Tests and investigations
There may be a number of reasons why you have been referred for further investigations. You may have gone to your GP with symptoms, had an 'abnormal' result via the screening programme or you may have a family history of bowel cancer. But whatever the reason, the specialist will choose from the range of investigations detailed below and explain why the test chosen is best for you.
Sigmoidoscopies (rigid and flexible)
A rigid sigmoidoscopy is a quick, straightforward investigation to look inside your rectum though an endoscope (like a thin, short telescope) passed into the back passage.
A flexible sigmoidoscopy allows the doctor to see inside the rectum and up into the lower part of the bowel on the left hand side. This is where the majority of polyps and bowel cancers start. During this procedure, if the doctor or nurse sees anything that needs further investigation, samples (biopsies) can be taken for examination in the laboratory. Find our more in our Flexible Sigmoidoscopy factsheet.
New research published in April 2010 in the medical journal 'The Lancet' suggests that a single examination of the lower colon and rectum using flexible sigmoidoscopy, on those between the ages of 55 and 64 years, reduced colorectal cancer mortality by 43% and incidence by one third. Read more about this breakthrough study.
Sigmoidoscopies can be done safely and comfortably in an outpatient clinic and do not require an anaesthetic or sedation. You will need to have some kind of bowel preparation prior to the test, to make sure that your bowel is clean and clear for the doctor or nurse to see the bowel wall clearly. The bowel preparation may either be some medicine to drink on the day before, or an enema ( medicine given straight into the back passage) on the day of the test.
Colonoscopy
A colonoscopy is an examination to look at the lining of your whole large bowel, to see if there are polyps or a cancerous tumour within any part of it. A long flexible tube (endoscope) with a bright light and a camera on the end is inserted through your back passage and enables the doctor or nurse to get a clear view of the bowel wall.
At your first appointment with the specialist team, a specialist nurse will explain what a colonoscopy involves, and will tell you about the special bowel preparation you will need to have before the procedure. This preparation is a combination of medicine to drink and a change in your diet, which together makes sure that the bowel is empty to allow the doctor to perform the examination effectively. The nurse will ask you about any medical conditions (e.g. diabetes, kidney problems) that they need to be aware of prior to you taking the bowel preparation and having the test. During the test, if the doctor sees anything that needs further investigation, photographs and samples (biopsies) can be taken.
If you are anxious about the procedure, talk to the doctor or specialist nurse about your concerns and ask whether you can have sedation during the investigation. If you have problems lying flat, or being able to curl up on your side to have the test done, please do let the nurse know straight away, so that alternative arrangements can be made if necessary.
After a colonoscopy, the gas that was used to inflate the bowel can sometimes get trapped under your ribs for a short time. Peppermint chewing gum or warm peppermint tea can help to relieve this. If the problem persists, you can talk to your pharmacist for more help and advice with special preparations to relieve your symptoms.
Virtual colonoscopy (also known as CT colonography)
Virtual colonoscopy involves using a CT scanner to produce two and three dimensional images of the large bowel and rectum.
During the procedure, gas is used to inflate the bowel via a thin flexible tube placed in your back passage. CT scans are then performed with you lying on your back, and then on your front, to enable the doctors to get a clear set of scans of your bowel.
Before the procedure, the specialist nurse will talk to you about the bowel preparation that you will have to take to make sure that the bowel is empty. This allows the doctor to perform the procedure effectively. The nurse will ask you about any medical conditions (e.g. diabetes, kidney problems) that they need to be aware of prior to you taking the bowel preparation.
If anything abnormal is detected you may need a colonoscopy to allow the doctor to take samples (biopsies).
Virtual colonoscopies are not currently available in every hospital.
What next?
Waiting for the results of the tests is a nerve-wracking time. Find out from the specialist nurse when you can expect to find out the results and how you will be told. Sometimes you are asked if you are happy to receive the results over the telephone. Think carefully about this – if you do have cancer you might prefer to be with the doctor and nurse when they tell you.
When you are told the results, if you do have bowel cancer, your doctor and specialist nurse will talk to you about what happens next.
