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Bowel cancer tests

Men and women discussing bowel cancer

This page tells you about tests for bowel cancer (also called colon cancer or colorectal cancer). You can find the following information

 

A quick guide to what's on this page

Bowel cancer tests

Usually you begin by seeing your GP, who will ask about your general health, examine you and do some blood tests. They may examine your back passage (rectum). Your doctor may then refer you to hospital for any further tests or X-rays.

At the hospital

A bowel cancer specialist will ask about your medical history and symptoms. The doctor or a specialist nurse can use a tube to look inside the rectum (proctoscopy) or the lower part of the large bowel (sigmoidoscopy). You usually have this done in the outpatient department. To have a sigmoidoscopy, you must have an empty lower bowel. You usually need to have a small enema or strong laxatives beforehand to clear your bowel out.

If they can see any abnormal areas, the doctor or nurse will take samples (biopsies). If you have any outgrowths of the bowel lining (polyps), the doctor or nurse will remove them and send them away to be examined under a microscope.

Your doctor may advise you to have a colonoscopy. This test looks at the whole of the inside of the large bowel. You have it in the outpatient department and it takes about an hour. For this test the bowel has to be empty. You will probably have medicine to make you drowsy just before the test. Your doctor or nurse will ask you to lie on your side and will pass a flexible tube into your rectum and up into your bowel. They can take photographs and biopsies of the bowel lining during the test.

Your doctor may arrange for you to have a barium enema, which shows an outline of the bowel using X-rays.
 

CR PDF Icon You can view and print the quick guides for all the pages in the diagnosing bowel cancer section.

 

Seeing your GP

Usually you begin by seeing your GP who will ask about your general health and may examine your back passage (rectum). This is called a rectal examination. You may have a blood test to check for anaemia. Anaemia is common in people with bowel cancer but may also be caused by other conditions. You may have blood tests to check if your liver and kidneys are working normally. Your GP may then refer you to hospital for further tests or X-rays.

 

At the hospital

The bowel cancer specialist will ask about your medical history and symptoms, and will probably examine your back passage (rectum). You may have this done in the clinic with a sigmoidoscopy, which examines the back passage and the lower part of your bowel. The specialist may also want to examine the rest of your bowel with a colonoscopy. Your specialist may ask you to have a barium enema, which shows up the outline of the bowel using X-rays.

 

Rectal examination

Your GP or the specialist at the hospital may do a rectal examination. They do this by putting a gloved finger into your back passage (rectum) and feeling for any lumps or swellings. The examination may be uncomfortable but should not be painful.

 

Sigmoidoscopy and proctoscopy

These tests allow the doctor or a specialist nurse to look inside the rectum (proctoscopy) or the lower part of the large bowel (sigmoidoscopy). There are 2 types of sigmoidoscopy – a rigid sigmoidoscopy and a flexible sigmoidoscopy. There isn't a great deal of difference in what actually happens when you have the test. The rigid sigmoidoscope has a tube that doesn't bend and is shorter. 

You usually have these tests in the outpatient department. You don't usually need an anaesthetic or medicine to make you drowsy. To have a sigmoidoscopy you must have an empty lower bowel. So you usually need to have an enema or take strong laxatives beforehand to clear your bowel out. Your doctor or nurse may arrange for you to do the enema or take the laxatives at home the day before you go into the department for the test.

Once at the hospital, you may be asked to change into a hospital gown. Under your gown you may also have paper trousers with a hole cut out of the back. Then the doctor or nurse will ask you to lie on the examination table on your left side. The doctor or nurse puts a thin tube called a sigmoidoscope into your back passage (rectum) and up into the large bowel. This is not usually painful but it is uncomfortable. If you find it too uncomfortable at any stage, just tell the doctor or nurse and they will stop. Once the tube is in place, a little air or carbon dioxide is pumped into your bowel. The air inflates the bowel slightly and helps the doctor or nurse to see the bowel wall more clearly.

If they can see any abnormal areas the doctor or nurse will take samples (biopsies) with the sigmoidoscope. If you have any outgrowths of the bowel lining (polyps) they will snip these off and send them away to be examined under a microscope. The whole procedure takes about 5 minutes. It may take a little longer if you need to have polyps removed but even then the test only takes about 10 to 15 minutes.

You should be able to go home as soon as the test is over. Some people have a small amount of bleeding from the back passage after sigmoidoscopy, particularly if they have had polyps removed. This is normal and usually clears up on its own over a few days.

