GP partner and educator Dr Anish Kotecha provides an overview of bowel cancer prevention, diagnosis and management in general practice, and the role of nurses at each stage.
Learning objectives
This module will provide an understanding of:
- The risk factors for bowel cancer
- Identifying signs and symptoms of bowel cancer
- The criteria for urgent referral for suspected bowel cancer
- The national screening programme for early detection of bowel cancer and how nurses can help promote this
- The main approaches to management of bowel cancer and how nurses can be involved in supporting patients after diagnosis and treatment.
Risk factors and prevention
Nearly 43,000 people are diagnosed with bowel cancer every year in the United Kingdom, making it the fourth most common cancer.
Risk factors of bowel cancer include:
- Age over 50
- A strong family history of bowel cancer
- A history of non-cancerous growths (polyps) in the bowel
- Longstanding inflammatory bowel disease such as Crohn’s disease or ulcerative colitis
- Type 2 diabetes
- An unhealthy lifestyle
- Family history.
Changes to a person’s lifestyle can help prevent bowel cancer such as avoidance of smoking, being physically active and maintaining a healthy weight, eating wholegrain foods and fruits and vegetables and reducing alcohol intake.
Related Article: Smoking rates fall most significantly in the North of England
Assessment – signs and symptoms
Nurses in all settings can be involved with the care of a person with bowel cancer or suspected bowel cancer and Advanced Nurse Practitioners (ANPs) may find themselves dealing with the first presentation of bowel cancer. An understanding of the possible warning signs of bowel cancer is essential, as well as where to go to seek further help.
Practice nurses may also be the first to hear about worrying symptoms from elderly patients coming into the practice for other reasons, such as flu jabs or to receive post-operative wound care, who may mention symptoms of bowel cancer in passing.
Possible symptoms of bowel cancer to look out for include:
- Change in bowel habit (either diarrhoea or constipation).
- Bleeding from the back passage.
- Blood in stool.
- Pain or a lump in the abdomen or in the rectum.
- A feeling of needing to evacuate the bowels (tenesmus).
- Unintentional weight loss.
- Loss of appetite.
The level of concern about bowel cancer will depend to a degree on age – the older the patient, the greater the concern. However, in younger patients the symptoms could still indicate significant pathology such as inflammatory bowel disease, or bowel cancer.
A bowel cancer can in rare cases block the bowel, causing an obstruction. This is a medical emergency and would present with symptoms such as abdominal pain or bloating, constipation as well as the inability to pass wind and a feeling of nausea or vomiting.
Anyone presenting with such symptoms should be advised to see their GP. After taking a history, the GP will then examine the patient including their abdomen and rectum. Initial investigations will likely include tests for:
- Anaemia (and the type of anaemia).
- Kidney function tests.
- Liver function tests.
- Thyroid function tests.
- Calcium levels (bone profile test).
- C-reactive protein and/or erythrocyte sedimentation rate (showing levels of inflammation).
- Faecal Immunochemical Test (FIT test).
Other tests the patient may be referred for include sigmoidoscopy, colonoscopy, CT colonography or a CT scan.
If a person is diagnosed with bowel cancer, they will likely have further tests done to categorise where it is, what type of cancer it is, the grade of the cancer and whether it has spread and so what stage it is as well.
Referral for suspected colorectal cancer
According to NICE guidelines, patients should be offered a FIT if they have certain signs and symptoms of potential colorectal cancer.1 If the FIT is positive, then the patient is referred under the urgent cancer pathway for investigations.
Related Article: Boost your CPD with the redesigned Nursing in Practice 365 platform
Patients will be offered the FIT if they:
- have an abdominal mass, or
- have a change in bowel habit, or
- have iron-deficiency anaemia, or
- are aged 40 and over with unexplained weight loss and abdominal pain, or
- are aged under 50 with rectal bleeding and either of the following unexplained symptoms:
– abdominal pain
– weight loss, or
- are aged 50 and over with any of the following unexplained symptoms:
– rectal bleeding
– abdominal pain
– weight loss, or
- are aged 60 and over with anaemia even in the absence of iron deficiency.1
Note that anyone with a rectal mass, an unexplained anal mass or unexplained anal ulceration does not need to be offered FIT before an urgent cancer referral is considered.
Related Article: Thousands of patients not invited to cancer screenings due to ‘incomplete’ GP registrations
To complete the full module visit the Nursing in Practice 365 website.
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Dr Anish Kotecha is a GP partner in South Wales. Dr Kotecha is also an RCGP South East Wales faculty education lead and Aneurin Bevan University Health Board Cardiff University communication skills tutor and examiner
