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The symptoms of cancer of the large bowel may include any of the following:
Sometimes the cancer can cause a blockage (obstruction) in the bowel. The symptoms of this are sickness, constipation, griping pain and a bloated feeling in the abdomen.
Although these symptoms can be caused by conditions other than cancer of the large bowel, it is important that you always have them checked by your doctor. As bowel cancer usually occurs in people over the age of 50, these symptoms in younger people are often thought to be due to other bowel problems such as irritable bowel syndrome (IBS) or ulcerative colitis. The symptoms of IBS and ulcerative colitis can be made worse by stress.
Usually, you begin by seeing your GP (family doctor) who will do an examination of your back passage and feel your abdomen. You may also be asked to take a sample of your stool (bowel motion) to the surgery so that it can be tested for blood.
If your GP thinks that a cancer may be present, or is not sure what the problem is, they will refer you to a hospital specialist.
At the hospital, the doctor will take your medical history before doing a physical examination. This will include a rectal examination. To do this the doctor places a gloved finger into your back passage to feel for any lumps or swellings. This examination may be slightly uncomfortable but it is not painful.
The following tests may be used in the diagnosis of cancer of the large bowel.
This is a special x-ray of the large bowel. It will be done in the hospital x-ray department.
It is important that the bowel is empty so that a clear picture can be seen. On the day before your test, you will be asked to drink plenty of fluids and to take medicine (a laxative) to empty your bowel.
On the morning of your enema, you should not have anything to eat or drink. This may vary slightly from hospital to hospital, but your doctor or nurse will give you an instruction sheet with advice.
Just before the test, to make sure that the bowel is completely clear, you may be given a bowel wash-out. The nurse will ask you to lie on your left side while a tube is gently passed into your back passage. Water is then passed through the tube. You will be asked to hold the liquid in the bowel for a few minutes before you go to the toilet.
For the enema, a mixture of barium (which shows up on x-ray) and air is passed into the back passage in the same way as the bowel wash-out. This ensures that a clear picture can be seen. It is important to keep the mixture in the bowel until all the x-rays have been taken. The doctor can then watch the passage of the barium through the bowel on an x-ray screen. Any abnormal areas can be seen.
The test can be uncomfortable and tiring, so it is a good idea to arrange for someone to travel home with you if possible.
This test allows the doctor, or nurse colonoscopist, to look at the inside of the rectum or the large bowel. It will be done in the hospital outpatient department or on the ward.
You will be asked to lie curled on your left side while a tube is gently passed into your back passage. A small hand-pump is attached to the tube so that air can be pumped into the bowel. This makes you feel that you want to pass a bowel motion, but the feeling will gradually go away once the test is over. A proctoscope is a short tube that just goes into the rectum. A sigmoidoscope is a longer tube that can be passed further up into the large bowel. With the help of a light on the inside of the tube, any abnormal areas can be seen. If necessary, a small sample of the cells (a biopsy) can be taken for examination under a microscope. The biopsy is not painful.
A proctoscopy or a sigmoidoscopy can be uncomfortable but not usually painful. You should be able to go home as soon as the test is over.
Colonoscopy If your doctor wants to look inside the whole length of the large bowel, you may have a colonoscopy. This will usually be done in the hospital outpatient department and takes about an hour.
For a colonoscopy the bowel has to be completely empty. This means following a careful diet for a few days before your test. The preparation is similar to that of the barium enema (described above). You will be given instructions about this by your hospital.
Just before the test, you may be given a tablet to help you feel more relaxed. Once you are lying comfortably on your side, the doctor, or nurse, will gently pass a flexible tube (a colonoscope) into your back passage. The tube is made up of flexible fibres. It can easily pass around curves and the whole length of the large bowel can be examined. A light on the inside of the tube helps to show any abnormal areas or swelling.
During the test, photographs and samples (biopsies) of the cells on the inside of the large bowel can be taken. A colonoscopy can be uncomfortable but the sedative will help you feel more relaxed.
Most people are ready to go home a couple of hours after their test. It is a good idea to arrange for someone to collect you from the hospital as you shouldn't drive for several hours after a sedative.
