Colorectal (bowel) cancer – Part 1

This booklet tells you about bowel cancer. You may hear it called colorectal cancer as it covers cancers of the colon (large bowel) and cancer of the rectum (the lower part of the bowel leading to the back passage). It explains treatment choices and tells you what support is available for you, your family and carers.

What is bowel cancer?

Cancer is a disease of the cells which make up the organs and tissues of your body and when these cells change the way in which they divide a tumour (growth) develops (see diagram below). Bowel cancer is the development of a malignant (cancerous) tumour in the colon or rectum.

What causes bowel cancer?

In most people the cause of bowel cancer is still unknown. Some people are at greater risk than others, for example, people who have inflammatory bowel disease or those who are more likely to develop polyps (warty growths) in the bowel.

People with a strong family history of bowel cancer may also have an increased risk of developing the disease.

Bowel cancer is mainly a disease of the western world and it is thought a high fat and low fibre diet may increase the risk of developing the disease.

Although bowel cancer and its treatment may need permanent changes to your diet and lifestyle, thousands of people have been treated successfully and have been able to return to normal, healthy and useful lives.

What are the signs of bowel cancer?

Bowel problems are common; we all get problems at some time in our lives. The signs and symptoms that someone may have bowel cancer are also common in people who do not have cancer.

If you have any of the following signs or symptoms it is safe to watch and wait for up to 6 weeks; but if they last longer than this, you must get advice from your GP.

The most common signs and symptoms that someone may have bowel cancer are changes in bowel habit.

You may:

• have looser, more diarrhoea-like motions.
• feel you need to go to the toilet more often than usual.
• notice blood when you pass your motions.
• have bleeding from your rectum that has no other known reason, for example, haemorrhoids (piles). If you are over 50, any rectal bleeding could be a warning of more serious problems, so you should go to see your GP as soon as possible.
• have unexplained anaemia.
• have a lump in your abdomen (tummy).
• have severe, unexplained, abdominal pain which has come on recently, especially if you are over 50.

Most people who have any of these signs or symptoms will not have bowel cancer, but it is very important to see your GP who will arrange for you to have further tests to rule it out.

Don’t be embarrassed or scared to see your GP: it could save your life.

How will my doctors find out what is wrong with me?

Your GP will advise further tests or scans to help find out what is wrong with you and to plan your treatment. You will be asked to go to the hospital for these tests and for specialist advice and treatment.

At the hospital, a doctor will see you and ask for details of your lifestyle, medical history and close family medical history.

You will then have a physical examination which will include:

• an examination of your abdomen
• an examination of your rectum with a gloved finger to feel for any lumps or swellings
• blood tests to check your general health

If needed, you will also have a sigmoidoscopy (See below).

At a later date you may also need:

• colonoscopy. (If this examination is needed you will be given a leaflet to tell you about it.)
• tissue biopsy
• ECG (electrocardiogram)
• CT/CAT Scan (Computed Tomography/Computerised Axial Tomography)
• CT colonography
• MRI Scan (Magnetic Resonance Imaging)
• RUS (Rectal Ultrasound Scan)
• CPEX (Cardiopulmonary exercise test).

What is a sigmoidoscopy?

A sigmoidoscopy allows your doctor to look at the inside of your rectum and the lower part of your colon. This is usually done in the hospital Outpatient Department.

You will be asked to undress from your waist down and to lie on an examination couch, curled on your left side.

Your doctor will then gently pass a sigmoidoscope (a viewing instrument like a small tube) through your anus into your rectum. A small amount of air will be pumped into your bowel through the sigmoidoscope.

This allows your doctor to see if there are any abnormal (unusual) areas in your lower colon and rectum. (See diagram on previous page, which shows the part of the bowel examined during a sigmoidoscopy.)

If needed, a tissue biopsy can be taken from the lining inside your rectum for testing in a laboratory.

A sigmoidoscopy is not painful, but can be uncomfortable; any discomfort can be eased if you are able to relax. You should be able to go home as soon as the examination is over.

What is a colonoscopy?

A colonoscopy is an examination that allows an endoscopist (a doctor or nurse trained to do endoscopies) to see the inside of your bowel.

A colonoscope (a soft flexible tube, about the thickness of a finger) is passed into your rectum and guided through your bowel. (See diagram below, which shows the area examined.)

This tube has a bright light and camera at the end of it that passes back a picture of the inside of your bowel on to a monitor.

Your endoscopist can then check if any disease or abnormalities are present. Tissue biopsies can be removed during this examination.

If your doctor advises you to have a colonoscopy to help find the cause of your symptoms, you will be given a leaflet that explains this examination in more detail.

What is a tissue biopsy?

A tissue biopsy is when a small piece of tissue is taken from your bowel during either a sigmoidoscopy or colonoscopy. This is sent to a laboratory for examination under a microscope. The result of this test can tell your doctor if the tissue from your bowel is healthy or if cancer cells are present.

What is an Electrocardiogram (ECG)?

An ECG records the rhythm, rate and electrical activity of your heart. This test is painless. Small electrodes (sticky pads with a special sensor) are put on to your chest and leads (wires) are attached to them. These are connected to a machine which traces (records) your heart reading. This test only takes a few minutes.

What is a Computed Tomography (CT) / Computerised Axial Tomography (CAT) scan?

A CT/CAT scan is a special type of X-ray which shows internal organs and soft tissues, for example, your bowel. This is unlike ordinary X-rays which mainly show solid tissues, for example, bones.

