Diagnosing bowel cancer
When you first see your GP they will ask about your symptoms and whether you have a family history of bowel cancer.
They will then usually carry out a simple examination of your abdomen (tummy) and your bottom – known as a digital rectal examination (DRE).
This is a useful way of checking whether there are any lumps in your tummy or back passage. The tests can be uncomfortable and most people find an examination of the back passage a little embarrassing but they take less than a minute.
If your symptoms suggest you may have bowel cancer, or the diagnosis is uncertain, you will be referred to your local hospital initially for a simple examination called a flexible sigmoidoscopy.
In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of bowel cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected bowel cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.
A flexible sigmoidoscopy is an examination of your rectum and some of your large bowel using a device called a sigmoidoscope. A sigmoidoscope is a long, thin flexible tube attached to a very small camera and light that is inserted into your rectum and up into your bowel.
The camera relays images to a monitor and can also be used to take biopsies (where a small tissue sample is removed for further analysis).
It is better for your lower bowel to be as empty as possible when sigmoidoscopy is performed, so you may be asked to carry out an enema (a simple procedure to flush your bowels) at home beforehand. This should be used at least two hours before you leave home for your appointment.
A sigmoidoscopy can feel uncomfortable but only takes a few minutes and most people go home straight after the examination.
More detailed tests
Most people with bowel cancer can be diagnosed by flexible sigmoidoscopy. However, some cancers can only be diagnosed by a more extensive examination of the colon. The two tests used for this are colonoscopy and computerised tomography (CT) colonography.
These tests are described in more detail below.
A colonoscopy is an examination of your entire large bowel using a device called a colonoscope, which is like a sigmoidoscope but a bit longer.
Your bowel needs to be empty when a colonoscopy is performed, so you will be advised to eat a special diet for a few days beforehand and take a laxative (medication to help empty your bowel) on the morning of the examination.
You will be given a sedative to help you relax during the test, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. This is not usually painful, but can feel uncomfortable.
The camera relays images to a monitor, which allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer. As with a sigmoidoscopy, a biopsy may also be performed during the test.
A colonoscopy usually takes about one hour to complete, and most people can go home once they have recovered from the effects of the sedative.
After the procedure, you will probably feel drowsy for a while so you will need to arrange for someone to accompany you home and it is best for elderly people to have someone with them for 24 hours after the test. You will be advised not to drive for 24 hours.
In a small number of people it may not be possible to pass the colonoscope completely around the bowel and it is then necessary to have CT colonography.
For more information about what a colonoscopy involves, watch this video: what happens during a colonoscopy?
CT colonography, also known as a 'virtual colonoscopy', involves using a computerised tomography (CT) scanner to produce three-dimensional images of the large bowel and rectum.
During the procedure, gas is used to inflate the bowel using a thin, flexible tube placed in your rectum. CT scans are then taken from a number of different angles.
As with a colonoscopy, you may need to have a special diet for a few days and take a laxative before the test to ensure your bowels are empty when the test is carried out.
This test can help identify potentially cancerous areas in people who are not suitable for a colonoscopy due to other medical reasons. A CT colonography is a less invasive test than a colonoscopy, but you may still need to have colonoscopy or flexible sigmoidoscopy at a later stage so any abnormal areas can be removed or biopsied.
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If a diagnosis of bowel cancer is confirmed, further testing is usually carried out to check if the cancer has spread from the bowel to other parts of the body and to help decide on the most effective treatment for you.
These tests can include:
- a CT scan of your abdomen and chest to check if the rest of your bowel is healthy and whether the cancer has spread to the liver or lungs.
- a magnetic resonance imaging (MRI) scan is also done for people with a cancer in the rectum to provide a detailed image of the surrounding organs
Staging and grading
Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer. Staging refers to how far your cancer has advanced. Grading relates to how aggressive and likely to spread your cancer is.
This is important as it helps your treatment team choose the best way of curing or controlling the cancer.
A number of different staging systems are used by doctors. A simplified version of one of the common systems used is outlined below.
- Stage 1 – the cancer is still contained within the lining of the bowel or rectum
- Stage 2 – the cancer has spread beyond the layer of muscle surrounding the bowel and may have penetrated the surface covering the bowel or nearby organs
- Stage 3 – the cancer has spread into nearby lymph nodes
- Stage 4 – the cancer has spread beyond the bowel into another part of the body, such as the liver
There are three grades of bowel cancer:
- Grade 1 is a cancer that grows slowly and has a low chance of spreading beyond the bowel
- Grade 2 is a cancer that grows moderately and has a medium chance of spreading beyond the bowel
- Grade 3 is a cancer that grows rapidly and has a high chance of spreading beyond the bowel
If you are not sure what stage or grade of cancer you have, ask your doctor.
Want to know more?
Bowel cancer screening
In England, everyone aged 60 to 74 who is registered with a GP is eligible for NHS bowel cancer screening.
This involves using a home testing kit to send off some samples of your stool to be tested for the presence of blood.
This can help detect bowel cancer before symptoms appear, making it easier to treat and improving the chances of surviving the condition.
Read more about bowel cancer screening.
Page last reviewed: 02/09/2014
Next review due: 02/09/2016