Bowel cancer, also known as colorectal cancer, can affect any part of the colon or rectum; it may also be referred to as colon cancer or rectal cancer, depending on where the cancer is located.
Bowel cancer screening is for people who do not already have bowel cancer, symptoms of bowel cancer, or any reason to have a high risk of bowel cancer.
Patient-centred care is healthcare that is respectful of, and responsive to, the preferences, needs and values of patients and consumers.
Bowel Cancer Australia provides essential support services uniquely designed for bowel cancer patients via our confidential Helpline with specialist telehealth support, as well as a national Peer-to-Peer Support Network and Buddy Program.
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If your GP suggests that you take tests or be referred to a specialist for further investigations, this does not mean you have bowel cancer.
It means that further tests and/or investigations are needed to determine the underlying cause of your symptoms or positive screening test result.
If you receive a positive screening test result or have higher-risk symptoms such as blood in poo or rectal bleeding, you should receive an urgent referral and have a colonoscopy within 30 days.
If symptoms are not considered higher-risk, you will receive a routine referral.
Further investigations will usually take place at a clinic in your local hospital.
The specialist will ask you questions about your symptoms (similar to questions asked by your GP), your general health and other medical conditions you might have.
You will sometimes be given the results from investigative tests immediately, or you will be called back to the hospital at a later date to receive the results.
If the further investigations for bowel cancer are negative, you may be diagnosed with another common gastrointestinal condition and given appropriate treatment.
If the further investigations confirm bowel cancer, you will meet with a specialist who will put together your treatment plan.
Your GP or specialist may recommend further tests and investigations to determine the underlying cause of your symptoms or positive screening test result, which may include:
A colonoscopy is a quick and generally painless procedure that allows for the full examination of the entire inner lining of your bowel (colon and rectum).
During the procedure, the colonoscopist spends most of the time looking for changes to the normal landscape of your bowel lining and removes anything that looks suspicious, like growths called polyps.
Polyps are usually harmless (benign); they can be slightly raised (sessile), look like they are on a stalk like a cherry (pedunculated), or can be very flat.
Adenomatous polyps however, can become cancerous (malignant), and if left undetected can develop into a cancerous tumour.
Polyps can be detected and removed before they develop into bowel cancer during a colonoscopy, and bowel cancer, if present, can be diagnosed.
The colonoscopy usually lasts around 30 minutes or less and is typically performed under a general anaesthetic.
Because of the sedation, you should arrange for someone to collect you and take you home following the procedure.
Video-capsule endoscopy has become an important tool for investigation of disorders of the small bowel. While there is interest in its potential for imaging the large bowel, the place for video-capsule colonoscopy is still uncertain.
Virtual colonoscopy (also known as Computerised Tomographic Colonography – CTC) is a procedure that uses a series of advanced imaging that permits minimally invasive evaluation of the colon and rectum without the need for sedation.
An alternative to traditional colonoscopy, this non-invasive imaging test uses CT scans to provide detailed images of the colon and rectum. It’s particularly useful for individuals who might not be able to undergo a standard colonoscopy.
A computer puts the pictures together to create detailed images that may show polyps and anything else that seems unusual on the inside surface of the bowel.
If the detailed images show polyps and anything else that seems unusual and your specialist wishes to perform a biopsy, you will need to have a colonoscopy.
It has an established place in investigation of symptomatic patients and following incomplete colonoscopy.
The risk for procedure-related complications is low, although CT involves larger radiation doses than the more common, conventional x-ray imaging procedures.
Several studies indicate that magnetic resonance colonography (MRC) could become an alternative to Computerised Tomographic Colonography (CTC) for imaging the large bowel, not having the disadvantage of radiation exposure.
An MRI (Magnetic Resonance Imaging) scan uses magnetism to build up cross-sectional pictures of the body.
MRI of rectal cancers is currently proposed as a technique for pre-operative staging of rectal cancers and as a technique for re-imaging cancers following pre-operative radiotherapy.
Before the scan, the patient may be given an injection of dye into a vein in the arm, to improve the image.
The scan takes about 30 minutes, during which time the patient will lie inside a chamber which is often long and narrow.
This can feel claustrophobic.
People who have heart monitors, pacemakers or certain types of surgical clips cannot have an MRI because of the magnetic fields.
Flexible sigmoidoscopy is a procedure to look inside the rectum and sigmoid (lower) colon (the first 60cm of the bowel) for polyps, abnormal areas, or cancer.
A sigmoidoscope is inserted through the anus and rectum into the lower part of the colon (sigmoid colon).
A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing.
It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer.
A barium enema is a series of x-rays of the lower gastrointestinal tract.
The patient lies on an x-ray table and a liquid that contains barium (a silver-white metallic compound) is put into the rectum.
The barium flows through the colon and coats the lower gastrointestinal tract.
X-rays are taken to look for abnormal areas.
Any abnormal areas show up as black against the white liquid.
This procedure is also known as a lower gastrointestinal (GI) series.
A faecal immunochemical test (FIT) can be completed in the privacy of your home. It tests for non-visible blood in poo, which can be an early sign of bowel cancer. The test only detects human blood from the lower intestines. Medicines and foods do not interfere with the test.
The test has been selected as the preferred testing method for Bowel Cancer Australia’s BowelScreen Australia program and the National Bowel Cancer Screening Program (NBCSP).
Screening test results may appear to be normal even though bowel cancer is present. A person who receives a false-negative test result (one that shows there is no blood in poo when there really is) may delay seeking medical care.
Screening test results may appear to be abnormal even though no blood in poo is present. A false-positive test result (one that shows there is blood in poo when there really isn’t) can cause anxiety and is usually followed by more tests (such as colonoscopy), which also have risks.
Visit Bowel Cancer Australia’s screening webpage for more information.
In August 2014, the US Food and Drug Administration (FDA) approved Cologuard, the first bowel cancer screening test looks for abnormal DNA and blood in your poo.
Patients with positive test results are advised to undergo a diagnostic colonoscopy.
In 2019, the FDA approved the expansion of the age range for Cologuard from 50 years or older to 45 years or older.
Cologuard is not currently available in Australia.
In 2016, CSIRO announced that a new, more accurate blood test to detect bowel cancer recurrence, known as Colvera™, had launched in the United States.
The blood test is the result of a collaboration between CSIRO, Flinders University and Clinical Genomics.
According to Professor Graeme Young of Flinders Centre for Innovation in Cancer said, “Our study has shown that Colvera™ is significantly more sensitive for bowel cancer than CEA and as such provides us with an improved, simple test that increases the likelihood of detecting curable recurrence.”
Clinical trials have shown Colvera™ to be more than twice as sensitive for bowel cancer recurrence as the current CEA test.
Colvera™ is not currently available in Australia.
Rhythm Biosciences has developed ColoSTAT®, a blood test that measures the presence of 5 protein biomarker levels in the blood.
When certain combinations of protein biomarkers are measured in a blood sample, and concentrations weighted using an algorithm, a bowel cancer risk score can be determined.
The ColoSTAT® test does not diagnose bowel cancer but is a tool for determining when colonoscopy or another type of diagnostic follow-up is recommended.
Different tests and investigations have different advantages and disadvantages, and you should discuss these with your GP or specialist. Things to consider may include:
The table below summarises key features of the different tests and investigations.