The Lifestyle Prescription: Bowel Cancer Symptoms, Survival & Prevention | Rena x Dr Anisha Patel

Dr Anisha Patel: Having me

Rena Annobil: got lots to talk about. So your experience of bowel cancer, obviously your wonderful book, which is super helpful for people. Um, also, um, this whole stigma around screening and symptoms and women's bodies, and I know that you are, you know, championing just women talking about their bodies more so that we can actually just get people to delve into things that are, are wrong with us instead of ignoring it and brushing it under the carpet.

Dr Anisha Patel: Yeah, a hundred percent. I mean, my, my sort of specialist interest is women's health in general practice. Mm. Uh, and that's what I lead for, but also the cancer side as well. But I have learned so much actually since the seven years since my [00:02:00] diagnosis about, you know, people's thoughts, their perceptions, and actually the challenge with challenges we are facing when it comes to cancers and women's health.

Rena Annobil: So with your cancer, obviously you're a doctor, did you recognize symptoms within yourself straight away?

Dr Anisha Patel: So I initially started with just feeling tired initially, and I'd become partner at my practice. My children were five and six. I was burning the candle at both ends when I had some blood tests, but they're all normal.

So I was like, okay. I was satisfied, but I was getting a bit more constipated. Um, and I thought, oh, it might be just lifestyle, irritable bowel syndrome, and I'd get a tiny little bit of blood on the tissue. Because I'd had piles and childbirth. I assumed that was because I was constipated. Mm. And it was very intermittent initially.

My husband is a bowel cancer specialist, so after a couple of months I did confide in him to say, I think this is probably, I just wanna run this past you. I'm probably gonna go to [00:03:00] the doctor. Mm-hmm. Was like, absolutely, go and get it checked. So I did go to the doctor and I was checked and they gave me treatment for constipation in piles, which actually was reasonable.

And they said if it doesn't get better then come back. And my symptoms were intermittent, but I had a couple of times where I'd had tummy pain. Couldn't really uh, describe why. And when I went on holiday in Italy in the summer, the symptoms got a lot worse. And actually, if you look back at the pictures, I've got thinner.

As the pictures went on, I was unable to run because I think I was becoming a knee. Emic, I thought it was the heat. And so when I got back from Italy, I went back to my GP and two weeks later, September, 2018, I was told I had cancer. And at that point it was. Locally advanced as stage three, um, rectal cancer.

Rena Annobil: Wow, that's really shocking actually. And the thing is, the symptoms that you described that you were, uh, feeling at the beginning, they sound very common amongst people. You know, [00:04:00] the, the, the constipation, feeling tired and that kind of thing. Even, you know, when it comes to women's health Yeah. After childbirth, there are certain differences or certain things that happen, um, that women, I don't know.

I just feel like. You put it down to, oh, okay. 'cause I've had a baby, you know, now things are different down there, or, uh, I get constipation more, or that kind of thing. Or I'm, you know, bloated more so. I just, I, I feel like a lot of people might not take them seriously straight away. Those things.

Dr Anisha Patel: That's the danger.

I mean, I think. Um, it's sometimes explained away or you haven't got time or you just think, oh, it'll settle down. But actually weeks and months, sometimes pass before someone then says, actually, I've been suffering with this. And I think for me, you know, I was 39, I had no risk factors for bowel cancer. My husband and I genuinely thought it'd be something like inflammatory bowel disease, like Crohn's disease.

Mm-hmm. Or ulcer, ulcer colitis, even though. My husband for a few years prior said, I'm seeing more and more young people with bowel cancer, [00:05:00] and I guess that is, there is that thing where actually you never think it can be you, but actually the one thing I always say now is cancer doesn't discriminate. It can be any of us and one in two people will get cancer.

Rena Annobil: Mm-hmm. And, you know, you said about the, the symptoms and, uh, well, lifestyle really, like, 'cause when a lot of us, when we, uh, hear bowel cancer, we think about, and I think it's because of news reports that we've read and stuff, what we know, probably misinformation a lot of the time. Oh, this person has a lot of processed meat, you know, and, and, uh, they don't lead a very healthy lifestyle.

These are thoughts that might come into a lot of people's minds. Um. What did you think That as well, and you know, you're saying that you were quite in a healthy space. Yeah. So were you, was that even more surprising?

Dr Anisha Patel: I think that's really true. So 54% of bowel cancers are preventable and we know mm-hmm.

That 96% of the population aren't getting enough fiber yet. A third of cases, um, that are preventable or due to lack of fiber. So we're meant to be getting 30 grams of fiber a day. There were [00:06:00] other risk factors, like you said, the processed and red meat consumption and being overweight, not exercising, uh, family history and, you know, I was brought up in a rahi household, you know, growing up.

Rena Annobil: Mm-hmm.

Dr Anisha Patel: We had meat as a treat at the weekend and usually fish the same with us. Yeah. Um, we had very much a plant-based diet growing up. My parents owned a healthy food business. We didn't have processed food. And what we do know is that there is this global rise in early onset bowel cancer, bowel cancer, under.

Fifties and it is growing exponentially. We know that since 1995, there's been a 24% increase. In bowel cancer under 50, and this is in 27 outta 50 countries worldwide. And in fact, some of the work that I'm doing at the minute is looking into other risk factors and why there is this global rise. And I'm doing that, um, with funding from the B Bay Fund and Cancer Research UK under the Cancer Grand Challenges.

