You will probably see many doctors, nurses and health professionals, who will work together as a multidisciplinary team to diagnose and treat you. It may be helpful to keep together documents about your appointments, information, letters and useful contacts. This will make it easier for you to know who to call and which doctors you have seen.
For most people, their bowel cancer is found after having symptoms. For others it may be discovered following a medical check-up. If you have symptoms, your general practitioner may arrange a test that involves having the inside of your bowel looked at. This could be with a short tube (sigmoidoscope) or a long tube with a small camera on the end (colonoscope). Sometimes a CT scan (computerised tomography scan) can be used to look at the inside of the bowel (CT colonography).
It can be a worrying time waiting for results, especially if you need several tests. If these tests do not rule out cancer but concern persists, it is usual to be referred to a bowel specialist. They will arrange further tests and advise you about treatment options. The purpose of these tests is to find out the type of bowel cancer you have and if the cancer has spread to other parts of your body. You may need to travel to another hospital for some tests.
In New Zealand, a bowel cancer screening programme is being rolled out region by region for those without symptoms.
The National Bowel Screening Programme is free for men and women aged 60 to 74 years who are eligible for publicly funded healthcare. It aims to save lives by finding bowel cancer at an early stage when it can often be successfully treated.
For more information, talk to your doctor, call 0800 924 432, or visit the screening website: www.timetoscreen.nz/bowel-screening/
The doctor feels the surface of your abdomen to check for any lumps.
The doctor inserts a gloved finger into your rectum to check for any lumps, swelling or bleeding.
X-rays, CT scans or PET (positron emission tomography) scans and MRI (magnetic resonance imaging) scans are used to make images of the inside of your body to see if you have a lump and if it has spread. These can be done before or after surgery.
A sample of your blood is taken to count the number of red cells in your blood (a low level [anaemia] can be a sign of bowel cancer).
CEA is a blood test that looks at a protein in your blood. The protein level is sometimes raised in people with bowel cancer; however, there are some conditions that are not cancer (for example, smoking) that can cause it to be raised.
CEA on its own does not diagnose bowel cancer, but if you have been diagnosed with bowel cancer, it can be useful for tracking progress.
This is most commonly used as a screening tool as part of a screening programme for bowel cancer. It is less helpful if you have abdominal symptoms. A normal faecal occult blood test does not exclude bowel cancer.
This is an older test using barium and X-rays to look at the lining of your bowel. There are now better tests than this available, and most doctors do not recommend this test anymore.
This X-ray technique is increasingly replacing barium enemas. The colon is emptied with a laxative. Air is then gently pumped into your bowel via your anus (the entry to your rectum). CT scans are taken of your abdomen. If abnormalities are found, this usually leads to a colonoscopy.
The doctor examines your rectum and the lower part of your bowel using a short tube (which is usually straight but may be flexible) called a sigmoidoscope. The doctor may also take a biopsy (a small sample of tissue).
Before your test you are given instructions on how to prepare your bowel for a colonoscopy. The doctor or nurse inspects the entire length of your large bowel by gently inserting a long, flexible tube with a video camera in it (called a colonoscope). This is passed through your anus and rectum into your colon (see the diagram below). You may be offered medication to help you relax during the colonoscopy.
If you have a pre-cancerous lesion, such as an adenomatous polyp of the colon or rectum, your surgeon or gastroenterologist may just remove the polyp from the bowel lining. A border of healthy tissue will also be removed. This is called a local resection.
Diagram showing a local resection of an early-stage bowel cancer
(Copyright: Cancer Research UK)
If there are any cancer cells within the polyp, your surgeon may decide you need a second, larger operation. This is to remove any cells that may have been left behind, and to make sure that the cancer is unlikely to come back.