| Bowel cancer | Faecal Occult Blood Tests | Diagnosing bowel cancer |
| Treatment for bowel cancer | Having a stoma |
This information has been reviewed by:
Dr Michael Jefford MBBS, MPH, MHlthsevMt, PhD, MRACMA, FRACP
Consultant Medical Oncologist, Peter MacCallum Cancer Centre
Doctors and other health professionals you may see
Computerised tomography (CT) scan
Carcinoembryonic antigen (CEA) test
Magnetic resonance imaging (MRI)
Positron emission tomography (PET) scan
The most common symptoms of bowel cancer are:
If you have not been diagnosed with bowel cancer and are just looking at these pages, please be aware that many of these symptoms occur without any serious disease being present. However, if you have any of the symptoms for more than two weeks, see your doctor for a check-up.
Your doctor will examine you and refer you for tests to see if you have cancer. This can be a worrying and tiring time, especially if you need to have several tests.
If the tests show you have or may have cancer, your doctor will refer you to a specialist, who will advise you about treatment options. You should expect to be cared for by a team of health professionals from the relevant major fields (see following list). Ideally, all your tests and treatment should be available at your hospital. This may not be possible in some non-metropolitan areas.
Specialists and other health professionals who care for people with bowel cancer include:
This section lists common tests for bowel cancer. You may have had some of them already.
This test helps the doctor to check the last six to eight centimetres of your bowel. Your doctor will insert a gloved finger into your anus to feel inside your rectum for anything unusual. The test will be a little uncomfortable and may make you feel like you are going to open your bowels, but you won't lose control.
This test looks at the lower part of your large bowel, including the rectum. Your doctor will put a firm or flexible lighted tube (sigmoidoscope) into your anus to see the lining of your bowel. This may be uncomfortable but should not cause severe pain. The test will only take 10 minutes.
You may have an enema to clean out your bowel before the test so all areas can be seen clearly. A fluid will be put into your rectum. This will give you watery diarrhoea, which will empty your bowel. This is called bowel preparation.
Before the x-ray, you will have a bowel preparation (see ‘Sigmoidoscopy', above).
A small tube will be put into your anus and up into your rectum. White liquid, called barium, will be put into your bowel. Then air will be pumped in to make the barium go into the creases in the bowel wall. This will show up the bowel lining clearly when x-rays are taken. This may be uncomfortable. The test will take about 30 minutes.
This test lets your doctor look for signs of cancer inside the whole of the large bowel. Before the test, you will have a bowel preparation (see ‘Sigmoidoscopy', above).
A long, flexible, lighted tube (colonoscope) will be put into your anus. It will be gently pushed through your large bowel to its beginning at the small bowel.
If doctors see anything unusual, they can pass small tools into the colonoscope and take out some tissue. The tissue can be examined under a microscope. This is called a biopsy.
You will have a sedative or anaesthetic; this will make you feel drowsy. You may feel some discomfort during or after the test but this should settle quickly. The test will take about 20 to 30 minutes. You should arrange to have someone take you home.
You may have a chest x-ray to check for lung or heart disease before surgery. Chest x-rays can also show if bowel cancer has spread to the lungs.
A CT scan is a type of x-ray that gives a picture of organs and other structures (including any tumours) in your body. It is used to see if cancer has spread into the lymph nodes, liver or lungs. CT scans are usually done at a hospital or a radiology clinic. It usually takes 30 to 40 minutes to complete this painless test.
You will be asked not to have a meal before the scan. You will have a liquid dye before the scan, in a drink and in an injection. This dye makes your organs appear white on the scans that are taken, so anything unusual will show more clearly. You will be asked to lie on a table that slowly moves through the CT scanner, which is large and round like a doughnut. Most people can go home as soon as their scan is over.
There is a small possibility of the injected dye causing an allergic reaction. You should tell your doctor if you are allergic to iodine or to contrast dyes, or if you are diabetic or have abnormal kidney function.
In this test, sound waves are used to create a picture of your bowel and organs nearby. An ultrasound scan is mainly used to see if cancer has spread to the liver. You will be asked to uncover your abdomen and lie on a table. Once you are comfortable, a gel will be spread on the skin over the area being scanned.
A small device (transducer) will be moved across your abdomen. It makes sound waves and receives echoes. A computer makes a picture of the echoes produced when the sound waves meet something dense, like an organ or tumour.
This test is painless and takes 15 to 20 minutes.
If a cancer is found in the rectum by other tests, your doctor may ask you to have an endorectal ultrasound. The transducer will be inserted into your rectum to see how large the cancer is, and whether it has spread. This test is used to help ‘stage' the disease. It can help the doctor decide whether you should have radiotherapy before surgery.
This blood test measures chemicals that are normally found or made in your liver. The test may be abnormal if cancer has spread to your liver.
This blood test looks for a substance (CEA) that is produced in high quantities by some cancer cells, especially in bowel cancer.
This test is like a CT scan, but it uses magnetism instead of x-rays to build up pictures of the organs in your abdomen. Like a CT scan, MRI is painless and the magnetism is harmless. You will be asked to lie on a table inside a large metal tube, which is open at both ends. The test may take up to an hour. The tube makes some people feel claustrophobic (afraid of being in a small space). If you think you are likely to feel this way, please tell the treatment centre in advance: you may be able to take someone into the room with you for support. The machine can be quite noisy.
Because the MRI scanner uses a powerful magnet, people with certain types of metal in their bodies should not have MRI scans. You should tell your doctor if you have any metal objects in your body (like a pacemaker), or clips from past operations, or (for example) if you have had injuries to the eyes or elsewhere caused by metal.
This is used to build up more information after an MRI or CT scan. You will be asked to not eat or drink anything before the PET scan. A small amount of radioactive material will be injected into a vein in your arm one hour before the scan. You will then be asked to lie or sit in a darkened room until the scan. For the scan, you will lie on a table and be moved through a large ring-shaped scanner. The tube may make some people feel claustrophobic. If you think you are likely to be affected in this way, please tell the treatment centre before your scan.
The tests described in the previous pages will show whether you have bowel cancer. Some can also show if it has spread. The cancer may have spread into blood vessels or lymph nodes near the bowel, or into organs further away, like the liver or the lungs. This is called metastasis. The tests help your doctors ‘stage' the disease so they can work out the best treatment for you.
Knowing if and how far the cancer has spread is called ‘staging' the disease. Staging helps your doctors to work out the best treatment for you. In Australia, the staging system for bowel cancer is the Australian Clinico Pathological Staging System (ACPS). You may also hear about the ‘Dukes' system, which is like the ACPS: Dukes stage A equals ACPS stage A, and so on.
Stage A: the cancer is confined to the bowel wall.
Stage B: the cancer has spread to the outer surface of the bowel wall.
Stage C: cancer is found in lymph nodes near the bowel.
Stage D: cancer is found at distant sites-for example, in the liver or lungs.
Ask your doctor to explain the stage of your cancer in a way you can understand. This will help you to choose the best treatment for your situation.
Another staging system being used more often is called the TNM system. It records how far the tumour (T) has spread through the bowel wall, if lymph nodes (N) are affected by the cancer and whether the cancer has spread to other parts of the body (M, for metastases).
