Your doctor will begin the diagnosis by asking you about your pattern of symptoms and whether you have any family history of bowel cancer. They will then carry out a physical examination that is known as a digital rectal examination (DRE). A DRE involves your doctor gently placing their finger into your anus, and then up into your rectum.

A DRE is a useful way of checking whether there is a noticeable lump, or mass, inside your rectum, as this is found in an estimated 40-80 per cent of cases of rectal cancer. A DRE is not painful procedure, but some people may find it a little embarrassing.

If your symptoms suggest that you may have bowel cancer, or the diagnosis is uncertain, you will be referred to your local hospital for further examination.

Further examination

There are three tests that are used to confirm a diagnosis of bowel cancer:

• sigmoidoscopy - is an examination of your rectum and some of your large bowel,
• colonoscopy - is an examination of all of your large bowel, and
• barium enema – is a type of X-ray that is used to study your bowel in more detail.

Sigmoidoscopy

A sigmoidoscopy uses a device called a sigmoidoscope, which is a thin, flexible tube that is attached to a small camera and light. The sigmoidoscope is inserted into your rectum and then up into your bowel. The camera relays images to a monitor that allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer.

A sigmoidoscopy can also be used to remove small samples of suspected cancerous tissue so that they can be tested in a libratory. This is known as a biopsy. A sigmoidoscopy is not usually painful, but it can feel slightly uncomfortable. Most people are able go home after the examination has been completed.

Colonoscopy

A colonoscopy is a similar examination to a sigmoidoscopy apart from a larger tube, called a colonoscope, is used to examine your entire bowel. Your bowel needs to be empty when a colonoscopy is performed, so you will be given a special diet to eat for a few days before the examination and a laxative (medication to help empty your bowel) on the morning of the examination.

You will be given a sedative to help you relax after which the doctor will insert the colonoscope into your rectum, and move it along the length of your large bowel. As with a sigmoidoscope, the colonoscope can be used to obtain a biopsy, as well as relaying images of any abnormal areas. A colonoscopy usually takes about one hour to complete, and most people are able to go home once they have recovered from the effects of the sedative. After the procedure, you will probably feel a bit drowsy for a while so you should arrange for someone to accompany you home.

Barium enema

As with a colonoscopy, a barium enema also has to be performed when your bowel is empty, so you will be asked not to eat or drink anything on the morning of the procedure, and you will be given a laxative to take. Before the examination begins, a nurse may wash out your bowel by placing a tube into your rectum and up into your bowel. Water will then be passed into your bowel.

A barium enema is performed in much the same way as washing out your bowel. Barium is a special type of liquid that shows up clearly on X-rays. During a barium enema, barium is pumped into your bowel and, afterwards, a doctor will study how it moves through your bowel on an X-ray. This is useful for spotting any unusual lumps, masses, or blockages in your bowel.

A barium enema takes around 15-20 minutes to complete and, afterwards, you should be able to go home. You may experience some stomach cramping for a few hours after the enema has been completed. However, this is normal and it is nothing to worry about. You will be advised to drink plenty of fluids as this will help to wash the barium out of your bowel. Your stools will have a white-grey appearance for a few days, but they should return to their usual colour soon afterwards.

Further testing

If a diagnosis of bowel cancer is confirmed, further testing is usually carried out for two reasons to check if the cancer has spread from the bowel to other parts of the body, and to help decide what will be the most effective treatment for you.

These tests can include:

• a computerised tomography (CT) scan, or magnetic resonance imaging (MRI) scan – to provide a detailed image of your colon,
• ultrasound scans – which can be used to look inside other organs, such as your liver, to see if the cancer has spread there,
• chest X-rays – which can be used to assess the state of your heart and lungs, and
• blood tests – in some cases of bowel cancer, the cancerous cells release a special protein, known as a tumour marker, which can be detected with a blood test.

Staging and grading

Once the above examinations and tests have been completed, it should be possible to determine what stage and grade your cancer is. Staging refers to how far your cancer has advanced, and grading relates to how aggressive, and likely to spread, your cancer is.

A staging system called the Dukes system is usually used to stage bowel cancer which has four stages measured from A-D.

• Dukes A – the cancer is still contained within the lining of the bowel or rectum.
• Dukes B – the cancer has spread into the layer of muscle surrounding the bowel.
• Dukes C – the cancer has spread into near by lymph nodes.
• Dukes D – the cancer has spread into another part of the body, such as the liver.

There are three grades of bowel cancer:

• grade one – is a cancer that grows slowly and has a low chance of spreading beyond the bowel,
• grade two – is a cancer that grows moderately and has a medium chance of spreading beyond the bowel, and
• grade three – is a cancer that grows rapidly and has a high chance of spreading beyond the bowel.

Related articles:

1. Bowel Cancer
2. Treating bowel cancer
3. Improve your knowledge of cancer
4. Causes of cancer
5. Treating cancer (1)
6. Treating Cancer (2)
7. Preventing cancer

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