And we've got a team worldwide from Harvard to [00:07:00] India to Italy, and we're, we're basically facing a race against time. I'm gonna be brutally honest. Trying to find the answers and work out who we need to screen earlier because it is those patients diagnosed younger, tend to di be diagnosed at a later stage, therefore have more brutal seek treatment and side effects, die more and you know, ultimately are presenting as an emergency rather than coming to me at those earlier stages.

Rena Annobil: Can you share any findings at the moment? In terms of the research,

Dr Anisha Patel: so the research, we know that there is a strain of bacteria called Ecolab actin, so we've heard of e coli.

Rena Annobil: Mm-hmm.

Dr Anisha Patel: There's a CoLab backin toxin that's found in the gut of those with bowel cancer at an increased prevalence. So we are doing further studies into this.

We are looking at all sorts of things, including environmental aspects, um, ultra processed foods. Um, we are looking at early antibiotic use. Um, and I think there is so [00:08:00] much that we don't know out there, but what we do know is that it's likely to be multifactorial. It's not just gonna be one thing we find, right.

There's gonna be lots of things that contribute and we actually think your risk develops. In early life, so childhood and maybe young, the younger adulthood years, we think that actually the um, precipitant or the thing you are being exposed to is during that period. So it's fascinating work.

Rena Annobil: It's fascinating, but also it's sounds a little bit scary as well.

These are are shocking figures. And, and when you're saying, you know, from childhood, things that you are exposed to, so I guess it's, uh, there needs to be more research done

Dr Anisha Patel: regarding that absolute. It sounds a bit. Absolutely. We've got another, we've done two years so far. We've got another three years. And as things uncover, and we're not the only team doing it, this is a race against time for many teams.

There's lots of work being done into early onset. Bowel cancer. But I just want to say there's also several other [00:09:00] cancers that are increasing in the under fifties, including breast cancer, lung cancer, head and neck cancers. So you know, there is something contributing to all these cancers. And we might just be starting to unlock those things, looking at bowel cancer first.

Rena Annobil: Right. Okay. And, um, I will come on to, um, things to be aware of in terms of our bodies and, and bowel cancer symptoms and things like that. But I wanna talk a little bit about, um, about your journey. Um, right. So obviously you got diagnosed stage three. Yeah. Okay. So that must have been like being on the other side, you know?

How, how was that for you and, and, uh, did you kind of, I don't know, like is it, is it really different to be a doctor and be the patient? Like, did you try to kind of, were you at work as part of it? You know what I mean? Like

Dr Anisha Patel: Yeah, I think it, you know, I think it was really, um, a double-edged sword to be [00:10:00] honest.

Uh, I. Obviously knew a lot more, um, and was better informed and obviously knew, was worried about it. Come, you know, coming back, going into my lungs and liver, all the things. You start sort of thinking about all the complications And actually it took me back to that time when I was on a bowel cancer ward, like a bowel ward, um, when I was a junior doctor and I remember the professor of bowel cancer, colorectal cancer, saying to me, so, you know, if I'd had the stage of cancer that I'd had.

Then 20 years ago, I had a 50% chance of dying. So for me, within five years. So for me, I've obviously got all these snippets of information that are sort of darting around my head. My husband's even more informed as a bowel cancer specialist. Yeah, and I think that was really difficult. But also on the same token, I also knew what was coming next to a degree.

Um, I've obviously never had major surgery chemotherapy. Um, [00:11:00] but I think for me it was a very humbling experience. I understand so much more the patient experience journey, the ripple effect on the family, um, how hard it is to navigate life after a life changing illness. Um, and actually for me, the biggest issue I had with it, and the thing that I had the most therapy for was the loss of control.

If I'm meant to be the doctor. Yeah. I didn't like being wheeled down a corridor. I would get really tearful. I didn't like going under anesthetic because people were doing things to me. So every time there was a place where I was outta control in a scanner, it was really difficult because I just felt like I didn't belong.

Rena Annobil: Yeah. But that's, I can understand that.

Dr Anisha Patel: Yeah.

Rena Annobil: Because of what you do. Um, did anything surprise you about the patient experience? Um.

Dr Anisha Patel: I think it's how vulnerable you are in that space. And I think I was given, you know, we [00:12:00] obviously always talk about options with our patients. It's a, it's a two-way process, but I think sometimes my specialists.

Gave me a bit too much. And actually what I really wanted them to do was advocate for me and my best interests. Yeah. And give me the best treatment they knew how to. Um, so I really did leave it to them and my husband to have those discussions, partly because I was in shock. Yes. I felt like it was an outer body experience.

I was just going through the motions. Mm. I just had to get through it mainly for my children. I was like, I don't want them to have to live through this. This is horrendous. They're five and six. I'm taking away their innocence. And I think for me, I've really struggled with that, which is why I think I've had to turn my, I want you to turn my negative into a positive.

I wanted them to see that out of adversity, you can. And you can do things and mom is still mom, but she has different challenges, which I'm thankful for. They are very understanding of.

Rena Annobil: That's really [00:13:00] young, you know, it's really young. That's really young. Um, it must have been so challenging to actually just cope with raising your kids and making sure that they were cared for at that time where you were going through the treatment.

