky 10 per cent!  In July I had a bowel resection.  Looking back, it all happened so quickly.   I felt I coped really well with the cancer at the time but I experienced more problems about se...

Nicole's story (41, VIC)

1

My mother passed away with breast cancer when I was 10, so I have always been diligent with screening and looking after my health.  I would go to my doctor on a regular basis to make sure everything was all OK.   In February of this year I had been quite tired, had a lot of back and abdominal pain so I went for a check-up with my GP.  Blood tests taken read an Hb of 72 so I was called immediately to go to hospital for a blood transfusion.  From there I underwent a colonoscopy and gastroscopy to find out...

Anis' story (72, NSW)

1

This story is about my father who was diagnosed with bowel cancer three days before Christmas in 2010 and passed away just five weeks later.   Dad was a young 72-year-old – he was healthy and active, ate well, enjoyed long walks, wouldn’t hesitate to climb up on the roof if necessary, and had never even been to hospital – so his diagnosis was a shock. He had lost his appetite and begun to lose weight about a month before his diagnosis but his doctor didn’t think it was a problem; in fact, he th...

Kathy's story (47, WA)

1

During a routine pap smear in August 2011, I mentioned to my doctor that I’d had an uncle who died from bowel cancer at only 51. Immediately the doctor suggested I give a stool sample and, when the results came back positive, a colonoscopy was arranged. A small tumour was found during the procedure, which fortunately was only at stage one. My doctors recommended surgery to remove the tumour as my best option so I went ahead with an operation. No stoma was required. I started chemotherapy after surgery to help minimise...

Kersti's story (56, NSW)

1

My story with bowel cancer began in February 2009 but if I’m honest, it began much earlier with symptoms of rectal bleeding and constipation which I didn’t follow up on with my GP. After my mum died, I went through a stage of not looking after myself; just lying on the lounge, eating way too much pizza and drinking excessively. I kept putting my symptoms down to haemorrhoids, bad diet and grief. My constipation was so bad I was twice forced to go to hospital. Scans were done but nothing showed up. On my third vis...

Lorna's story (56, NSW)

1

As a registered nurse for over 30 years, I understand the value of good health and pride myself in maintaining a healthy lifestyle. I see my GP every year for routine blood tests and always attend for routine mammogram when requested. However, when the bowel screening test arrived, I put it in a cupboard until I had time....

Ben's story (28, VIC)

1

I was 28 when I was diagnosed with bowel cancer in January 2011. I’d had rectal bleeding, changed bowel habits and stomach pain for a while but had put off investigating the symptoms – I was living in China at the time so I figured it was either an intestinal infection that I couldn't seem to shake or a reaction to something I’d eaten. ...

Katie's story (35, WA)

1

My brother Jeff was just 31 when he was diagnosed with bowel cancer. He passed away nearly two years later in June 2013. He left behind his beautiful wife Nicole and two gorgeous daughters, aged six and four. Jeff did not have any symptoms that rang any alarm bells until he started to feel like he had no energy. He looked pale and we urged him to visit his doctor for some blood tests which showed him to be anaemic. He then had a colonoscopy and gastroscopy, which showed up a large doughnut- shaped tumour in his colon....

Amanda's story (37,WA)

1

My mum was in her mid to late 40s when she was diagnosed with bowel cancer. She died at the age of 50, when I was 27, 11 years ago this year. Mum had experienced symptoms for some time, starting with bowel upsets, stomach pain and changes in her bowel habits. The doctors suggested it was gastro, then Irritable Bowel Syndrome - you name it, they suggested it. When I look back it felt as though they were fobbing her off. They never suggested looking into what was causing the problems....

Kym's story (33, VIC)

1

I was diagnosed with bowel cancer in May 2010 at the age of 31. My bowel habits had started to change about two years before, including small amounts of blood on the toilet paper, but I had been told earlier that I had a haemorrhoid so I thought that might explain the bleeding. I was also diagnosed with anaemia just before I fell pregnant about a year after; I would later learn that anaemia can be an indicator of bowel cancer. It wasn’t until two months after giving birth that I went to see my GP about the bleeding,...

Ann's story (37, ACT)

1

I was diagnosed with bowel cancer at the age of 37, totally unexpected at such a young age. The only real experience I’d had with the disease was watching my grandfather live with a colostomy bag after the removal of his bowel when I was a child. But I no longer consider this an ‘old man’s disease’....

Stacey B's story (36, WA)

1

My husband Peter was diagnosed with bowel cancer in June 2012 at age 36. He was referred for a colonoscopy by our GP as he had been experiencing rectal bleeding and a consistent change to his bowel habits. The colonoscopy results found a tumour which was biopsied and confirmed to be cancerous. Peter was then sent for a CT scan and MRI to confirm locations and check for the possibilities of metastasis....

Seher's story (30, NSW)

1

My family was shocked by the news in April 2011 when first told my Dad had bowel cancer. It was difficult to process as my Dad is such a healthy man. Initially my Dad went to his GP to have a check up on his prostate. It was after his assessment that the GP was concerned Dad’s bowel may require further investigation. After discussing his health with his doctor it was apparent Dad had experienced a change in his bowel habits, was anaemic and had noticed gradual weight loss....

Are you at risk?

           
Both men and women are at risk of developing bowel cancer.  The risk is greater if you -

  • are aged 50 years and over; or
     
  • have a personal or family history of bowel cancer or polyps; or
     
  • have had an inflammatory bowel disease such as Crohn’s disease or ulcerative colitis.

There is emerging evidence regarding type 2 diabetes as a potential risk factor for bowel cancer, however further research is required.

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Bowel Cancer Australia publishes a quarterly email Newsletter - highlighting all the latest developments in bowel cancer advocacy, awareness, education, support and research, as well as important services available to bowel cancer patients, loved ones and the community.

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Healthy eating can be a challenge, particularly for bowel cancer patients.  Making things easier and providing practical support is really important to us here at BCA, so check out the helpful high and low fibre recipes, put together by Nutrition Adviser, Teresa.

We also have a range of nutritional resources developed specifically for bowel cancer patients.