Lower Gastrointestinal (lower GI) Cancers

Bowel or Lower gastrointestinal (or lower GI) cancer refers to cancers of the large bowel (colon and rectum) and the anus. Large bowel cancer is the fourth most common cancer affecting men and women in the United Kingdom. Bowel cancer is more likely to be diagnosed in older patients; more than nine out of ten new cases are diagnosed in people over 50, and nearly six out of ten cases are diagnosed in people aged 70 or over. Bowel cancer, however, can affect anyone of any age. The chances of curing a patient of bowel cancer are highest when the cancer is diagnosed at an early stage.

St George’s University Hospitals NHS Foundation Trust provides bowel cancer screening and diagnostic, surgical and oncological services for colonic, rectal and anal cancer patients.

Bowel cancer patients are looked after by medical professionals, including colorectal surgeons, clinical nurse specialists, oncologists, radiologists, and histopathologists. This is the lower gastrointestinal multi-disciplinary team.

Do I need any tests to confirm the diagnosis?

Bowel cancer may cause symptoms such as bleeding from the back passage, a change in bowel habit (diarrhoea or, less commonly, constipation), weight loss, abdominal pain or tiredness and lethargy because of anaemia. We aim to assess patients with bowel symptoms and tailor their investigations to make a diagnosis as quickly as possible. This would usually include a combination of blood tests, stool tests (tests of your poo), radiology (X-ray) tests or endoscopic (internal telescope) tests.

To reduce the time needed to make a diagnosis when we have received your referral from your General Practitioner, we will either directly organise a test (e.g. flexible sigmoidoscopy), schedule a telephone consultation with a specialist nurse who will book the right investigations for you, or you will be seen urgently by a colorectal surgeon in clinic. A combination of the following tests will be used to make a diagnosis:

• Blood tests and/or stool tests
• Proctoscopy
• Rigid Sigmoidoscopy
• Flexible sigmoidoscopy
• Colonoscopy
• CT colonography is a Computed Tomography ( CT ) examination to look at the large bowel (colon)
• Computerised Tomography (CT) scan

Endoscopy (flexible sigmoidoscopy and colonoscopy) services are provided in a state-of-the-art facility at St George’s Hospital, one of the National Training Centres for endoscopy. It is also one of the colorectal cancer screening centres offering bowel scope screening at the age of 55 or colonoscopy if you have a positive test from the bowel cancer home screening kit.

The vast majority of patients referred as potentially having bowel cancer are diagnosed as having a different bowel condition; these patients will be informed of the diagnosis and then seen routinely in the colorectal clinic if necessary.

If you are diagnosed with bowel cancer, you will be seen by one of the team to offer support and information about what will happen next and organise staging investigations. Staging investigations are used to see whether the cancer is localised to the bowel or has spread to other organs. The commonly used staging investigations are;

• CT scan
• Magnetic resonance imaging (MRI) scan
• Ultrasound
• Positron Emission Tomography-Computed Tomography (PET-CT) Scan

What treatments are available?

The treatment plan for each patient with bowel cancer is discussed by the multi-disciplinary team (lower gastrointestinal MDT). The MDT meet each week. The treatments offered to depend on the type and stage of the bowel cancer. The lower gastrointestinal MDT team determines the best way of treating cancer. The appropriate team member will then meet with you to discuss how bowel cancer will be treated. Treatment options for bowel cancers will vary and maybe by a combination of treatment modalities. The main treatment options are:

• Surgery
• Chemotherapy
• Radiotherapy

Colorectal cancer surgery is performed at St George’s Hospital through either open or laparoscopic techniques. Postoperative care is provided in our specialist surgical wards.

Chemotherapy is offered on-site in both a day case and inpatient setting—St George’s Hospital partners with The Royal Marsden Hospital to provide radiotherapy treatment.

As a university hospital, active research into colorectal cancer is being undertaken within the trust and as part of national studies.

What is Personalised Cancer Care?

 Personalised Cancer Care means your team will support you to take an active role in your cancer care by giving choices and control based on what matters most.

Together with your key workers’ team, like your Clinical Nurse Specialist and Macmillan Support worker, we will aim to help you access the care and support that meets your individual needs from the moment you receive your cancer diagnosis so that you can live as full, healthy and active a life as possible.

You will be invited to complete a Holistic Needs Assessment (HNA) to identify any concerns you may have when you have been diagnosed with cancer. These concerns may be physical, emotional, practical, financial and spiritual.

You will answer a simple set of questions or fill in a checklist about all areas of your life. It is to find out about the concerns you may have. You are often asked to rate how important these concerns are to you. It could help you decide what to discuss first during the assessment.

Once you have completed the assessment, your Clinical Nurse Specialist will discuss your needs, maybe face-to-face in a clinic or over the phone. During the discussion, you and your Clinical Nurse Specialist will agree on the best ways to manage your needs and concerns. They will write down what you have decided in a document called a care plan.  They may write it during the discussion. Or they may make notes and send them to you afterwards. Your care plan will record the following:

• The main concerns you talked about
• Suggestions and actions to help you manage your concerns
• Services that may be able to support you, and any referrals that are made
• What is already being done to help – for example, the services you are already using
• Information about who to contact if you need more help
• The details of other health or social care professionals with whom you have agreed to share the information.

You may not wish to complete the holistic needs assessment at this time. The care you receive will not be affected in any way, and we will be happy to discuss this again in the future

 Health and wellbeing information and support also include:

• Access to the Macmillan Information & Support Centre to find out what support is available in the community, e.g., practical, financial, and how to access it
• Help with understanding cancer and its treatment and how to manage its impact through videos and workshops run by healthcare professionals at St George’s and in the community.
• Attend wellbeing activities which are great opportunities for you and your carers to get together with others affected by cancer.