When it comes to bowel cancer, he is exactly the right person to talk to: Dr Volker Fackeldey, a specialist in general and visceral surgery, specialized visceral surgery and a coloproctologist, heads the Mainfranken Bowel and Rectal Center in the Kitzinger Land region. In this interview, he talks primarily about the risks of developing bowel cancer – but also about the chances of recovery. Because bowel cancer can be beaten – provided it is detected early and treated effectively.
Around 80,000 people are diagnosed with bowel cancer every year in Germany alone. This makes it the second most common malignant disease in both women and men. For around 29,000 of those affected, bowel cancer is fatal. It need not be that way, says Dr Volker Fackeldey, because: in ninety per cent of all cases, bowel tumors develop from initially benign polyps.
However, bowel cancer can be truly insidious. This is because those who develop it often do not notice it for a long time. Initially, there are simply no symptoms – and bowel cancer develops extremely slowly. It is only in the later stages of the disease that the first signs of bowel cancer become apparent. Certain signs should raise immediate alarm: for example, anyone who notices changes in bowel habits, such as persistent diarrhea or blood in the stool, should not delay seeing a doctor. Other symptoms include constant tiredness, unintentional weight loss and a general lack of energy.
The main factor that can lead to bowel cancer is poor dietary habits. Diet often plays a major role in medicine, and when it comes to bowel cancer, the picture is clear: the healthier and more balanced our diet, the lower the risk of bowel cancer. A diet low in fiber and high in meat puts a strain on the bowel, as do the classic culprits nicotine and alcohol. However, genetic factors can also trigger the development of bowel cancer – as can chronic inflammatory bowel diseases such as ulcerative colitis, i.e. inflammation of the large intestine. Important to know: people with type 2 diabetes are generally more susceptible to bowel diseases!
Prevention is key
The figure is surprisingly high: more than half of patients with bowel cancer could be cured! And it’s simple, as Dr Fackeldey emphasises: “Not even one in three people take advantage of the screening measures available today. Yet it is strongly recommended,” says the specialist. “Health insurance funds cover the costs of screening – the colonoscopy – for women from the age of 55 and for men from the age of 50.” Wasn’t the age for men also 55? “That’s right, but it was lowered from 55 to 50 because men are more prone to bowel cancer than women,” explains Dr Fackeldey.
Of course, genetic predisposition also plays a major role, but much of it seems to be controllable. “The fact is that the risk increases with age. The usual lifestyle-related issues such as being overweight, excessive consumption of red meat in particular, and excessive alcohol consumption all contribute negatively to the risk,” criticizes Dr Fackeldey.
Genetic predisposition is an important factor when it comes to screening. Dr Fackeldey recommends: “If the mother or father has had bowel cancer, the risk for the next generation is two to four times higher, so regular screening is strongly advised in all such cases.”
Accounting for around five to seven per cent of cases, the most common form of hereditary bowel cancer is hereditary non-polyposis colorectal cancer (HNPCC, also known as Lynch syndrome). The predisposition is inherited from one parent and is therefore present from birth. Colorectal cancer can develop even at a young age, but it can also lead to other tumors. There is an 80 per cent probability of developing the disease, which is why timely screening is particularly important.
Early detection: colonoscopy
Many people are afraid of a colonoscopy – or feel embarrassed about it. Yet such an examination is completely straightforward nowadays. Before a colonoscopy is carried out, it must be ensured that the bowel is empty. To achieve this, a laxative is usually administered the day before. During the examination, a sedative may be given, or a short-acting anesthetic such as propofol. The examination is not painful, though it may be slightly uncomfortable.
“You need to bear the following in mind: if nothing unusual is found during the examination, you have about ten years’ peace of mind until the next screening. If an adenoma – a tumor that usually originates from glandular tissue, is encapsulated within an organ and is mostly benign – or a suspicious polyp is found, it can be removed immediately. If there is any doubt, a tissue sample is sent to the pathology department for further examination. The patient then receives a definitive diagnosis and need not fear that bowel cancer is developing in their body; instead, countermeasures can be taken immediately,” says Dr Fackeldey encouragingly.
Given this approach, everyone in the relevant age group should take the plunge and book a screening appointment. You usually feel heroic and good after such ‘chores’ – then it’s done!
During a bowel screening, a video colonoscopy is usually performed. This involves carefully inserting a thin tube into the bowel via the rectum. If they wish, the patient can watch everything on a screen, which can be quite fascinating. The colonoscope itself has a suction device used to remove stool residues or fluids. Small instruments can be inserted via a small working channel to remove polyps or take tissue samples if necessary. A colonoscopy is a routine examination and carries little risk. And most importantly: around 97% of existing adenomas – potential precursors to cancer – are detected!You can generally remain optimistic even if abnormal tissue affected by cancer is discovered following a colonoscopy. This is because, when detected early, bowel cancer is one of the most treatable forms of cancer. “I often see patients, as was the case just recently, who are fifty years old and have been successfully treated without the need for chemotherapy,” explains Dr Fackeldey. “Many patients, on the other hand, who did not attend screening, deeply regret this when the disease is detected late and at an advanced stage,” he adds.
“Our location is excellent!”
Incidentally, anyone can look after their gut flora: “I recommend a classic high-fiber diet. That gives the gut something to do and prevents it from becoming sluggish,” advises Dr Fackeldey, adding: “Too much fat is unhealthy, and meat consumption should be reduced. Red meat in particular – pork, beef, lamb and game – is not easily tolerated by the gut in large quantities.” Of course, in this context, one should pay attention to the origin of the meat, which is easy to do if consumption is kept to a minimum.
So it is actually better to spend a little more money on good quality rather than buying cheap meat from discount stores. The reason: meat from discount stores usually comes from animals that have been treated with medication – in other words, from factory farming, which is also ethically hard to accept. “Avoid regular consumption of alcoholic drinks and instead make yourself a pot of green tea every now and then – your gut will thank you for it!” recommends Dr Fackeldey.
Dr Fackeldey, who was born in the Rhineland, whose parents are both doctors and whose daughter also aspires to become a doctor, is optimistic. “The technology available to us doctors is getting better and more sophisticated all the time. In the long term, I can envisage a genetic marker for screening that can quickly identify hereditary factors. The quality of life for my patients during bowel cancer treatment is constantly improving, and research is making progress,” he says, looking to the future with satisfaction. “Our location in the Kitzinger Land region is excellent, and we have a great many patients who travel from far and wide to be treated here. And – far more people should be taking advantage of screening via colonoscopy!” he urges at the end of this encouraging conversation, for which we are very grateful.
Dr Volker Fackeldey has been heading the Mainfranken Bowel and Rectum Center for over ten years. As the coloproctology center of excellence at the Kitzinger Land Clinic, the center specializes in the treatment of the large intestine and rectum and is renowned throughout the state. As a specialist, Dr Volker Fackeldey has numerous specializations and additional qualifications. He is not only a specialist in general and visceral surgery and in special visceral surgery, but also in sports medicine, proctology and chiropractic therapy. What sets him apart as head of the Mainfranken Center for the Large and Rectum is a particularly advanced qualification – namely the ‘Coloproctology EBSQ’ (European Board of Surgical Qualification in Coloproctology).
