Talking 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. 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 GP 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 your bowel habits. 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 did you start 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 straining 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 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 abdomen 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.
Your GP may also ask you to complete a home test on a sample of your stool – see ‘Testing for hidden blood’ below.
If your GP cannot 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 treatment your doctor prescribes 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 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 it is more common in the 60+ age group, bowel cancer is becoming increasingly common in younger people too.
Guidelines for urgent referral
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 abdomen – you should be referred immediately and this referral will be marked as ‘urgent’ on a two week fast track referral.
‘Urgent’ doesn’t mean you have cancer. Most people with high risker symptoms do not have cancer but it should be ruled out by further investigations.
The guidelines for urgent referral to hospital for investigation published by NICE (National Institute for Health and Care Excellence) are:
- Any patient aged 40 and over with unexplained weight loss and abdominal pain or
- Any patient aged 50 and over with unexplained rectal bleeding or
- Any patient aged 60 and over with:
– iron-deficiency anaemia or
– changes in their bowel habit, or
- Any patient where a test has shown that there is occult blood in their faeces (hidden blood in their stool) – see below.
In addition, GPs should consider referring the following patients for an appointment within two weeks:
- Patients with a mass (lump) in their rectum or abdomen.
- Patients under 50 with rectal bleeding and any of the following unexplained symptoms:
– abdominal pain
– change in bowel habit
– weight loss
– iron-deficiency anaemia.
The maximum waiting time for non-urgent consultant-led treatments is 18 weeks from the day your appointment is booked through the NHS e-Referral Service, or when the hospital or service receives your referral letter. Please see more about NHS waiting times here.
Testing for hidden blood
In July 2017 NICE recommended that people without rectal bleeding who have unexplained symptoms, but do not fall into the age categories listed above, should be offered a faecal immunochemical test (qFIT). This test looks for hidden blood in a sample of your stool (poo). In GP practices where this recommendation has been introduced, patients will be asked to take a single sample at their next bowel movement and post the test to a dedicated laboratory. Pilot schemes are underway and there is growing evidence that the qFIT could flag up patients who should be referred for a colonoscopy or rule out bowel cancer in patients with bowel symptoms.
Being referred to the hospital
You may wish to ask your GP:
- If they are sending an urgent or non-urgent referral request
- Why they have chosen this referral type
- How long they think it will be before you hear from the hospital.