Dr Anisha Patel: It, yeah, it was really difficult, but I had an army behind me and that's the other thing, you know. I really feel, because when I see patients and they haven't got that army behind you, how much more difficult, lonely, and isolating it can be. I mean, I've never felt so lonely. I joke about this, I said I felt, I feel so lonely.

And people are like, but there's people around you all the time helping. But I think that actual experience of cancer is so lonely, which is why I wrote my book. But I had, you know. Parents-in-law, parents, brothers, everyone and friends every day leaving food parcels on the doorstep, doing a rotor to take my children to things.

And I feel sad. Yes, I did miss out on some of their firsts. I didn't get to take them ice skating. I didn't get them to take them to something else, uh, to a theater play, but someone else did. And I'm grateful they got to do [00:14:00] that. And I had to prioritize surviving.

Rena Annobil: And you're here, you're here for them now.

Dr Anisha Patel: I'm here now and they're like 13 and 14. They say to me, mom, cancer's not that bad, is it? You're like, on tv, you're writing a book, you're going to this event. Oh, you're just recording another podcast. Oh, you're, and actually, I, I, what I really make clear to them is, is that I would give all of this back in a heartbeat.

Like I love the work that I'm doing now. It's emotionally exhausting, but I, I, it's so rewarding. It's so cathartic as well. This is how I can still be a GP because I see cancer and I'm trying to exclude cancer. Every single day. And patients do sometimes come to me because they know. I know.

Rena Annobil: Yeah.

Dr Anisha Patel: I get it.

Rena Annobil: And, and also for, for your children to think that about you shows what strength you have. You know that you are giving this image to your kids that you are breathing through. Right. And obviously you're, you're so passionate about what you're doing as well. Um, so. The life after. [00:15:00] Well, can I just go back to your treatment actually?

Yeah. In terms of treatment, what, what did that, uh, involve? Did you have chemo and how long did that go on for?

Dr Anisha Patel: Yeah, so I was really fortunate. Most people with my stage cancer would have chemo radiotherapy first, but because I was young, they took a calculated punts to just open me up first and they, um, and see if I needed it, see if it had spread.

And actually they spared me that initial chemo radiotherapy. So I had major surgery removing half of my rectum, which is. What stores your poo and part of my bowel and I'm now left with a permanent bowel dysfunction. I had a stoma temporarily to allow the bowel to heal. I had more surgery to have that stoma re reversed and my bowel re plumbed back together.

And then I went quite grueling chemotherapy. I mean, it was the pits, I'm gonna be honest. Um, and then, and then I was, I was done. And then, you know, having scans every six months and living from scan to scan for five years.

Rena Annobil: Wow. Okay. And

Dr Anisha Patel: that's hard.

Rena Annobil: That is, yeah.

Dr Anisha Patel: Um, you know, you [00:16:00] put your life, whole life on pause.

As we wanted to move house, we didn't move house. I couldn't get travel insurance initially. I couldn't get other insurance. You know, that all the things that we take for granted. Actually, you know, the, they, they all became, um, difficult. But actually I was fine with that. I was living, I was surviving and actually we used to live from scan to scan, which was difficult.

So we'd have four months of living our, trying to live our best lives and an urgency to live. And then it would be scan time again, worrying about the scan, worrying about the result, getting the result, processing it, and then back on the same circuit. That was tiring for my husband and for me. Mm-hmm. Um, and I think people really underestimate life after cancer because they just go, Bish bash bosh, you are done off, you pop.

You should be bouncing around like you've survived. And yeah, I am. I'm, I'm eternally grateful I've survived, but it's come at a [00:17:00] cost to my family and to me,

Rena Annobil: you know. Like people see you bouncing around, you know, you're looking absolutely beautiful. You know, we see you, um, out there spreading, uh, really important messages, um, about female health, about, about, um, you know, cancer awareness, that kind of thing.

But in terms of being about cancer survivor, like you told me about your treatment just now. What are those lasting effects for you physically?

Dr Anisha Patel: So, physically, um, chemotherapy damages the nerves in your hands and feet. So, um, every time I touch, uh, cold or my feet touch cold, I've got like nerve pain, sharp nerve pains.

Um, I, I don't have as much balance in my feet anymore, so I fall a lot more because it, it damaged the nerves. I've got this permanent bowel dysfunction, so. Today, I think I've already gone to the toilet. I don't mind sharing. It's like 10, 37 times today. Um, and sometimes is

Rena Annobil: that normal for you?

Dr Anisha Patel: So that that can be completely normal?

Some days it's more, [00:18:00] um, and I can go and eat out or go, you know, when I'm abroad it's, it, it can be really difficult. If I get a stomach bug, I can't actually leave the room, you know? Um, and then we've got all the other effects. So it's impacted my kidneys, so my kidney function isn't as good. Um, I've gone into.

Early menopause and people who go into menopause surgically or medically often have a menopause that's like a crash menopause with worse symptoms. Okay. And so that has been a whole different thing that I had to navigate a lot earlier than some of my compa trays. And the mental aspect, I mean, for me, the mental aspect has probably been as big a of a deal as the physical aspect.

I never had mental health difficulties. Till cancer, and actually it took me a long time to accept that I had PTSD and that I had anxiety. I had a counselor at my cancer center run through a charity, which I was very fortunate to have, and [00:19:00] she took me through 18 months of counseling and that's how my doctors get cancer.

