Talk to your GP

If you have been experiencing any of the higher-risk symptoms  of bowel cancer for 3 weeks or more, your GP will want to see you straight away. Some people struggle with working up the courage or finding the time to make this important appointment, and this delay only increases the worry and fear. Your GPs will listen carefully to your concerns. They will encourage you to talk about the symptoms you have been having, including those problems affecting your bottom and any other intimate subjects. Whatever you have to say, they will encourage and support you to share your concerns with them, so that they can help you.

The more information you can give to your doctor about your bowel habits and what has changed recently, the easier it will be for them to make an accurate diagnosis – so don't be shy, and don't put it off.

Before you go to the GP

Before you go to the doctor, it might be useful to keep a diary recording the symptoms you have been experiencing, and for how long. It may also be worth printing this page, considering your answers to the questions below and take it with you to your appointment.

At the doctor's surgery

If you go to the GP with a bowel related problem, here is a list of routine questions which your doctor should ask as part of your consultation:

• How recently have you started to notice the symptoms?
• Have you noticed any bleeding from your bottom? If you have, what did it look like - bright red, dark red - and how much blood was there?
•  Have you noticed looser, more diarrhoea-like poo, and going to the toilet more?  Or, are you trying to go and feel that you are constipated, or unable to completely empty your bowel?
• Is there any family history of bowel cancer, or any other cancer?
• Have you experienced any unusual abdominal (tummy) pain or lumps?
• Have you unexpectedly lost weight or become more tired recently?

Your doctor should also ask you additional questions on:

• your lifestyle and diet (to identify any other possible risk factors)
• your own past medical history
• any medicines you might be taking (including pain killers,anti-inflammatory medicines,  indigestion remedies, antibiotics and laxatives)

Your GP will need to know how your symptoms are affecting your quality of life. This is a particular problem if the work you do makes it very difficult to cope,or if you are having to take time off because of embarrassing problems with changing bowel habit, or if your ability to work is being affected by pain; feeling tired or dizzy or getting short of breath; not being able to eat properly or needing to go to the toilet more frequently.

Examinations/investigations

In addition to asking questions about your symptoms, your GP will feel your tummy for any lumps or tenderness, and should also perform a rectal examination ( a gentle examination with a gloved finger to look for and feel for any suspicious lumps in the bottom or rectum).

If your GP does not examine you, you should ask why they have chosen not to.

Your GP may also choose to ask you to have a blood test to see if you have anaemia or anything else that may help with a diagnosis.

What next?

If your GP can not find any clear cause for your symptoms, you may be asked to watch and wait for a week or so, to see if they settle on their own, or with the treament your doctor prescribes for you to make you more comfortable. The younger you are, the more likely it is that your GP will want to exclude other, simple reasons for your symptoms as they are usually- but not always - related to diet and lifestyle choices.

It is very important to be clear about when you should go back to your doctor again if the problems you are having get worse, or do not get better. You should then be referred to your local hospital for further investigations by a specialist.

However old you are, you should never be told by your GP that you are too young to have bowel cancer. Whilst bowel cancer is more common in the 60+ age group, bowel cancer is becoming increasingly common in younger people too.

At any age, if your symptoms include any unexplained "higher risk" signs - bleeding from the bottom, changed bowel habit, anaemia or a lump in your tummy - you should be referred immediately and this referral will be marked as URGENT on a two week fast track referral.

These guidelines for urgent referral to hospital for investigation are set down by NICE (National Insitute for Clinical Excellence):

Refer urgently patients (reference: http://www.nice.org.uk/nicemedia/live/10968/29813/29813.pdf)

• Any patient, aged 40 years and older, reporting rectal bleeding with a change of bowel habit towards looser stools and / or increased stool frequency persisting 6 weeks or more
• Any patient aged 60 years and older, with rectal bleeding persisting for 6 weeks or more without a change in bowel habit and without anal symptoms
• Any patient, aged 60 years and older, with a change in bowel habit to looser stools and / or more frequent stools persisting for 6 weeks or more without rectal bleeding
• Any patient of any age with a right lower abdominal mass consistent with involvement of the large bowel
• Any patient of any age with a palpable rectal mass (a lump in the back passage), intraluminal and not pelvic (a pelvic mass outside the bowel would warrant an urgent referral to a urologist or gynaecologist)
• All patients who are men of any age with unexplained iron deficiency anaemia and a haemoglobin of 11 g/100 ml or below
• All patients who are non-menstruating women with unexplained iron deficiency anaemia and a haemoglobin of 10 g/100 ml or below

Being referred to the hospital

Most people referred for further investigation will not turn out to have bowel cancer. You may wish to ask your GP:

• If they are sending an urgent or routine referral request
• Why they have chosen the referral type they have (urgent v. routine)
• How long they think it will be before you hear from the hospital

'Urgent' doesn't mean you have cancer. People with higher risk symptoms of bowel cancer should be seen within 2 weeks, according to national guidelines issued by the Department of Health. Most people with high risker symptoms do not have cancer but it should be ruled out by further investigations.