Gastroenterology

Bowel cancer is the fourth most common cancer in the UK. If it’s detected at an early stage, before symptoms appear, it’s easier to treat and you are more likely to survive.

All men and women in Cornwall between the ages of 60 and 74 are invited for screening every two years. People over age 74 can also request a screening kit from the programme hub on the freephone number below.

What’s involved in screening?

The testing is carried out at home using a faecal occult blood (FOB) test. If you’re between 60 and 74 and registered with a GP, we’ll send you a home test kit in the post, with full instructions that you can use to collect a tiny stool sample. You then send this back to us in a hygienically sealed freepost envelope.

The test kit is used to detect tiny traces of blood that are invisible to the naked eye and will let you know whether you need to come in for further investigations.

Receiving your test results

You’ll usually get your results within two weeks of returning your sample.

There are three types of results. Most people (98 in 100) will receive a normal result. Sometimes we get an unclear result and we’ll ask you to take the test again.

If you receive an abnormal result it means we may have found blood in your sample. This is not a cancer diagnosis, the abnormal result may have been caused by bleeding from bowel polyps or other conditions such as haemorrhoids (piles). We will invite you in for a colonoscopy so that we can investigate sooner.

You can read more about the faecal occult blood test on the NHS Choices website.

Colonoscopy

If you have an abnormal FOB test result, we’ll offer you an appointment with a specialist screening practitioner to discuss having a colonoscopy. During a colonoscopy, we examine the lining of the bowel wall using a thin flexible tube, called a colonoscope, passed into the rectum (back passage) whilst you’re under sedation. At your appointment we’ll fully explain the procedure to you, take a full medical history and assess your fitness for a colonoscopy. If you decide to go ahead with the colonoscopy, we’ll book you in for an appointment.

A colonoscopy is the most effective way to diagnose bowel cancer and treatments are more likely to be effective if bowel cancer is detected early. A colonoscopy can also remove any polyps we find, and prevent cancer developing in the future.

Find out more about having a colonoscopy on the NHS Choices website.

After your colonoscopy, we will send you a letter with your results, or give you the option to come in for a follow up appointment to discuss your results.

Contacts and further information

Bowel Cancer Screening Programme Hub Freephone

0800 707 60 60

Bowel Cancer Screening department at Royal Cornwall Hospital

01872 252076

For further information on bowel cancer:

• Information on Bowel Cancer from Cancer Research UK
• Bowel Cancer UK
• Beating Bowel Cancer

We look after patients who have been diagnosed with anal, rectal and colon cancers.
We also work with our colleagues in upper gastrointestinal to care for patients with carcinoid tumours.

What happens when you are first referred?

You may be referred to us through a number of routes; a routine bowel screening, a referral from your GP, another surgeon or a gastroenterologist, or because you’ve come in as an emergency.

Once you have been referred, you might be invited for a colonoscopy. If you’re not fit enough for a colonoscopy, the first test may be a CT enema or CT pneumocolon. After this, you might be offered further tests such as an MRI, PET scan, Octreotide scan or an examination under anaesthetic. Your results will then be discussed at the Multidisciplinary Team (MDT) meeting.

After your case has been discussed at the MDT, (which usually takes place on Fridays) one of our Cancer Nurse Specialists will call you straight after to discuss the best course of action, whether that’s surgery, chemotherapy, radiotherapy or a combination of these. We’ll then arrange any necessary outpatient appointments.

Where will you be treated?

Initial outpatient appointments take place across Cornwall at our main hospitals and community hospitals.

All chemotherapy or radiotherapy treatment, and appointments with your oncologist take place at the Royal Cornwall Hospital in Truro.

If you need to be admitted to hospital as an emergency, oncology patients will most likely stay on Lowen Ward, our specialist oncology ward. You may also be admitted to MAU.

Surgery

All bowel surgery takes place at the Royal Cornwall Hospital.

• For planned surgery you’ll be admitted through Theatre Direct.
• If you need emergency surgery, you’ll be admitted to the St Mawes Lounge and Unit.
• After your surgery, you’ll recover on Pendennis Ward.

If your bowel cancer has spread to your liver or lungs, and surgery is appropriate, your surgery will take place at the specialist centre at Derriford Hospital in Plymouth.

Patients who need complicated rectal surgery will go to the complex cancer centre at St Mark’s Hospital in London, where they provide excellent care and a specialist service for patients with recurrent and advanced pelvic cancers.

Patients who need surgery for pseudomyxoma peritonei will go to the Basingstoke and North Hampshire Hospital.

The Colorectal Cancer Team

We have two Colorectal Cancer Nurse Specialists, Clare Ferris and Candy Coombe, who look after patients throughout their journey. You can contact them on 01872 252693 or clareferris@nhs.net / candida.coombe@nhs.net.

Gastrointestinal Nurses (GINs)

Our GI Nurses assess patients referred to us through two-week wait and care for them on our wards and theatres. They will also call you after you have been discharged after surgery to check on your recovery.

Clinical Genetics Team

Although most cancer is not inherited, some bowel cancers can be genetic. To help patients identify other family members who may be at risk, we work with the Clinical Genetics Team based at the Royal Devon and Exeter Hospital. You can find out more about what they do on their website.

Further support and information

Support groups

Cornwall Bowel Cancer Support Group meets four times per year between 10am and 4pm at Probus Village Hall. They also have a private support group on Facebook. Your CNS can invite you if you’d like to join.

Patient support group for Stoma Care runs meetings in Carnon Downs and Lanhydrock. You can find more information on the Cornwall Ostomy Support Website and in their private Facebook Group.

Websites

The Beating Bowel Cancer website has excellent information on bowel and anal cancers, including secondary bowel cancer.