Two blog started it. I cathart wrote through it. I'd then release it, I'd run away, didn't want to look or engage, and then I'd read it to my therapist and then I'd process and go onto the next chapter. And for me, that has been therapy in itself and I've had, I've got a toolbox now to manage my physical and emotional wellbeing.

It's not always perfect. Mm-hmm. But I always say to people, for whatever you live with, mental health wise, physical illness wise, you need your own toolbox. And your toolbox is gonna be different to my toolbox. Mm-hmm. I can share some of the things that might be helpful, but you need to, to try and with the mental health aspect.

That was, um, that was really difficult. And I think even though I'm better now, there are still times where it rears its head. There are things that are triggering. There are things that take me right back and I use my tools to drive manship.

Rena Annobil: Is there a sense of [00:20:00] anxiety that you carry with you afterwards?

I have, uh, speak spoken to some cancer survivors and they, they do talk about that kind of thing, or does your toolbox help you to manage that?

Dr Anisha Patel: Is there is anxiety that comes with it. Look, you are dealing and you are living with one of the biggest uncertainties you could possibly live with, and that fear of recurrence never goes away for some people.

So I'm five years outta what we call surveillance of being heavily monitored. I still have regular colonoscopy checks, but I've got to a place because of my husband as well that I know if I survived five years, I think I'm going to be okay. But. If I've had one cancer because of the treatment I had, and by virtue of having one cancer, that puts me at a greater risk of having another cancer.

So that never really leaves me. I know that, that, that, that fear will be there, but I try and compartmentalize it. I use my tools and for me, the urgency is for my kids and my urgencies to live life. [00:21:00]

Rena Annobil: So your experience and your knowledge has this, um, made you kind of reshape the way that you look at your health and wellbeing, you know, uh, things like how you move your body and um, the things that you eat?

Dr Anisha Patel: Yeah, so as I say before, I was, we were fairly healthy. I was always active, I was always exercising and I have been since childhood and, and movements medicine. For me, I think I'm much more aware of. Self-care. I think women are awful at self-caring. Awful, dreadful. But I have actually learned to be, and I shouldn't say selfish, I, I've learned that it's a necessity.

Self-care isn't an option. And I've really been cautious about implementing that into my life, about trying to reduce stress where we can. About making sure that our diet is really varied. So, although I was conscious of this before because my mom always showed us good eating [00:22:00] habits, I'm very conscious now of making sure we hit that 30 grams of fiber that yes, if my children want a bacon sandwich, I don't have a.

Breakdown about it. I used to, honestly, I used to get palpitations if they wanted to.

Rena Annobil: Yeah.

Dr Anisha Patel: But if it's for a tree, 'cause it's your birthday, you knock yourself out because I don't want to make things forbidden. But I'm very conscious of what we eat and it's a bit of a joke, uh, about the food police in the house and me being like that.

But actually I hope that some of those things they'll take into adulthood. And I think that's really important. So yeah, I am very conscious. I live by the 80 20 rule though, and I wrote in my book as well, you know, if you want to go and have that steak and a bottle of wine on your birthday, you need to do that.

You know? Yeah. We've gotta live that balance.

Rena Annobil: Let's talk about your book now. So, got it here. Um, everything you hoped you'd never need to know about bowel cancer, a doctor's very personal guide to getting through the shit and beyond. And I know I've taken a look through your book and it is, the way that you have described this is, [00:23:00] it's, it's like your, it's like a friend.

Dr Anisha Patel: Yes. That's exactly companion.

Rena Annobil: Yeah. Yeah. And I think, and I can imagine that this. Is, is the friend that people need when they're going through that experience, you know, if they've been diagnosed with, with bowel cancer, because let's face it, um, Anisha you know this and, and I know this in this day and age, like people are Googling symptoms and, and relying on AI to give them all the information they need.

And so the fact that you have, have turned your pain into purpose and written this, um, is, is amazing. Like when did you know that you wanted to, to write this? And is this what you probably wanted when you were going through this?

Dr Anisha Patel: So I, do, you know what? Everything that's happened to me, Reen, I'm gonna be really honest, has grown organically, and I love that authenticity and I really wanted to keep that.

Mm. And so when I blogged my way through it, it was selfishly for me, it was catharsis initially. But then I realized when I was researching and writing and then sharing, people were like, oh wow. [00:24:00] Thank you for this. And so I continued. And then obviously the great. Dame Deborah James did so much to raise awareness of bowel cancer.

Yeah, she did. And actually people were wanting to talk about it, so I was actually approached by a publisher, having had people through social media contacted me saying, you should really put this in a book. I was like, oh, yeah, yeah. You know, I, I'm not a writer, but I actually, I learned to write through my pain, like writing.

I, I, I absolutely adore writing now and even for non-cancer stuff now, even through my social media. I write about day-to-day things that people can relate to. Because it's cathartic for me, but I actually know it holds someone else's hand and that it is relatable and you're not alone. And that was what the book was for.

So when the publishers approached me, they said we would like an a Z of bowel cancer. And I looked at them thinking. Oh, really? Um, and I said, I'll tell you what, I'll write you the half, first half of the book is the 80 Z of bowel cancer. What everything you need to know from the risk factors to treatments, to what you need to pack in your hospital bag, but it's also for the [00:25:00] carers, for the relatives, for the loved ones.

