Being diagnosed with bowel cancer often comes as a terrible shock. As the news sinks in and you are ready to talk about what’s going to happen, the most important thing to remember is that it’s your body you are discussing.
Don’t be rushed into making decisions and don’t be frightened to ask the doctor or nurse to explain things again if you don’t understand. Your cancer has a whole new language and it is going to be a while before you understand it all. The experts treating you can sometimes forget this – don’t let them!
Tests to assess how far the cancer has spread
You will need to have more tests to find out the extent of the cancer and whether it has spread to other parts of your body. This process is known as ‘staging‘.
The doctor will choose from a range of investigations which will usually include blood tests, X-rays and a CT scan. You may also have an MRI scan, PET scan and / or ultrasound. At each stage, your specialist team should take time to tell you what the results are and they will explain why you need to have these and any other tests done.
CT – gives a series of cross-sectional images of the body which shows the size of the tumour and its location. You lie on a bed which slides slowly backwards and forwards through a doughnut shaped machine.
MRI – the best type of scan for detecting liver lesions and to establish whether they are cancerous. You lie on a bed which then slides into a tunnel about 1.5 metres long. The procedure is painless but the scanner is quite noisy so some departments will provide earplugs.
PET – uses low-dose radioactive glucose solution which is injected into a vein, usually in your arm. You then rest on a bed which slides into a doughnut-shaped scanner. The scan shows cancerous cells as bright spots where the glucose is taken up more rapidly than normal cells. A PET scan can show the difference between scar tissue and active cancer tissue.
Putting together your treatment plan
Once your doctor has received your test results, he / she will be able to discuss your diagnosis more fully with you. This will help you to understand your options as you start to get involved in putting together your individual treatment plan. This will be unique to your own personal circumstances, and will depend on a number of factors including the type, size and location of the cancer and your general health.
All decision making will be done jointly between you and your MDT (multi-disciplinary team). Your doctors will help you to understand the advantages and disadvantages of what is being proposed so that you can be confident in the decisions taken, and satisfied that your individual needs and wishes have been fully considered.
Your specialist nurse will also make an assessment of your general health and fitness – known as Holistic Needs Assessment – and consider any underlying health problems. It is also important that they understand what home and family issues need to be considered as well as any practical concerns, as these might also have an impact on your health and treatment choices. This process will also help you to manage your own care much more effectively so that you will know when and how to ask for help.
There are three main types of treatment for bowel cancer, based on – surgery, chemotherapy and radiotherapy techniques. Depending on the stage and location of your cancer, you will usually receive one or a combination of these treatments. Bowel cancer patients may also receive targeted therapies if the bowel cancer has spread to other parts of the body.
Patients sometimes choose to seek a second opinion from another consultant or hospital. This may be at the suggestion of family members keen to ensure all possible treatment options are being explored. Or it may be that patients are unhappy regarding their treatment pathway or decisions that have been made by their current team.
We would recommend that you discuss your concerns with your GP or consultant first. It may be that talking things through can address some of your worries, allowing you to continue on your current pathway uninterrupted.
It is possible to get a second opinion by asking your GP or your current consultant to refer you on. This can be arranged via the NHS, or privately as you wish. Asking for a second opinion can feel uncomfortable, but it shouldn’t be an issue. Most doctors would prefer that you are confident in your team and the treatment being planned.
A second opinion will require all your scans and reports to be sent over to the other consultant, and your case to be discussed at their multi-disciplinary team meeting. This will quite often mean a wait of a week or two to allow all of this to happen, which can be quite stressful for the patient and their family.
Generally speaking, we wouldn’t recommend delaying treatment in order to have a second opinion. However, some patients feel that it is worth taking the time to look at other options before starting treatment.