Bowel Cancer Screening

Focus on Bowel Cancer Awareness Month

Bowel Cancer Screening and your Stoma

Bowel Cancer is the third most common cancer in the UK and the second highest cause of cancer deaths, Whilst survival from the disease has improved over the last decade, over 36,000 people are diagnosed each year and approximately 16,000 will die from the disease. Treatments for bowel cancer often include surgery with the possibility of chemotherapy and/or radiotherapy - treatments which in themselves are often debilitating and lengthy. However, when diagnosed early it is in fact very treatable this is why it is so important to raise awareness and encourage more people to go to their GP.

April is Bowel Cancer Awareness month - this is the time to improve bowel cancer symptom recognition amongst all of us and to promote services such as the National Bowel Cancer Screening Programme which increases the possibility of early detection of the disease. If bowel cancer is detected early less treatment may be required and the outcome is generally better.

The Bowel Cancer Screening Programme

Every two years the programme automatically invites everyone registered with a GP (between the ages of 60 and 74 in England, Wales and NI and aged 50-74  in Scotland) to complete a Faecal Occult Blood Test (FOBt) at home. If you are older and wish to participate you can request a test kit from the programme. It is a simple test kit requiring two small specimens of stool from three seperate bowel movements to be placed in the windows on the card (dated appropriately) and then sent back to "The Hub" - the testing centre. if the test is unclear you may need to repeat the test up to three times.

The FOBt detects traces of hidden blood in the motion, but it cannot determine the actual cause. Therefore following an abnormal result you will be referred to your local screening centre. You will be sent a clinic appointment with a specialist nurse, called a screening practitioner, to discuss the findings and, if fit enough, offered further investigation, usually a colonoscopy (a telescope examination of the bowel) to potentially determine the cause of the abnormal result.

As the FOBt detects traces of hidden blood in the motion, there are many harmless reasons why this test can show an abnormal result.

Ostomates' questions about Bowel Cancer Screening

As I already have a stoma do I need to do the test?

Remember having a colostomy does not safeguard you from developing a bowel cancer in your remaining bowel and it certainly does not exclude you from participating in the screening programme. You may not be sure how much of your bowel is left following your surgery, but your stoma nurse or GP may be able to explain this. If you are participating in the programme the specialist screening practitioner can, with your permission, check your medical records to confirm this.

If your stoma surgery was due to bowel cancer, you are likely to be having regular check-ups with your consultant. If your surgery was many years ago any follow-up investigations may have now stopped and in this case it would be advisable to do the test. However, even if follow-up is continuing you can still participate in the programme, but remember that no investigation should be performed or duplicated unnecessarily as all procedures carry potential risks so it may be useful to discuss this with your consultant or stoma nurse.

If I have no colon or rectum will this test pick up signs of cancer in other parts of the digestive system?

The programme is to detect polyps and cancers in the bowel and the subsequent investigations following an abnormal result on the FOBt are desgined to look at your rectum and colon (large bowel).Therefore if you no longer have a colon or rectum this screening programme is not suitable for you as the initial FOBt is not a diagnostic test and the investigations offered are only to visualise the colon and rectum.

How do I collect samples for the FOBt?

The most important part of the process is collecting your stool samples. Remember you need two samples from three bowel movements within two weeks. Ideally you need a fresh sample, not stool already collected in your appliance. Whilst your stoma may not always be predictable, if you know when it is likely to be active and are prepared to set aside some time in the bathroom to obtain your sample each time, this is the ideal. Collect the bowel motion on a tissue and the take sxamples from 2 different parts.

If you need to take your samples from your appliance, apply a new pouch and once your stoma has worked take two samples from the fresh stool, endeavouring to take them from different parts of the specimen. (It may be easier to cut open the pouch allowing the contents to be spread out enabling easier access to the stool.) If you use a flushable pouch you can still follow the procedure and then simply flush away after obtaining your samples.

If you irrigate your colostomy try taking your initial specimen when the first formed stool is expelled down the sleeve and then take the second specimen later on in the procedure. if your output is loose it may be helpful to have two receptacles (e.g. two clean margarine tubs) ready to collect samples.

Are there any precautions I should take to avoid contaminating the sample?

 The most important factor is to exclude any obvious blood. if you see blood it is likely to cause an abnormal FOBt result. So when you clean your stoma prior to collecting a sample, make sure you do this as gently as possible to prevent bleeding from the mucosa (the surface of the stoma).

If you have any granulomas that bleed on a regular basis, either from the edge of the appliance rubbing on the stoma or when you are cleaning it, consult your stoma nurse. She will be able to advise if this can be treated or whether any ointment or solutions can be used to reduce the problem.

I have a Hartmann's end colostomy/I have a loop colostomy. Do i need some other tests to screen for cancer in the redundant section of my bowel?

In most cases this type of stoma should be temporary and therefore the redundant part of your bowel will be checked by the surgical team managing your care.

Participating in the screening programme requires faecal specimens taken from your stoma which is from the functioning part of your colon and therefore it cannot detect abnormalities in the redundant section of your bowel. If, however, you do participate in the programme and end having a colonoscopy the redundant part of your bowel will also be checked.

This screening programme is about keeping you healthy and to reduce your risk of dying from bowel cancer. The method of specimen collection may be lengthy and it may be awkward but you are the expert when dealing with your stoma - it hasn't stopped you from leading a full and active life - so go on do the test!

Shelley Biddles
Lead Nurse, Nottinghamshire Bowel Cancer Screening Programme

Diana Wilson
Clinical Nurse Specialist, Stoma Care, Charter Healthcare

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