So if you know someone with it, it, it's got all the tips for that. And I put in my diary entries to sort of illustrate my thought processes through the time. But the second half of the book, what I said to the publishers was, this is what I want to write about because you can't find it in the literature in one place about how you navigate mental health, the loss of self-identity, the fertility it takes away, the menopause, the bowel function, the side effects of chemo.

How'd you get back to work? How'd you have those conversations with your employers? If you are from a, um, minority group or from the, you know, LGBT group, how do you navigate what resources are out there? Mm-hmm. How do we make sure everyone's involved? How do you nudge your relative to go to screening?

Because actually a third of people don't turn up to screening. And I think all of those things are real passionate moments and things that I discovered as I was going along that need to be addressed. [00:26:00]

Rena Annobil: Well, it's a great book and, you know, um, this is, it's for everyone actually, because this, you know, in here you've got stuff like what's normal when it comes to like going to the toilet and that kind of thing.

Things that you need to, to be, to be eating. And it's, it's one of those things, bowel cancer, you know, I said in the intro that the symptoms are embarrassing to talk about a lot of the time, which is why a lot of people don't, um. In terms of symptoms and early detection, like what, what do you kind of, um, advise to people and how much do you think that, like, do you think people take it seriously?

First of all, um, what their poo looks like, for example.

Dr Anisha Patel: So we know that half people don't look before their flush, and I know you don't have to look every time.

Rena Annobil: Mm.

Dr Anisha Patel: But if you never look. How will you know when there's blood in the pan? How will you know when it's not normal? And this is my, I guess my slogan.

If you don't check, if you don't know your normal, how will you know when it's not?

Yeah.

Dr Anisha Patel: [00:27:00] And you know, actually, interestingly, bowel Cancer UK did a, did a study on the under fifties, um, called The Never Too Young Study, one in Three People Didn't Know Blood was a symptom of bowel cancer,

Rena Annobil: right?

Dr Anisha Patel: 50% of those diagnosed with bowel cancer young didn't know it could happen to them.

And a lot of people don't know all the symptoms of bowel cancer. So the way I ask people to try and remember it 'cause it is difficult, um, is by the acronym bowel. Okay? So B is for blood in your poo or blood in the pan on the tissue. O is for an obvious change in bowel habits. So that might be constipation, diarrhea, going more frequently, not feeling like you've emptied your bowel properly.

A change in shape of the poo. So my poos were like ribbons because the tumor was pressing on it, compressing it. So they're coming out long and thin. W is for weight loss. That's unexplained. Is for extreme tiredness and L is for a lump in your tummy or tummy pain. And when I talk about persistent change in bowel habit, I mean more than three weeks.

Okay? So yes, if you go away on [00:28:00] holiday and you get a stomach bug, you might be up to seven days, but if you've got symptoms three weeks or more, you really need to be going to see the gp. And what I want to reassure listeners is most of the time it's not bowel cancer, but we can check. We've got simple blood tests, poo tests, now literally dipping a stick in poo, which is the same stick as the bowel cancer screening program can tell us So much information whether you need for furthermore tests.

Rena Annobil: This is really important information. So important. So thank you for sharing that. Um, do you think that there is still, uh, a lot of embarrassment when it comes to going to the doctor though? Do people think, oh, okay, the doctor's gonna have to put their hands up my bum and all this kind of thing? Yeah. And do they do that?

Let's be real here.

Dr Anisha Patel: Yes. I mean. We as a society are up to blame for this. Surely historically, we know the children says, bum far pooey. And you see parents

Rena Annobil: going, sh mm-hmm

Dr Anisha Patel: We're hushing our children and telling them that it's dirty. Mm-hmm. It naughty, it's [00:29:00] embarrassing. You don't talk about stuff like this.

So when they get to adulthood. Then they're worried that they can't talk about those things openly. And what I really encourage our listeners is, is that actually have these open conversations with our children, with your nieces, with your nephews, with your grandchildren. Use the right words. Use bottom, vulva, vagina, you know, poo, whatever you want.

Don't hush it away. Actually, that's where the stigma comes from. That's where the embarrassment comes from. And actually, this is worse in certain communities. Um, it's not spoken about often in the Asian community, for example. You know, I know that I'm one of the only ones and thankfully there's more and more people now like me coming out that represent us because people think, oh, you don't see an Asian person getting bowel cancer.

Well, yes you do. There are lots of us. It's just that we're historically may not have been represented in campaigns or historically we've not wanted to talk about it. 'cause it's not what you do do. You know, you [00:30:00] don't talk about cancer, you just get on with a treatment and you know, even my therapist said to me.

She said, Anisha, when I go to the ward, there's people of all backgrounds, but in my room I only see Caucasian people. And she said she had one Muslim lady come to her and she had to lie to her family where she was going when she was going for therapy. This is still happening. Yeah, we're in 2026. Cancer is shit.

Why are we still doing that? Why are we still hushing it? And actually. Dame Deborah James, she really opened up that arena for talking about poo. It was the poo cancer, the brown cancer that no one, no one ever wants to talk about, but it's the UK's second biggest cancer killer. And in the US it's now the number one cancer killer in the under fifties.

