Colorectal cancer services at UHSussex

You will be referred to us if:

Your GP has referred you on a faster diagnosis pathway. This is because you have symptoms that may indicate you have bowel cancer. You will have had either a colonoscopy, CT scan or both to confirm this.

You may have taken part in the national bowel screening programme.

You may have been referred as an emergency referral e.g. as an A&E patient.

Your doctor may need to do a series of tests to find out more about your cancer. You may need to undergo one or more of the following investigations.

Faecal Immunochemical Test (FIT)

FIT is a home test kit and check for hidden blood in “poo”.

Many things can cause hidden blood in motions but we know that high levels of hidden blood can indicate a higher risk of serious causes such as cancer.

Most people with high FIT results will still have nothing serious in their large bowel (colon & rectum).

Colonoscopy or Sigmoidoscopy

This is a test which allows the doctor to assess the lining of the large bowel.

X-rays and scans

These scans also build up a picture of the inside of your body by taking a series of images:

• CT (computerised tomography) scan
• MRI (magnetic resonance imaging) scan
• PET scan (positron emission tomography)

Blood tests

The specific blood test for bowel cancer is called CEA (tumour marker).

It may take up to a couple of weeks to complete these investigations. Should you have any concerns during this time, please contact your clinical nurse specialist. Further information about all cancer investigations can be found on the Macmillan or Bowel Cancer UK websites.

• Endoscopy
• Imaging (Radiology)
• Blood tests

Usually, if you have been diagnosed with cancer, a team of health professionals will work together to plan the treatment that is best for you. This is called a multidisciplinary team (MDT). The multidisciplinary team for bowel and anal cancer meets on a weekly basis to discuss individual patients’ treatment and care.

The MDT will meet to discuss the results of tests and plan your treatment. They will consider things including:

• the type and size of the cancer, and whether it has spread (its stage)
• your general health
• national treatment guidelines for your type of cancer
• your preferences about any treatment options.

You do not attend the meeting but a member of the cancer team, usually your cancer doctor and specialist nurse, will tell you about the results of the meeting. You may be given a choice of treatment options, which your specialist will discuss with you.

You need to have as much information as you need to make your decision. Doctors need your permission before they can give you any treatment. This is called consent.

Who will be involved in my care?

• Multi-disciplinary team coordinators, who ensure your care pathway is smooth and timely.
• Specialist Colorectal Cancer surgeons, trained to perform operations to manage cancer
• Specialist Oncologists, (cancer doctors), trained to prescribe therapies such as chemotherapy and radiotherapy
• Clinical Nurse Specialist, (CNS), specialist trained nurses will have a key role in coordinating your care with different members of the multidisciplinary team to ensure you have the guidance and support you require.
• Radiologists, who will have special expertise interpreting scans in relation to bowel, rectal and anal cancers
• Histopathologist, a specialist doctor who analyses tissue under the microscope

At your appointment with your consultant and specialist nurse we will explain your diagnosis and treatment options. Your consultant will explain the aim of the treatments and whether the aim is to cure or control the cancer. We will make you aware of the benefits and side effects of treatment. All treatment options will be discussed with you and we can also talk through what may happen if you decide against any treatment. You will be guided through these treatment options and supported in making your decision.

We would advise that you bring a relative/friend to support you at this appointment.

Surgery

Surgery to treat colorectal cancer aims to remove the tumour, as well as part of the colon or rectum that it may be attached to.

The extent of your surgery will depend on which part of your bowel is affected and how far your cancer has spread. If you have surgery for colorectal cancer, you may need to have a stoma.

A stoma is an opening in the stomach that’s connected to the digestive system. It allows poo and other waste to leave your body and into a pouch. A stoma may be temporary or permanent, depending on the surgery you’ve had.

Our clinical nurse specialists will support you after your surgery and teach you how to manage your stoma and adapt to changes in your bowel habit.

Chemotherapy

If you’re diagnosed with colorectal cancer, you may receive chemotherapy to kill cancer cells and reduce the risk of the cancer coming back.

Radiotherapy

Radiotherapy uses high-energy rays (radiation) to treat cancer. Our experts use specialist machines to precisely deliver high-energy x-ray radiation to colorectal tumours to destroy cancer cells and stop them from spreading.

Radiotherapy may be used:

• Before surgery to shrink the cancer and increase the chances of complete removal.
• Instead of surgery to cure or stop the spread of early-stage cancer, if you cannot have surgery.
• As palliative radiotherapy to control symptoms and slow the spread of cancer in advanced cases.

Targeted medicines and Immunotherapy

Targeted medicines kill cancer cells.

Immunotherapy is where medicines are used to help your immune system kill cancer.

Targeted medicines or immunotherapy are sometimes used to treat advanced bowel cancer that has spread to other parts of the body.

Clinical research

Clinical trials are a type of medical research involving people. They can include people with different illnesses and conditions. Or sometimes, they include healthy people who volunteer. Trials are done in all areas of medicine. Cancer clinical trials only involve people affected by cancer.

This type of research is important because it shows which treatments are most effective and safe. This helps healthcare teams plan the best treatment for the people they care for.

Referral to a specialist centre

Some patients may require specialist treatment and may be referred to another NHS organisation.

What if my cancer cannot be cured?

If you’ve been diagnosed with advanced bowel cancer, it may be hard to treat and not possible to cure. The aim of treatment will be to slow down the growth and spread of the cancer, to help with the symptoms, and help you live longer.

Finding out cancer cannot be cured can be very hard news to take in.

You’ll be referred to a team of doctors and nurses called a palliative care team.

They will help you to manage your symptoms and make you feel more comfortable.

The palliative care team can also help you and your loved ones get any other support you need.

Follow-up is how we talk about what happens after you finish your treatment. This has been carefully planned for you and is called a personalised follow-up (PFU). This information explains your follow-up. If you have any questions, please speak to a doctor or nurse caring for you

You can contact the colorectal clinical nurse specialist (CNS) team at any time during your follow-up if you have any concerns.

What to expect after completing treatment

Following completion of treatment, you will usually meet your consultant and specialist nurse.

This may be an in-person appointment at the hospital or a phone call. The team will explain what your follow up will look like.

Patients are usually then followed up for 3 to 5 years after completing their treatment. This may involve some phone call appointments or face to face appointments at the hospital.

Tests during follow up

After you have finished your treatment, you need to have 3 main tests over 5 years.

• A blood test to check your carcinoembryonic antigen (CEA) levels. CEA is a type of protein in the body. Some colorectal cancers produce CEA.
• A colonoscopy to check the inside of your bowel. You do not need this test if all of your large bowel has been removed.
• A CT scan to create detailed pictures of the inside of the body.

Test results

You get your test results in a letter through the post if everything is normal. If there are any concerns, your colorectal care team will phone you.

The effects of treatment, such as surgery or radiotherapy, can sometimes make it difficult for us to read the results. We might ask you to come back to the hospital to have more tests or scans. If this happens, we will phone you.

It’s important to make sure we have your correct address and telephone number.

If you do not get your results 4 weeks after having your tests, please call the colorectal clinical nurse specialist (CNS) helpline.