A CT/CAT scan records cross-sectional images (pictures taken from different angles that look like slices through parts of your body), which can help your doctor to see if there is any disease present.

If your doctor advises you to have a CT/CAT scan to help find the cause of your symptoms, you will be given a leaflet that explains this in more detail.

What is a CT Colonography?

A CT Colonography (also known as virtual colonoscopy is a type of body scan which looks at the large bowel (colon). It is an alternative test to a colonoscopy. A soft tube is placed in the rectum and gas is then pumped through the tube, inflating the large bowel.

This is done using an electronic pump so the pressure inside your bowel can be carefully controlled. Once the bowel is inflated a CT scan is performed which takes lots of pictures of the bowel. The entire examination usually takes up to 45 minutes.

What is a Magnetic Resonance Imaging (MRI) scan?

An MRI scan uses strong magnetic and radio waves to produce images of the inside of your body. If you have a cardiac monitor, pacemaker or any other metallic objects in your body, you may not be able to have an MRI scan because of the magnetic fields.

If your doctor advises you should have an MRI scan to help find the cause of your symptoms, you will be given a leaflet that explains this in more detail.

What is a Rectal Ultrasound Scan (RUS)?

This is an ultrasound scan of the inside of your rectum using a special ultrasound probe, which is inserted into your rectum. A picture of the inside of your rectum will be shown on a monitor and photographs may be taken.

These can help your doctor to see if there is any disease present. Sometimes a tissue biopsy of the lining of your rectum can also be taken by passing a special needle along the ultrasound probe during your rectal scan. An ultrasound scan is a painless examination using sound waves to make pictures of the inside of your body.

Diagnostic ultrasound is safe and no radiation (X-rays) is used.¹

If your doctor advises you to have a rectal ultrasound scan to help find the cause of your symptoms, you will be given a leaflet that explains this in more detail.

What is a Cardio-pulmonary exercise test (CPEX)?

This is a test to check your lung capacity using either an exercise bike or hand crank.

Who decides what treatment I need?

Treatment plans for every patient are discussed at a weekly Multi-Disciplinary Team (MDT) meeting and they advise what the best treatment choices are for you.

What is a Multi-Disciplinary Team (MDT) meeting?

MDT meetings are attended by healthcare professionals involved in your care, for example:

• your colorectal surgeon (A doctor who specialises in surgery of the bowel).
• your gastroenterologist (A doctor who specialises in problems of the digestive system).
• a specialist colorectal nurse who will also be your key worker.
• a radiologist (A doctor who specialises in x-ray, ultrasound and other similar examinations, and reports on the findings of these examinations, to help your MDT decide on the best treatment choice for your problem).
• an oncologist (A doctor who specialises in chemotherapy and radiotherapy treatments).
• a pathologist (A doctor who specialises in the study of cells and specimens in the laboratory).

These MDT meetings are held to discuss your results and which treatments will be recommended for you.

They are a requirement of every Cancer Unit, to make sure cancer treatments are agreed for each individual patient.

As there are so many people involved in your care, one of the specialist nurses will become your key worker. He or she will make sure you receive the right care, at the right time, and act as a link with other members of your MDT.

He or she will answer any questions you may have and advise how you can obtain any further information and advice. Your key worker’s name will be written in your healthcare records so everyone involved in your care knows who he or she is. Should you wish to change your key worker, let your specialist nurse know and he or she will arrange this for you.

How will I find out my results?

You will be given an appointment to return to the clinic, usually 2 weeks after your tests. Your surgeon and specialist nurse will discuss your test results, diagnosis and treatment choices with you.

Very occasionally some tests may need to be repeated, or results may not be ready, so you may need to attend more than once.

You can decide how much you want to be involved. Some people want to know everything and be fully involved in their treatment; other people prefer to have less information and involvement.

When you have been told you have bowel cancer, you may be too shocked to take all the information in. If you just want to go home and not discuss things any further at that time, we will arrange another appointment for you.

Many people find it helpful to bring a relative or friend with them. Your specialist nurse will give you his or her telephone number in case you have any worries or concerns.

Your Colorectal Team is there to support you and your family. You will be given as much time as you need to consider your choices before making a decision. Your GP will be informed of your results and diagnosis within 24 hours of you being told. You may wish to make an appointment with your GP to talk about your cancer.

How will I feel?

Anyone coping with a diagnosis of cancer and its treatments can feel very vulnerable, angry, upset and fearful for the future. These are normal reactions and at times you may feel very alone and unsure of how to deal with your feelings. It is important to remember there is help available; do not be afraid to ask for or accept help.

Specialist nurses are trained to listen and support you in coming to terms with what you and your family are going through. They are part of a support team which includes, for example, Primary Care Teams (your GP and his or her Team), Macmillan nurses, ward nurses, chaplains, clinical psychologists, volunteers, patient support groups, therapists, counsellors and Social Services.

How can colorectal cancer be treated?

Surgery, radiotherapy and chemotherapy are all treatments for colorectal cancer. Your MDT may recommend a combination of some or all of these, depending on the stage of your cancer and where the cancer is in your bowel.

All treatment choices will be fully explained to you, including the benefits and risks. You will also be given written information to take home. If you choose not to have certain treatments your decision will be respected. Talk to your doctor or nurse if you have any worries or concerns.

You may find other people with colorectal cancer will have different treatments from you. This is because each case is different and your treatment is planned for you.

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

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Email: [email protected]

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Telephone: 01642 617617

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The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

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Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]