 

Colonoscopy

A colonoscopy looks at the whole of the inside of the large bowel. You have this test in the outpatient department and it takes about an hour. The bowel needs to be empty. You will be given a list of things to help prepare your bowel for the test. These are likely to include

  • Stopping iron tablets
  • Not eating solid food for 1 or 2 days before the test
  • Drinking plenty of clear fluids
  • Taking laxatives

Laxatives can affect people differently. You will need to go to the toilet frequently and for some this is urgent. You may also have a griping stomach. It is a good idea to stay at home on the day you take the laxatives so that you are close to a toilet.

When you arrive at the hospital, the nurse or technician will ask you to remove your clothes and give you a gown to change into. Under your gown you may also have paper trousers with a hole cut out of the back. You will probably have medicine to make you drowsy just before the test. This is called a sedative. You nearly always have a colonoscopy with sedation and painkillers because it would be uncomfortable without them. You may be able to have a colonoscopy without a sedative if you have particular reasons for wanting to. You would need to talk to your doctor or specialist nurse beforehand about this.

Your doctor or nurse will ask you to lie on your side. They will pass a flexible tube into your back passage (rectum) and up into your bowel. As the tube bends easily it can pass around the curves in the bowel. So your doctor or nurse can examine the lining of the whole length of your bowel. The light inside the tube helps them to see any problem areas or swelling. They can take photographs and biopsies of the bowel lining during the test. Your doctor or nurse may also spray a dye onto the lining of the bowel to make abnormal areas show up more clearly. This is called chromoscopy.

Diagram showing a colonoscopy

You should be able to go home a couple of hours after the test. You shouldn't drive for about 24 hours after having the sedative. If you have had a sedative you should have someone with you to take you home. If you live alone, ideally they should stay overnight just to make sure that you are all right.

Colonoscopy is a very safe test. But like all medical tests it does have risks. There is a very small risk of making a hole in the bowel wall called a perforation. This only happens in about 1 out of every 800 colonoscopies at most. But we have mentioned it because it is a serious complication for the very few people it affects. If you have a perforation, you would have to go to the operating theatre for emergency surgery to repair your bowel wall. And you would need strong antibiotics to prevent abdominal infection.

 

Virtual colonoscopy (CT colonography)

Virtual colonoscopy is also called CT colonography. Instead of having the colonoscope put inside your bowel, the doctor looks at pictures created by a computer. 

Before the test you have laxatives and plenty of fluids to clear out your bowel. You also follow a special diet for a couple of days beforehand. Your doctor or nurse will give you full details. The test uses a CT scanner, so you have this test in the CT scanning department. You can have it as an outpatient.

Just before the test the doctor or nurse puts a small tube into your back passage to pump air or carbon dioxide inside. This helps to open up the bowel, which gives clearer pictures on the scan. You then have two CT scans done. You have one scan lying on your back and one lying on your front. A computer matches up the two scans and makes a virtual scan of the inside of your bowel. This shows up any growths on your bowel wall. You may still need to have a colonoscopy if you need a biopsy.

 

Barium enema

This is an X-ray of the large bowel. Doctors sometimes use it instead of a virtual colonoscopy. For this test you have to have an empty bowel. You will be

  • Given laxatives to take the day before
  • Asked to drink lots of fluids the day before
  • Asked not to eat solid food on the day before the test
  • Asked not to eat and drink anything on the morning of the test

When you arrive at the hospital a nurse or technician will ask you to change into a gown. Under your gown you may also have paper trousers with a hole cut out of the back. 

Before the test you may have a bowel washout, although most people don't need this because laxatives generally work very well. A bowel washout is a bit like having an enema. The nurse passes a tube into your rectum and passes water through the tube. The water then drains out of the tube again into a bowl or bucket. As the water drains out, it washes out the inside of the bowel.

Barium is a white liquid that shows up on X-rays. You have a mixture of barium and water passed into your rectum in the same way as the bowel washout. But you have to try to hold the liquid in the rectum this time, until all the X-rays have been taken.

The barium passes through the bowel and shows up any lumps or swellings. The doctor can watch on an X-ray screen.

The test can be uncomfortable and tiring. It is best to have someone to take you home afterwards. After the test you may be constipated and your first couple of stools will be white.

You may want to ask the doctor or nurse for a mild laxative to take home with you after the test. Your stools will go back to normal after you have passed the barium out of your system.

 

After your tests

After your tests for bowel cancer you usually go back to the hospital to get your results. This is bound to take a little time, even if only a week or so. Understandably, this is a very anxious time for most people.

While you are waiting for results it may help to talk to a close friend or relative about how you are feeling. Or you may want to contact a cancer support group to talk to someone who has been through a similar experience.

Look at the bowel cancer organisations page for organisations that can put you in touch with a support group. There are also details of organisations that can tell you more about counselling and help you to find sources of emotional support and counselling in your area.

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Updated: 8 August 2013