If the biopsy shows that there is a cancer in the large bowel, further tests are often needed to find out the size and position of the cancer, and to see whether it has spread. This process is called staging, and may take some time. The results will help you and your doctor to decide on the best treatment for you.
Sometimes, during and after the period of treatment, these tests may be done again to check on your progress.
Although tests are useful in diagnosing bowel cancer, no one test can give all the necessary information. For example, sometimes even modern scans cannot pick up tiny areas of cancer. Occasionally, other medical conditions show similar results, making it difficult to decide what is and is not cancer.
Doctors have to think about all the information they get from the different tests and examinations, along with your symptoms and medical history. For this reason, it is often best for the doctor to discuss test results with you personally.
You will probably have blood tests to assess your general health, and also to check for a particular protein that is sometimes produced by bowel cancer cells. The protein is called carcinoembryonic antigen (CEA).
X-rays are often taken to check the health of your heart and lungs.
An ultrasound scan uses sound waves to look at internal organs, such as the liver and the inside of the abdomen, to see whether there is any spread of the cancer to other organs. You will usually be asked not to eat or drink for at least 6 hours before the test.
Once you are lying comfortably on your back, a gel is spread onto your abdomen. A small device, like a microphone, which produces sound waves, is passed over the area. The sound waves are then converted into a picture by a computer. The test only takes a few minutes.
In some situations you may have a probe (like a tube) inserted into the rectum to produce ultrasound scans. This is known as an endoscopic ultrasound (EUS).
A CT scan takes a series of x-rays which builds up a three-dimensional picture of the inside of the body. It can show the size of the tumour in the bowel and whether it has spread beyond the bowel. The scan is painless but takes longer than an ordinary x-ray (from 10 to 30 minutes).
CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least 4 hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.
Just before the scan, a similar liquid is also passed into your back passage through a small tube. Although this may be unpleasant at the time, it makes sure that the best possible picture is produced. Once you are in position, the scan will be taken.
You will probably be able to go home as soon as the scan is over.
This test is similar to a CT scan, but uses magnetism instead of x-rays to build up cross-sectional pictures of your body. It can help to show the stage of the cancer and can give the surgeon information to help them plan the operation.
Some people are given an injection of dye into a vein in the arm to improve the image. During the test, you will be asked to lie very still on a couch inside a long chamber for about 30 minutes. This can be unpleasant if you don't like enclosed spaces. If so, it may help to mention this to the radiographer. The MRI scanning process is also very noisy, but you will be given earplugs or headphones to wear. You can usually take someone with you into the room to keep you company.
The chamber is a very powerful magnet, so before going into the MRI room you should remove any metal belongings. People who have heart monitors, pacemakers or certain types of surgical clips cannot have an MRI because of the magnetic fields.
Pet scans are a new type of scan and how effective they are in the diagnosis of bowel cancers is not yet known. These scans are not available in all hospitals and you may have to travel to a specialist centre to have one. They are not often necessary but you can discuss with your doctor whether one would be useful in your case.
A PET scan uses low-dose radioactive sugar to measure the activity of cells in different parts of the body. A very small amount of a mildly radioactive substance is injected into a vein, usually in your arm. A scan is then taken. Areas of cancer are normally more active than surrounding tissue and show up on the scan.
It will take several days for the result of your tests to be ready, and a follow-up appointment will be arranged for you before you go home. Waiting for results can be a difficult time and you may need support from your family/p>
The stage of a cancer describes its size and whether it has spread beyond its original area of the body. Knowing the extent of the cancer helps the doctors to decide on the most appropriate treatment.
Often the exact stage of a bowel cancer can only be known after it has been removed by surgery.
Generally, cancer of the large bowel is divided into four stages, from small and localised (stage A), to spread into surrounding structures (stages B and C) or other parts of the body (stage D). If the cancer has spread to distant parts of the body, this is known as secondary cancer (or metastatic cancer).
Doctors often use a staging system created by a pathologist called Dukes to describe large bowel cancer.
The Dukes system is gradually being replaced by the TNM staging system.
Although this system is more complex, it can give more precise information about the tumour stage than the Dukes method.
If the cancer comes back after initial treatment it is then known as recurrent cancer.
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