The Pelvic Radiation Disease Association has useful information for people suffering from pelvic radiation disease.

The Macmillan website has dedicated sections on the following cancers:

• Anal cancer
• Colon cancer
• Rectal cancer
• Small bowel cancer

Patient Information Leaflets

Please click here

The Cove Macmillan Cancer Support Centre

Offers advice and support on all aspects of living with cancer. The centre is on the Royal Cornwall Hospital site in Truro. Find out more here.

We use endoscopy, where we use a long, thin and flexible tube with a light and camera at one end, to investigate, diagnose and treat a full range of gastrointestinal conditions.

We have two specialist endoscopy suites at the Royal Cornwall Hospital and West Cornwall Hospital in Penzance, where we offer a full range of endoscopic procedures, including;

Our units have the latest Olympus endoscopes and a new endoscopy reporting system that allow us to carry out regular audits of our endoscopy practice against national guidelines and standards.

Endoscopy services are provided by consultant physicians and surgeons, associate specialists, clinical assistants, nurse endoscopists and a consultant radiographer.

Find out more about endoscopy procedures and how you can prepare yourself for it on the NHS Choices website.

We see a wide variety of emergency patients with problems such as acute upper gastrointestinal haemorrhage, colitis, hepato-biliary disease and decompensated liver disease. These patients are usually admitted through the Medical Admissions Unit and then then transferred to Gastroenterology and Liver Unit, our specialist 29-bed gastrointestinal ward.

Find out more:

• Gastroenterology and Liver Unit (including directions, visiting times etc)
• Coming to stay in hospital with us as an inpatient
• Visiting an inpatient

We see around 6000 new and 9000 follow-up patients at our outpatient clinics each year.

Our outpatient clinics take place at both Royal Cornwall Hospital and West Cornwall Hospital and at outreach clinics at St Austell, Bodmin, Redruth, Hayle, Helston and the Isles of Scilly.

Most are general gastroenterology clinics but we also hold clinics specifically for:

• Inflammatory Bowel Disease (IBD)
• Hepatology.
• Hepatitis C and alcohol-related liver disease (nurse-led and based in Redruth Hospital)

We also run telephone clinics for :

• Coeliac disease
• Inflammatory Bowel Disease (IBD)
• Jaundice hot-line
• Dysphagia clinic
• Direct referrals to investigate iron deficiency

Find out more about visiting the Royal Cornwall Hospital as an outpatient.

The Gastroenterology department at the Royal Cornwall Hospital cares for more than 2000 patients with Inflammatory Bowel Disease (IBD), the majority of whom are suffering with either Crohn’s disease or ulcerative colitis.

We have eight medical Gastroenterologists and six surgical Gastroenterologists who are specialists in managing IBD. They work primarily at the Royal Cornwall Hospital but also hold weekly clinics in West Cornwall Hospital and a variety of other community hospitals across the county. The team is supported by two IBD specialist nurses as well as specialist radiologists, histopathologist, a pharmacist, stoma care nurses and dieticians.

Being referred to the IBD team

If your GP suspects that you might have IBD, you will be referred to a Gastroenterology clinic via NHS Choose and Book. You will be able to choose who you see and where you are seen. You will be seen by either your named consultant or a registrar (a junior doctor in specialist training) working under the supervision of that consultant.

In the rare event that your GP feels that you are too ill to wait to be seen in the clinic then your GP can liaise directly with one of the team and either arrange a more urgent outpatient appointment or admission to hospital.

Admission to hospital

If you need to be admitted to hospital, you’ll come in either via your GP or A&E. Initially, you’ll be seen in A&E, the Ambulatory Care Unit or in the Medical Admissions Unit. Once you’ve been assessed, you’ll then be transferred to a ward, most likely Carnkie.

Day Unit

Some treatments require a day visit to hospital. Commonly this is for intravenous medications.

Monitoring your IBD

Long term follow up arrangements depend on your personal preference and the severity of your IBD.

We prefer to see you at a clinic if your symptoms are severe or complicated, or if your treatment requires close supervision.

For more stable patients, our two specialist nurses provide annual telephone follow up clinics. We’ll give you a date and time for a short telephone consultation to check on how you’re doing. If during your telephone review, we feel your symptoms warrant further investigation then we’ll arrange a face to face consultation with either the specialist nurse or your consultant.

If your condition deteriorates between your telephone review dates, it is important that you speak to your GP or call our IBD telephone helpline as soon as possible.

The IBD Helpline Service

This is a 24hr answerphone helpline that patients can contact at any time. Simply call 01872 252178 and leave a message. In your message, please tell us clearly your full name, hospital number (if known) or date of birth, along with a contact number and best time to call. One of our IBD nurses will call you back as soon as possible (usually within 2 working days). Please don’t call the helpline if it’s an emergency, contact your GP or call NHS 111, or dial 999/come to the Emergency Department if you think your condition is life threatening.

Additional help and support for patients with IBD

When you are diagnosed with IBD, your consultant will give you an explanation of the specific disease and possible treatments. If you require further information, the IBD nurses are very happy to see you face to face at the Royal Cornwall Hospital in Truro or speak to you on the phone.

The Crohn’s and Colitis UK support group have a wealth of information and are strong supporters of IBD related research. There is also a local Crohn’s and Colitis UK support group. Meetings are held in the Knowledge Spa at the Royal Cornwall Hospital every two to three months. Please ask your IBD nurse for details about the next meeting.

You can also read more about IBD on the NHS Choices website.

Contacts for the IBD team

IBD helpline

01872 252178

IBD email

rch-tr.IBDnurse@nhs.net