DIAGNOSIS AND ASSESSMENT

Symptoms and screening

The colon and rectum together are known as the large bowel, with cancer of the large bowel known as colorectal cancer. More than 95 per cent of colorectal cancers are adenocarcinomas.

In its early stages, bowel cancer often has no symptoms. This means that a person could have polyps or bowel cancer and not be aware of it. If symptoms do appear, the most common ones include: blood or mucus (slimey material) in the faeces; an unexpected change in bowel habit; general discomfort in the abdomen; constant tiredness; weakness and paleness.

Having these symptoms does not mean that you have bowel cancer. However, if you are experiencing these symptoms, you should discuss them with your doctor.

Ninety per cent of bowel cancer is curable if it is found early and has not yet spread to other parts of the body. Your GP can arrange for you to have the current screening test, called the faecal occult blood test (FOBT). In addition, endoscopic screening can find polyps, which can be removed before they develop into cancer.

It is recommended that if you are over the age of 50, you should talk to your doctor about appropriate screening. It is important to realise that ‘screening’ is only appropriate in patients without symptoms. If you have symptoms listed above, these need to be investigated directly (usually with a colonoscopy).

Diagnostic Testing at Macquarie University Hospital

Macquarie University Hospital’s Colorectal Cancer Program now has a team of more than 20 gastroenterologists and surgeons working side-by-side in advanced purpose-built facilities.

Specialist nurses and allied health professionals work with our gastroenterologists and surgeons to make up an expert multidisciplinary team. It is this team that will guide you through the process of testing to determine a diagnosis.

Macquarie University Hospital’s stand-alone day-only endoscopy suite has been equipped with state-of-the-art equipment. Advanced technology allows for high-definition imaging during standard gastroscopy and colonoscopy procedures, and enhances the detectability of subtle lesions in the early stages of cancers.

Our team has the capacity to select one or more of several different tests to diagnose bowel cancer:

• rectal examination
• colonoscopy and sigmoidoscopy
• CT colonography
• x-ray, ultrasound, rectal ultrasound, CT scan or MRI scan
• blood tests, including a carcinoembryonic antigen (CEA) test.

Part of diagnosis is determining the stage of your cancer. In Australia, the staging system for bowel cancer is the Australian Clinico-Pathological Staging (ACPS) System and has four stages:

• Stage A – the cancer is confined to the bowel wall
• Stage B – the cancer has spread to the outer surface of the bowel wall
• Stage C – cancer is found in lymph nodes near the bowel
• Stage D – cancer is found at distant sites, for example, in the liver or lungs.

You may also hear about the ‘Dukes’ system, which is similar to the ACPS.

Another staging system being used more often is called the TNM system. It records how far the tumour (T) has spread through the bowel wall, whether lymph nodes (N) are affected by the cancer and whether the cancer has spread (metastasised) to other parts of the body (M).

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