The journey to diagnosis in bowel cancer

Written by: Professor P N Haray
Edited by: Sophie Kennedy

The diagnosis of bowel cancer while in its early stages gives a greater number of treatment options and higher survival rates. Therefore, knowing the warning signs to look out for is vital. In this informative article, leading consultant colorectal surgeon Professor Puthucode Haray sheds light on the symptoms of bowel cancer and the journey to diagnosis.



Where exactly does bowel cancer occur?


Colorectal cancer, commonly referred to as bowel cancer, usually begins as growths on the inner lining, or mucosa, of the bowel. These lumps or polyps can slowly become cancerous over time.



How important is an early diagnosis?


Bowel cancers are very slow-growing tumours and have a pre-cancerous stage called polyps. These are small lumps on the lining of the bowel, like pimples, which can take several years to become cancerous. Even once a cancerous change has happened, progression from early to an advanced stage can be quite slow, often taking a year or more. Polyps can often be removed by colonoscopy, which is a long, flexible tube with an attached camera inserted into the bowel, thus avoiding surgery.


Once a lump has turned cancerous, surgery is usually the best option. However, early diagnosis is vital as cancers in the early stages need no further treatment such as chemotherapy. The earlier the cancer is detected, the more likely it is to be able to achieve a cure and lower the chance of any recurrence.



What are the early symptoms of bowel cancer?


Rectal bleeding either mixed with the motions or only on the toilet paper can be one of the symptoms. This is especially true if it is persistent for several weeks. The bleeding can be bright red or darker, old blood and may not be a large amount at all. Any recent change in bowel habits needs to be taken seriously. This is especially important if the change becomes persistent rather than a one-off and is not related to any dietary changes or changes in medication.


Symptoms like abdominal pain and weight loss can also occur. Sometimes bowel cancers cause no symptoms at all until they are very advanced. At this stage they present with complications such as bowel blockage or perforation needing emergency care.


This is why there is a screening programme in many parts of the world to help detect any bowel cancer or pre-cancerous polyps in people who have no symptoms at all so that they can be diagnosed and treated at an early stage with excellent results. The screening involves a stool test which checks for microscopic amounts of blood and if positive, a colonoscopy is arranged. Different health care systems have different age criteria for when bowel screening is commenced and the frequency at which the tests are repeated.



What advice would you give to patients who have symptoms?


If someone has any bleeding per rectum or a change in their bowel habits, I would strongly advise that they should see their general practitioner or a specialist. Often the symptoms may be due to something simple, but it is much better to get it checked out.



What different tests are done to diagnose bowel cancer?


The first step is a thorough examination by a competent professional, including a rectal examination. Specific tests may need to be arranged such as blood and stool tests as well as camera examinations of the bowel or scans. The camera tests can be a full or partial colonoscopy (flexible sigmoidoscopy) which is done by using a narrow flexible tube inserted into the back passage.


CT scans are also commonly used which are whole-body scans specialised to look at the large bowel in more detail. These specialised scans are known as CT colonography or virtual colonoscopy. For cancers in certain situations we may need to arrange MRI scans and there are other more specialised scans required in some cases such as the PET scan.



If you are concerned about your bowel health and wish to book a consultation with Professor Haray, you can do so by visiting his Top Doctors profile.


For more information on bowel cancer care and other related subjects, please visit Professor Haray’s free colorectal education website. In the patient section, you will find a lot of useful information including patient stories with detailed videos to explain every step of the process.

By Professor P N Haray
Colorectal surgery

Professor Puthucode Haray is a leading consultant colorectal surgeon in South Wales. He utilises his 20+ years of professional expertise to provide his NHS and private patients with the highest level of care.

Throughout his entire medical career, Professor Haray has continued to expand his knowledge and further excel in skill. He has mastered numerous techniques, including laparoscopic (keyhole) colorectal surgery (of which he is a pioneer), the diagnosis and surgical treatment of bowel cancer, the THD (transanal haemorrhoid dearterialisation) operation for haemorrhoids and the management of benign conditions such as inflammatory bowel disease and diverticular disease.

Aside from complex operations, Professor Haray also provides day case/outpatient treatment for conditions such as fissures, fistulas and haemorrhoids. He is also highly skilled in the use of colonoscopy and endoscopy for diagnosis and treatment, including the diagnosis of bowel cancer.

He has won several awards including Winner of the Best Hospital Doctor (Surgery) in the UK and Best Surgical Trainer in Wales. Professor Haray is an incredibly active participant in surgical research and teaching: he has over 150 publications and presentations to his name and is a regularly invited speaker at local and international conferences. Over the past 10 years, he has also been involved in training established consultant surgeons across the UK and internationally in the techniques of laparoscopic colorectal surgery.

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