We, things have gotta change and that's why we're having this conversation today. So I'm really grateful to have these platforms where people are welcoming these conversations. Absolutely. [00:31:00] As I say, the Bristol stool chart, look it up if anyone's, you know, anyone see it. Like people dunno what a normal poo is.

So when they come to me, they say. I've got a problem downstairs and I'm thinking, well, there's three holes there. Which 1:00 AM I going for? Is it the urethra where your urine comes out, your vagina or your bottom, or Uranus? Um, and then we get to the bottom of things, sorry, no pun intended. Literally. And then we have to move on to actually, where is the blood coming from?

I don't know. I dunno which hole it's coming from. Because they don't check, and that's not their fault. It's the fact that we haven't been taught how to advocate for ourselves. That's another thing I'm really passionate about health literacy, because actually that's one of the issues where people don't take up screening, where people don't know symptoms, where people don't understand health and what to look for.

Particularly again, in certain groups where it's worse that we need to be providing that education.

Rena Annobil: Absolutely. Now, if there are people who, uh, have, have listened to what you said and they're like, well, I sometimes have this, you know, I'm kind of concerned about things, but I'm [00:32:00] really nervous about going for screening, what would, what would you say to them?

Dr Anisha Patel: So if you have got symptoms, you need to go to see your gp. And I would say to them, write down your list of symptoms. 'cause that can sometimes help. And actually it's brilliant because it helps you get to the point of what you. Um, want to say, tell them what you're worried about. Tell them your concerns and tell them what you hope for.

Tell the doctor you're embarrassed. Actually, we will go above and beyond to try and make things more reassuring. If you know, you might be having an intimate examination, wear a skirt. If you're a lady, for example, you don't have to take everything off, um, and actually be inquisitive. Ask questions. But remember your doctor.

Is doing this day in, day out. So if I see a bottom, it's no different to looking at an arm. I am listening to your history and I'm looking at that body part, looking for clues to give me the diagnosis. I'm not worried if you've shaved, if you've had a shower. I don't care. I just want to get to the bottom what what [00:33:00] things are.

And remember, one in 12 of my consults are gut related. So I'm looking at a lot of bottoms. I do a lot of women's health. I'm looking at a lot of vaginas and vulvas. I'm doing this all day. So, yeah, take someone with you as well. That's another thing you can do. Yeah,

Rena Annobil: I mean this would, this makes me feel better 'cause I once had to have an examination and um, like a doctor literally had to put her hands up my bum.

And then I saw her the next day somewhere completely out of context at some kid's activity thing. And I was just like, oh my God. And I felt so embarrassed and I don't think she cared at all. I mean,

Dr Anisha Patel: she probably doesn't, not being funny. She probably doesn't even, she's so many patients, she's probably like, oh, have I seen you

Rena Annobil: before?

Actually. I, I think. I think so. And I was there going, oh my God, she's gonna be like that bomb. And that face, it's you.

Dr Anisha Patel: My memory's

Rena Annobil: good. It's

Dr Anisha Patel: not that good.

Rena Annobil: Oh my gosh. Um, so I wanna just talk to you now about breaking taboos in women's health. 'cause I know's something that's something that you are really passionate about as well.

Uh, conversations around women's bodies. Yeah, they [00:34:00] definitely need to be louder, don't they?

Dr Anisha Patel: A hundred percent need to be loud. Women's health has been, um, ignored for years. All the research has been done in males, often white males. Only 2% of, uh, research goes into women's health research currently, so we, that's crazy.

Need to be working harder and things are starting to turn, but it's really slow and we're seeing that in places and conditions like endometriosis. A lot more about that. We're hearing a lot more about the gyne cancers. We're hearing a lot about more about maternity experiences between, particularly in black and Asian people.

Yeah. Where they have, um, a real discrepancy in the care that they're given. I mean, it's just mind blowing. But yeah, we've gotta keep championing, keep talking and doing what we're doing. I mean, I'm gonna test you now. Tell me the five gynecological cancers.

Rena Annobil: Okay. So I was gonna ask you, but let me see. Um, okay, so, right.

Um. [00:35:00] Ovarian cancer.

Dr Anisha Patel: Yep.

Rena Annobil: Cervical cancer.

Dr Anisha Patel: Yep.

Rena Annobil: Um, I actually, oh my God, what are the other ones? Ovarian cancer. Vagina

Dr Anisha Patel: Vaginal cancer.

Rena Annobil: Okay. Right. And then, and the

Dr Anisha Patel: vul cancer and endometrial wound cancer. Now you are

Rena Annobil: not, see, I didn't, I didn't know.

Dr Anisha Patel: No. And you're not alone because. Actually, most people can only name one or two of these.

Mm. Um, and only one in four, one in five can name in four. So if we don't know what cancers and bits can get cancer, how do we know? How do we know what to check? And it's these things that I really, really want to get into schools and, and, and into a sort of PHSE curriculum, but not to scare people. This is not to scare and fear Mongo and cause health anxiety.

I want [00:36:00] to sort of remove the embarrassment and go towards empowerment, to move the ease along, because actually if you feel empowered as a woman, then you can advocate for yourself much better. And historically, back in Victorian times, women were often just sort of cast away that you are, you've got hysteria, you've got anxiety, everything even if you had a physical problem was hysteria.

