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The purpose of this section is to provide information to people who are in any way affected by colorectal cancer. You could be a patient who has been recently diagnosed with colorectal cancer and wanting to find out more about the condition, or a relative who wants more information about bowel cancer.
This section has been designed to help you through the large amount of information on the internet about bowel cancer. We shall provide a short summary of each of the topics involved, and then a series of links to external resources. We hope that the information provided from this information is of use to you.
What to expect when visiting us
As a caring institution we do understand that it may be a stressful time for you and that it may at times require courage for you to attend our colorectal clinics. Our experienced staff at the colorectal department are all very friendly and will support you during your hospital visit, making it a positive experience.
On your arrival
On arrival you will be asked to sit in the waiting area. There may be a wait as clinics often do not run on time. A nurse will call your name and you will be taken to the examination room, where you will be given all the time you need to discuss your condition.
The attending doctor will ask you questions about your health and perform an examination (for example of your abdomen). He will then advise you to have some tests done if deemed necessary.
Routinely performed clinic tests
A lot of useful information can be obtained by performing rigid sigmoidoscopy. This procedure is aimed to get a good view of the lower end of the bowel. Though it can cause discomfort, it will help the doctor reach a diagnosis to help your condition. At times blood tests are also arranged to be performed during the same visit.
Other tests that may require a seperate visit
You may be asked to have one or more of the following additional procedures:
- Colonoscopy – this procedure is done to assess the large bowel and help us explain the cause of your symptoms. It is carried out under sedation and a thin tube with an end camera is inserted through the back passage. Photographs and tissue biopsies (sent to the lab) are taken of relevant areas. It is usually a painless procedure.
- Flexible Sigmoidoscopy – very similar to the colonoscopic examination but offers a more limited view of the bowel. Performed to assess left sided large bowel symptoms.
- CT scan – uses the same technique as an ordinary x-ray but uses much more ‘photographs’ to build a more detailed image of the body.
- MRI scan – Unlike x-rays, this imaging technique uses a magnetic field and radiowaves to image the body in finer details
- PET scan – this form of imaging help to locate disease in the body by the use of a tracer (substance given at the time of the scan). It is mainly used for cancer diagnosis and treatment.
- Ultrasound scan – quick and safe, this scanner uses sound waves to generate pictures on a screen that are representative of the relevant body parts.
What happens next
Once the results are available, you will be called back to the clinic to discuss your treatment options. The doctor will advise you about the treatment options and will help you make an informed choice. Depending on your condition, the following might happen:
- You might not need to see us again, in which case your GP will be informed about the outcome via a letter.
- We might need more information on your condition before offering any treatment, in which case we will need to see you again in clinic after you have had the recommended additional tests.
- Surgery might have been recommended, in which case you will be directed to our pre-operative clinic to assess your fitness for surgery. Depending on your health status, you might need to be seen by an anaesthetist. He will advise you on the steps that need to be taken to make your surgery as safe as possible.
What is Colorectal Cancer?
The digestive system is a long tube extending from the mouth at one end to the anus (bottom) at the other end. The purpose of the digestive system is to break down food that is eaten so that energy and nutrients can be absorbed into the body. It also plays a role in absorption of water and the excretion of some waste products from the body.
The digestive system is divided into many parts along its length. Food which is taken into the mouth is chewed to help to break down the food. It is then swallowed and passes down the oesophagus to the stomach. In the stomach the food is broken down even more with the addition of digestive juices. After being in the stomach the food then passes into the small bowel where all the energy and nutrients are absorbed into the blood stream. Any non-absorbable contents of the small bowel pass into the large bowel. This is where water is absorbed into the body to make the contents of the bowel more solid. The solid contents are finally stored as a stool in the rectum until this is excreted out of the body through the anus when you go to the toilet.
The whole of the bowel is lined by epithelial cells which are a protective coating to the bowel wall. These cells are programmed to constantly replicate and produce new cells as old cells are eroded from the inner edge of the bowel. This replication is a very tightly regulated system, but sometimes damage to the regulation system can cause it to go wrong and cause more new cells to develop than are needed. If this happens then a small outgrowth will develop from the bowel wall, this is called a polyp.
Polyps in themselves are harmless and will not cause any problems. However if they continue to grow they have the potential to develop into a cancer. This means that if any are seen at a colonoscopy (a small camera passed up through your bottom into the bowel) then they will be removed.
If the polyp continues to grow then it can develop into a cancer. When this happens the cells are no longer acting as “normal” bowel cells but are replicating in an uncontrolled manner. Also, the cells develop the ability to invade into other tissue such as other structures nearby, or migrate to distant organs such as the liver or lungs. The cells become immortal and no longer die off and this is part of what makes treatment of cancer so difficult.
Symptoms of Colorectal Cancer
There are a number of symptoms that are suggestive of colorectal cancer. You may have only one or two of these symptoms but to rule out colorectal cancer they will all need to be investigated.
However, having these symptoms does not necessarily mean that you have colorectal cancer as a number of other conditions can present with similar symptoms.
Symptoms of Colorectal cancer
Change in bowel habit – this may mean that you are going to the toilet more or less frequently than usual, or that you have developed a bowel habit that varies from diarrhoea to constipation.
Blood in or around the stool – you may have noticed that there is blood in your stool or that your stool is darker than usual.
Pain in the abdomen.
Pain on opening your bowels.
A feeling of not having properly emptied the bowel after going to the toilet
Weight loss for no apparent reason.
Loss of appetite.
An increased feeling of tiredness and lethargy.
There are also indications from tests that your doctor has done such as:
- Anaemia – this is where you have not got enough red blood cells in your blood, these are the cells that carry oxygen around the body. If you are anaemic it could be that you are bleeding from somewhere that is not noticeable.
- Positive Faecal Occult Blood test (see below for details).
Many other non-cancerous conditions can also have these symptoms e.g:
- Haemorrhoids (piles)
- Irritable Bowel Syndrome
- Ulcerative colitis
- Crohn’s disease
Investigations
There are a number of different tests used in the diagnosis and treatment of bowel cancer. These are:
Treatment
There are a number of different treatment options for bowel cancer, depending on your circumstances. These are: