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Below are a list of routine questions and examinations which your
doctor should ask and offer to establish a diagnosis for your
symptoms. If he or she does not, you should ask why not.
Again, it may help to print off this list, consider your answers and
take it with you to your appointment.
Questions
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Has the frequency with which you pass or try to pass motions
increased or have your motions become persistently looser over a few
weeks, without going back to normal?
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If you haven’t had a change of bowel habit but have bleeding from
the bottom, have you any other symptoms like straining, soreness, pain
and itchiness? If you answer ‘yes’ to this, you may be suffering from
piles and treatment for this may be tried first.
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Have you got any history of bowel cancer in your family?
Examinations and tests
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A rectal examination, also know as a ‘PR’ - a painless examination
with a gloved finger to feel for any suspicious lumps in the bottom or
rectum, which might be cancer
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A blood test - to see if you are suffering from anaemia, which could
be a sign of bowel cancer.
Your doctor should also ask you general questions about your lifestyle
and diet, to determine any other possible risk factors.
Being referred to the hospital
 If your doctor feels that you should have further investigation for
bowel cancer, he or she will refer you to a hospital consultant or
specialist clinic. If you have the higher-risk symptoms of bowel
cancer, you should be seen within 2 weeks, according to national
guidelines from the Department of Health.
Most people referred for further investigation will not turn out to
have cancer. How you are investigated depends on what’s available at
your local hospital. You should ask your GP the following questions:
1. Is it an urgent or a routine referral?
‘Urgent’ doesn't mean you have cancer! People with higher risk
symptoms should be referred within two weeks for investigation. Most
people with these symptoms do not have cancer but it should be ruled
out by special tests.
2. How long is the waiting list for routine referral?
This varies around the country but it could mean several months. If
lists are long and you are worried, say so.
3. What kind of investigation are you recommending?
Resources vary around the country and depending on your symptoms, some
tests may be better than others. The most common tests will be a
barium enema, flexible sigmoidoscopy or colonoscopy.
4. Am I seeing a specialist?
Ask if your GP knows the doctor to whom you are being sent. Is he/she
experienced in dealing with bowel cancer and what does your GP think
of him/her? Most people are sent to diagnostic clinics run by
specialist nurses and doctors.
5. Is the specialist part of a team?
If you do have cancer, research shows that patients treated by the
team approach do better. That is, treated by a doctor or surgeon who
is part of a multi-disciplinary team, where all the professionals
involved in your care work together and hold team meetings.
Being treated by a multi-disciplinary team will depend on where you
live and local resources but if you ask to see a multi-disciplinary
team then your doctor may be able to arrange this for you.
What are the different investigations for bowel cancer?
Rigid sigmoidoscopy
This enables the doctor to look inside your rectum through a tube,
like a thin, short telescope, passed into the back passage.
Flexible sigmoidoscopy
A thin flexible tube, with a camera or light on the end enables the
specialist to look inside the first 60cms of the bowel. You may be
asked to arrive an hour earlier at the hospital for "prepping". A
nurse will take your blood pressure, ask you some questions about your
health and give you a small enema - a treatment to empty your bowels.
You should be able to go home straight after the test. You may
experience some mild cramps but these should pass quickly.
Colonoscopy
A colonoscope is a longer version of the sigmoidoscope, and is a long
flexible tube that can look inside the whole bowel. During the test,
photographs and samples (biopsies) of the cells on the inside of the
large bowel can be taken. You stop eating the day before and take
laxatives beforehand to clear out your bowel. Liquids are allowed. You
are usually sedated and are ready to go home about 2 hours after the
test. You should arrange for someone to collect you and take you home.
Barium enema
A special X-ray examination where you have to take laxatives the day
before to clear out the bowel. The enema, a mixture of barium (a thick
white liquid which shows up on x-ray) and air is passed into the back
passage through a tube. Any abnormal areas show up black against the
white liquid. You will be able to go home straight after the test. For
a couple of days after a barium enema, your stools may be white. This
is nothing to panic about – it is just the barium being removed from
the body. You may also feel constipated for a couple of days and be
given some laxatives to ease this.
What next?
You will be called back to the hospital a few days after the tests, to
receive the results. This can be a nerve-wracking time, so talk to
friends, family, or your GP if you feel worried. If the diagnostic
tests for bowel cancer are negative, you may be diagnosed with another
common gut condition and given appropriate treatment.
laterlife.com supports the Beating
Bowel Cancer Campaign
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