And that's where the word hysteria comes from,

Rena Annobil: right?

Dr Anisha Patel: What have we done to women? We've made them feel that actually it might all be in their head, that they won't be taken seriously, that there'll be gaslit, that they will not be believed. Why would you want to go to a healthcare professional if you feel like you won't be believed?

Why? Because actually, you feel bad enough as it is. But why are we normalizing that? And I don't like the word suffering, but it is. Why are we normalizing suffering? It's like the heavy period narrative. I had heavy periods growing up. [00:37:00] Mum wasn't probably told what a heavy period was. My mum.

Rena Annobil: Mm-hmm.

Dr Anisha Patel: We were, I could talk to her about it, but she just thought if you leaked on the bed, you leaked on the bed.

And that was part of your cycle. If I had pain, you took some painkillers? Mm-hmm. But then it started impacting me and I started thinking about endometriosis as I became a doctor, and then it took me three years to have my first child and then I had my bowel cancer surgery. And what did they say to me?

Your bowels covered in endometriosis. Did you know you had bad endometriosis?

Rena Annobil: Wow.

Dr Anisha Patel: Oh my God. I was just, I was straight down getting a coil straight away, and I've had no problems since. But with my daughter now, I am talking periods all the time, and I have gone to her swim club. I've gone to their school to teach them what a heavy period is, because if you don't know what a heavy period is, you'll think that's just normal for you.

But if anything affects your quality of li life, your ability to go to work, your ability to go to school, you are getting anemic. That's a [00:38:00] heavy period.

Rena Annobil: This is, is so important to talk about this kind of stuff because it is like, a lot of these things are just shrouded in, in shame and secrecy, and it's insane.

The, the, uh, the amount that you said is invested into women's health. The fact that we are actually giving birth to next generations. Right? Yeah. Excuse me. Can we have some attention to our actual bodies please? Yeah. It's really like, it actually makes you quite angry, to be honest with you. Um, so, you know, those, those, uh, the gyne cancers Yeah.

Right. That we talked about. Are they often difficult to detect and why is that?

Dr Anisha Patel: Yeah, so particularly ovarian cancer. Mm-hmm. You know, March, we just had ovarian cancer awareness month. The symptoms are vague, that's the problem. And they can mimic a lot of other mm-hmm. Things so. The acronym beats. So bloating, um, is for B, so you feel persistently bloated, not just after food all the time.

And then [00:39:00] eating, um, is e and that means that if you feel full really quickly or your appetite's gone

Rena Annobil: mm-hmm.

Dr Anisha Patel: That, that can be, um, a problem as well. Um, a appetite loss. And then t your toileting changes, your toilet changes. You want to go for a wee more or find difficulty going for wee, or you going for a PU more.

Mm-hmm. And sorry, A was for abdo pain, so tummy pains or pelvic pains. So I think, you know, those could be a number of things. And sometimes women get misdiagnosed as IBS because of it, but we need to be doing those tests. With a lot of the other gyne cancer. So for the vulva it might be, um, uh, itching in your vulva that's persistent.

A new mole, a new, um, lesion on your vulva discoloration. But you need to be putting a mirror down there to look. And how many people do you think check their vulvas?

Rena Annobil: Well, I think people do. And then, and also when you say that you need to be checking with the mirror, a lot of people are like, oh my God, I'm not gonna do that.

Like, do you [00:40:00] know what I mean?

Dr Anisha Patel: But how will you look at your skin? And 4% of people check their always regularly, so. Cancer. Yes, it's a cancer as you get older, but these are still things you need to be aware of. And if you don't know what's normal, we go back to it. But bleeding. So for a lot of the other GY cancers, it's all about bleeding patterns.

So you have a period, but if you are bleeding in between periods, bleeding after sex, mm-hmm. Bleeding after menopause discharge, that's abnormal for you. You need to be getting checked. Okay. And we can do all the checks and we can refer you and you can get diagnosed early. 'cause getting an earlier diagnosis for any cancer saves lives and you have less invasive treatment.

Rena Annobil: Okay. You know, Anisha, um, there are a lot of people now because of the rising rates of cancer. You know, there is a certain, uh, anxiety about like, oh my God, is this cancer? Is that cancer? Is that cancer? Now we do need to know all this information that you, you've said, yeah, we, we obviously need to take that on board, but where is that balance [00:41:00] for people that you would like to see between being scared and anxious about all these things and.

Feeling empowered.

Dr Anisha Patel: Yeah, and I think you are right that it's. It's a kind of gray line, isn't it? Where that can tip for some people. And I do see much more health anxiety, interestingly, because of information online than I used to 10 years ago. And the problem with some of that information is that it's misinformation.

So I think a, you need to be going to trusted sites, trusted clinicians who are actually working in the field right now, not people that are, you know, used to be used to be in the field because things are evolving all the time. And what I want people to remember is. This information is to empower you. So if you get those symptoms, you can go to a doctor and present yourself and describe your worries so that the doctor can then do the necessary tests and investigations to either reassure you or diagnose another condition.

'cause there are lots of other reasons you can get these symptoms and you equally need to get treatment and a [00:42:00] diagnosis for that or get you onto a cancer pathway. But most of the symptoms and the things that I see when you come to us. Most times, nine times outta 10. It's not cancer. It's not cancer, but we must, we must be getting checked.

