OPINION: Newly Revised NICE Guidelines in early Cancer Diagnosis. 24 June 2015.

Submitted by CBCSG Member Pat Jennings

Awareness in Recognising the Early Symptoms of Colorectal Cancer.


In the news yesterday, the NICE Guidelines for early diagnosis of cancers, were “turned on their head”, in an effort to improve the figures on early diagnosis of all cancers in the UK. It was stated that Great Britain, lags sorely behind a great number of European countries, in

referring patients at an optimum early stage, to ensure the most beneficial outcome for the patient.


The new guidelines give GPs greater authority and freedom, in sending patients with any symptoms, for example severe abdominal pain, which may be a possible symptom of many cancer types, directly for investigative procedures such as colonoscopies or CT scans.


From my own experience of being late diagnosed, after consulting with the GP for at least ten

months with the symptoms, and ultimately being diagnosed at advanced Stage 4 Rectal Cancer, with metastases on the liver and lungs, I wish to highlight the problem of the fairly regular occurrence of inaccurate colonoscopy and Stool (Poo) Tests.  These tests investigating for blood in the stools, such as the National Bowel Screening Programme provide, for patients over 60 years of age, are known as faecal occult tests and have an even poorer rate of bowel cancer detection, than colonoscopies do.


According to Cancer Research, Colonoscopy investigations miss 10% of all bowel cancers.  When results for colonoscopies are inaccurate, it may leave the patient or GP falsely reassured.


Inaccurate test results may occur because of technical or human error, or it may be that a particular cancer is an aggressive and rapidly developing strain and so be hard to detect.  Apparently, some bowel cancers are slow growing, developing over years, and others are extremely fast growing and rampant.


In my case, I experienced the early signs of bowel cancer - persistent loose stools, followed closely by constipation and haemorrhoids, exactly 6 months after undergoing investigation for bowel cancer, and reported it immediately and for several weeks and months afterwards to the GP, so it begs the question, that in tests, was the cancer missed unavoidably or avoidably, undetected because of its minor state at the time, or did the cancer develop newly and under its own volition, post-colonoscopy, and grow rapidly, by pure chance at that exact time?  Both tests had been carried out - a Stool Test and colonoscopy, and both resulted in “normal” findings.


In literature on Bowel Cancer Screening and Investigation by Colonoscopy, it is advised to undergo further tests, if any symptoms persist or prove troublesome or unusual to the patient, during the post- testing period.  GPs and patients alike, should be equally aware of this fact.


IBS – Irritable Bowel Syndrome and Colorectal Cancer.

Irritable Bowel Syndrome is a non-life threatening condition which is managed by medication. It often continues as a medical condition on and off, throughout a patient`s lifetime.


Colorectal Cancer, or cancer of the colon or rectum, if not diagnosed at a very early stage, requires substantial and invasive treatments and surgeries. Colorectal Cancer is often terminal.  


These two, IBS a nonlife threatening condition: and Colorectal Cancer when left to advance, can be a terminal disease, can run concurrently. One can mimic the other to a certain extent.


The symptoms of loose stools or diarrhoea, constipation and abdominal pain can be common to both. Quite often, IBS is diagnosed, when it is actually Colorectal Cancer which is the real cause.


Diagnosis of symptoms, through guesswork, which has not used a process of elimination for bowel cancer, leaves time for the cancer to develop. When diagnosed in its later stages, Colorectal Cancer is much more difficult to treat, and sometimes the cancer is untreatable if it is too far advanced. 


Having an IBS diagnosis, does not have any bearing on an increased chance of developing Colorectal Cancer. 


It is important to be aware that whether an IBS diagnosis has been made only in recent times, or in years gone by, (as IBS can be active on and off for years), that if symptoms become decidedly aggressive or unusually persistent to the patient, that investigations to eliminate Colorectal Cancer should be carried out. This could be the case, when as loose stools becoming more active and more persistent than previously, or when constipation becomes so pronounced, that reoccurring Haemorrhoids (Piles) prevail or persist.


Reviews of IBS, especially when patients consult with persistent or unusual changes to their

condition should be taken seriously and thoroughly followed up.


Other Diseases of the Colon.

Some people with Crohn`s Disease, have a slight increased risk of developing Colorectal Cancer, in later life, according to the NHS website on Crohn`s Disease. Diverticulitis was suggested in research, to have an association with a higher risk of left-sided Colorectal Cancer. So it is worth bearing in mind, if these diseases are present, that patients and GPs need to remain vigilant, if or when, symptoms persist or change in any unusual way.


Patricia Jennings.

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