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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 the age of 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, diagnostic, surgical and oncological services for patients with colonic, rectal and anal cancers.

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

Our aim at St George’s Hospital through each step of the pathway is to provide patient centred care.

Do I need any tests to confirm 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), organise 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 make a diagnosis:

  • Blood tests and/or stool tests
  • Proctoscopy
  • Rigid Sigmoidoscopy
  • Flexible sigmoidoscopy
  • Colonoscopy
  • CT colonography
  • CT scan

Endoscopy (flexible sigmoidoscopy and colonoscopy) services are provided in a state of the art facility at St George’s Hospital which is 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 positive test from the bowel cancer home screening kit.

With the exception of PET CT all radiological services are provided on site at St George’s Hospital, Tooting or at Queen Mary’s Hospital, Roehampton.

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 as having a bowel cancer you will be seen by one of the team to offer support, 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
  • MRI scan
  • Ultrasound
  • PET-CT Scan
What treatment are available?

The treatment plan for each individual patient with bowel cancer is discussed by the multi-disciplinary team (lower gastrointestinal MDT).  The MDT meet each week.  The treatments offered are dependent on the type and stage of the bowel cancer.  The best way of treating the cancer is determined by the lower gastrointestinal MDT team.  The appropriate member of the team will then meet with you to discuss with you how the bowel cancer will be treated.  Treatment options for bowel cancers will vary and may be 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 on 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 there is active research into colorectal cancer being undertaken within the trust and as part of national studies.