During April, Bowel Cancer UK is raising awareness of bowel cancer screening to improve early diagnosis of the disease. Specialist nurses and doctors at Basildon University Hospital, along with bowel cancer patients, emphasise the importance of completing the test that could save your life.
Not everyone who receives a test kit completes it, and of those who do, not everyone invited for further investigation attends. These people are missing out on the best way to detect the disease early, when it is easier to treat and there is the greatest chance of survival.
Test kits are posted every two years to people aged 60-75. Last year in south Essex, 72,000 kits were sent out. Of those, 41,000 – 57 per cent – were returned to the laboratory for checks to see if there was any blood in the sample, which can be an early sign of bowel cancer. Following this analysis, 768 people were offered appointments with a nurse qualified as a specialist screening practitioner (SSP).
The SSP talks through the findings with the person, and recommends they attend hospital for a colonoscopy. In 2016, 561 people in south Essex took up this invitation, but 207 – more than a quarter of those asked – did not.
This shortfall concerns doctors and nurses at Basildon University Hospital who run the bowel cancer screening programme, and those who care for the people who are diagnosed with the disease.
Tracy Denny, lead colorectal nurse specialist, is part of the multi-disciplinary team (MDT) that plans treatment for patients who have been diagnosed with bowel cancer, and may possibly have secondary cancer in other parts of the body.
She said: “It’s very sad, but we do regularly meet patients with no symptoms who say, ‘I binned the first two test kits I was sent, and now I wish I hadn’t’.”
“We know that some people are not keen to carry out the test kit, or attend for a colonoscopy, because they think it’s unpleasant and embarrassing. We find that it is men who are more likely to feel this way. Some of us in the team have family members, who even though they know about our work, have to be persuaded to take the test. It may not be the nicest thing to do, but it certainly beats getting cancer.”
Karen Steggles, lead bowel cancer screening nurse at Basildon Hospital, heads the team of SSPs who see and assess patients in clinics if they have had a test result that is positive for blood.
The SSPs also spend time going out and about into community areas, such as shopping centres, particularly in places where they know the return rate of the test kits is low.
Most patients with a positive result will be invited to attend Basildon Hospital for a colonoscopy, a test to check the inside of the large intestine using a tiny camera on the end of a flexible tube. This may show that there are polyps in the bowel – growths that may develop into cancer in the future. Removing them reduces the risk of getting bowel cancer.
Karen said: “We give people as much information as possible to encourage them to have a colonoscopy. If they decline, we write to their GP so they are aware, and we ask the patients to keep a careful watch for symptoms and get in touch with us if they are concerned.
“We talk to patients about the colonoscopy and what it involves. They can have some mild sedation during the procedure. Embarrassment can be a problem, and some people may prefer to have an endoscopist who is the same sex and we will always arrange that. “We make them feel as comfortable as possible during procedure – the techniques are so much better than they used to be and it is often not painful.”
If the colonoscopy shows there is cancer in the bowel, the patient will be referred to the colorectal MDT, who will plan the right treatment, including scans to check what stage the cancer is at, and whether it has spread.
The cancer may be treatable, and this may or may not involve the patient needing a colostomy. This may only need to be temporary, and all patients receive care and support from the hospital’s stoma nurses.
Dr Zia Mazhar, (left), gastroenterology consultant at Basildon Hospital, is the clinical director of the NHS bowel cancer screening programme. She said: “The message we want to emphasise is that early tests and early treatment saves lives.
“If you are aged 60 or over and you receive a test kit, please complete it, and encourage others to do the same. Everyone should check the symptoms of bowel cancer on the NHS website, and if you have concerns, speak to your GP.
“Don’t be embarrassed, and don’t be afraid. It’s important to remember that bowel cancer can be prevented by screening, and also that it can be treatable. We have an expert team of compassionate doctors, nurses and therapists who will give care, treatment, advice and support every step of the way.”
Patient case studies
Geraldine Nolan (left), 66, was careful to complete screening tests when she received them in the post. After the second one, she received a letter asking her to attend an appointment with a specialist screening practitioner.
She said: “I was not particularly worried – the main thing was to get it checked. I saw a very friendly and helpful nurse at a clinic, who referred me to hospital for an endoscopy.
“This showed there were two polyps that were possibly cancerous. They were able to remove one straight away. The other one was confirmed as cancerous and I had surgery to remove it.
“I had been told that if I needed a stoma, it might be reversible, but in fact it is permanent. But I am managing with it very well – I am very active, and go the gym five times a week.
If I ever need advice I can call the stoma nurses or any of the colorectal nurses; they are all so helpful.”
Geraldine will have follow-up appointments with the colorectal nurses for the next eight years, with regular scans and blood tests alongside planned colonoscopies.
She added: “All the staff who cared for me at Basildon Hospital were wonderful. “The bowel screening test saved my life and I tell all my friends to make sure they
complete and return theirs when they receive it in the post.”
Geraldine, who lives in Benfleet, worked for the Ministry of Justice before she retired. She has two grown up children and two grandchildren.
She recalled: “I said when I was in hospital ‘I am going to get through this, I have a lot more cuddles to give my grandchildren and family.’”
Bob Hackett is a former patient who survived bowel and liver cancer twice over ten years. He is now a member of the cancer services user group at Basildon Hospital and gives regular talks at meetings.
Bob was originally diagnosed on 14 December 2001 at the age of 47 and is now a long- term survivor.
He said: “I was lucky to be diagnosed in time because I hadn’t been feeling unwell. My wife had read an article about the symptoms of bowel cancer and realised that I had been experiencing some of them.
“I went to my GP and was referred for tests, but I certainly didn’t expect to be diagnosed with cancer. Initially I didn’t know if I would see that Christmas, but thanks to excellent care and treatment, I survived and now try to encourage others in the same situation.” For more on the cancer services user group, email firstname.lastname@example.org