Rena Annobil: Okay. And is there anything else that you want people to know about bowel cancer? Uh, the symptoms or any of the, the gyne cancers that affect women?

Dr Anisha Patel: So I really want people to take up screening invites for breast, cervical bowel cancer. We have these wonderful systems in place in the uk. This is something NHS does brilliantly, is screening for cancer.

It's evidence-based for bowel cancer. You reduce your risk of dying by 25% through the bowel cancer screening program because they're detected. All screening programs are to detect cancer when you have no symptoms. And the reason I'm emphasizing this is people think a, I'm not gonna do it 'cause I haven't got any symptoms.[00:43:00]

B, they get the wrong test. They've got symptoms and think I'll do my screening test. That's not for that. If you've got symptoms, you go to your doctor, okay? And if you have a loved one at home who might be in the age bracket, so over 50 for breast cancer, over 50 and over for bowel cancer and 25 and over for cervical cancer, you need to be just nudging them today.

Text them. Have you done any screening for whatever cancer? Because it will save lives and it makes sure that we can get cancer hopefully at the earliest stages.

Rena Annobil: Mm-hmm.

Dr Anisha Patel: Guess how many people don't turn up for cancer screening?

Rena Annobil: What is it like? Is it 50% or something like that?

Dr Anisha Patel: It's one in three People don't go

Rena Annobil: right.

Dr Anisha Patel: Don't respond. Don't turn up for their screening invite.

Rena Annobil: The bowel cancer screening, is that something that people are invited for as well? Like

Dr Anisha Patel: cervical screening? Yes, it's National. National screening program. Sends out letters, right, and kits at home. So actually the bowel cancer screening test you can do [00:44:00] in the privacy of your own home.

So you get a little kick through the post you literally, it's a stick. You need to just. Dip it in the poo. There's no sort of, you know, massive amounts of feces or poo. You need to put in a pot. It's literally dip it in and put it back in the post. It's as simple as that. Okay? And I say to people, if it comes through the post, you put it by the toilet straight away.

Don't put it off, don't put it under the filing. Don't say, I'll do it later. Just do it. We all know what we like. I, I, I would probably forget about it if I didn't just do it there and then.

Rena Annobil: Okay.

Dr Anisha Patel: But, um, I think it's really important that we just, you know, even my own father, I, you know, my husband and I said, dad, have you, when he was, um, in the age groups, have you done your test?

He's like, oh, no, do I need to? I'm like, dad, come on. But I think, again, it's this. It's the health literacy and the understanding of the test. People need to understand why you are doing the test and it's to try and catch cancer when there's no symptoms.

Rena Annobil: What is the age range then when people would get that test sent out to them?

Dr Anisha Patel: So it's every two years from the age of [00:45:00] 50 for bowel cancer screening. Right?

Rena Annobil: Right.

Dr Anisha Patel: Um, up to 74. They've lowered the threshold recently. Okay. Um, and it's taken time 'cause you need the manpower and the infrastructure to deal with the positive test. And if you have a positive test, um, only one in 10 of those will be a cancer.

So don't worry if you get a positive test back. Okay.

Rena Annobil: Anisha, it's been so interesting speaking to you and this is such like essential information and I really, I think that people are gonna just take so much away from this conversation. So thank you so much for, for coming on and chatting to me, and thanks for, you know, what you're doing to raise awareness every day.

You are doing this on social media. Uh, so doc, uh, doctors get cancer too. Doctors.

Dr Anisha Patel: Doctors get cancer too. Yeah.

Rena Annobil: Okay, great.

Dr Anisha Patel: Thank you.

Rena Annobil: Which everybody should follow. Um, and uh, finally. This is called the lifestyle prescription. Yeah. And we, I do ask guests that, is there any lifestyle prescription that you would wanna share with the listeners?

It doesn't have to be related to, to bowel cancer. It can of course, but something that has, [00:46:00] uh, helped you, uh, in terms of health and wellbeing that you would wanna recommend to people.

Dr Anisha Patel: I think I'm gonna prescribe fiber to all my patients. Okay. Fiber is. Not a sexy nutrient in social media. It's all about protein, carbs.

Yeah. But fiber, to me is the sexiest ingredient, uh, um, nutritional elements, because 96% of us aren't getting enough. But it's gonna reduce your risk of, um, diabetes, reduce your blood pressure, reduce your cholesterol, keep you fuller for longer.

Rena Annobil: Mm-hmm.

Dr Anisha Patel: It's gonna help your digestion, your gut microbiome, which we know is responsible for so many things from your skin to your mental health.

Obviously reduces your risk of bowel cancer, and I just think we need to be getting more of it, and you need to actually think about getting 30 grams a day. It's not something that falls from the tree because there's such an old approach, processed diet out there. We really need to be looking at the back, back of packets and stuff and adding these things in.

I don't believe in [00:47:00] diets. I believe in adding things in, making sure it's worth it.

Rena Annobil: Okay. Thank you. That's so important. So it is not all about protein, it's about fiber as well. Uh, thank you so much for, uh, watching and listening to this podcast. I'm sure that you have taken, um, some great things away, and please do share this with other people as well because it's definitely beneficial to, to all our health.

Um, thank you so much and join me again on the next one.