Colorectal cancer

Colorectal cancer is a primary cancer of the colon (large bowel), rectum. Anal cancer is a primary cancer of the anus or anal canal.

Further information about colorectal or anal can be found on the Macmillan website or bowel canceruk.org.uk

At Barts Health the care of patient with colorectal and anal cancer is provided at Whipps Cross, Newham and The Royal London Hospitals.

The clinic appointments and treatment can take place at all hospital sites.

If you are having tests or undergoing treatment for colorectal cancer you will be given the contact number for a specialist nurse who will support you throughout your treatment.

Investigations

Your doctor may need to do a series of tests to find out more about the cancer. You may need to undergo one or more of the following investigations.

Colonoscopy

This is a test which allows the doctor to assess the lining of the large bowel.  The colonoscope (a flexible tube with camera attached) is carefully passed through the anus into the large bowel.  During the test the instrument is used to photograph any areas of the bowel which appear abnormal.  Samples (biopsies) may also be taken from these areas. The biopsies are sent to the laboratory to be tested for the presence of cancer cells.

The scans listed below build up a picture of the inside of your body by taking a series of images.

Blood tests

There may be several blood tests which you may need to assess your general health.  The specific blood test for bowel cancer is called CEA (tumour marker).

It may take up a couple of weeks to complete these investigations. Should you have any concerns during this time please contact your clinical nurse specialist (key worker).

Further information about all cancer investigations can be found on the Macmillan website or Bowel Cancer UK 

Treatment options

The colorectal/anal cancer team at Barts Health have regular meetings called MDTs (multidisciplinary team meetings) this is where a group of health professionals with expert knowledge in colorectal and anal cancer will manage your investigations and treatment.

You do not attend the meeting but a member of the colorectal/anal cancer team, usually your specialist nurse, will tell you about the results of the meeting. You may be given a choice of treatment options, which your specialist will discuss with you. If you don't understand what you've been told, let the staff know so they can explain again.

Before you have any treatment, you will need to give permission (consent).

Further information about types of treatment used for treating colorectal anal cancer is available on the Macmillan website or Bowel Cancer UK.

Your appointments

Surgical colorectal cancer clinics for patients at The Royal London Hospital and Newham Hospital take place on Tuesday morning at The Royal London Hospital. Surgical colorectal clinics for patients at Whipps Cross take place on alternate Monday and Tuesday mornings and occassionally on Tuesday and Thursday afternoons - this is on a adhoc basis. 

Medical oncology clinics are held at St Bartholomew’s Hospital every Monday (all day), Tuesday afternoon for follow up clinics and Wednesday afternoons for new patients. 

Clinical oncology clinics are held at St Bartholomew's Hospital every Monday morning for new patients and every Thursday for follow up clinics.

You will see your specialist doctor in the clinic after the multidisciplinary team has met. Your doctor might talk to you about your diagnosis and treatment plan and you can also talk to them about any concerns you may have.

It may be a good idea to take someone with you to your clinic appointment. You may also find it useful to have a list of questions ready to make sure you get the information you need.

Your care team

The colorectal and anal cancer team at Barts Health include the following staff:

Colorectal surgeon

Specialist doctor who is trained in operating on colorectal and anal cancers.

Medical oncologist

Doctor trained in diagnosing and treating cancer patients with Chemotherapy.

Clinical oncologist

Doctor trained in diagnosing and treating cancer patients with Radiotherapy.

Consultant radiologist

A doctor who is expert in interpreting

X-rays and scans. They may also perform biopsies (taking tissue samples) with the aid of imaging techniques.

Consultant pathologist

A doctor who looks at tissue samples under a microscope to search for cancer cells.

Clinical Nurse Specialist (CNS)

An experienced cancer nurse who acts as your key worker. They will give you advice and support as you go through investigations and treatment and support you through your care pathway.

Member of the palliative care team

The Palliative Care Team specialises in relieving pain and other symptoms, including psychological difficulties caused by cancer.

Multi-disciplinary team co-ordinator

The co-ordinator provides administrative support to the colorectal and anal cancer team and aims to ease the pathway from referral to treatment.

The colorectal and anal cancer team are a group of experts, and will work with you to conduct and provide the best care plan possible.

If you have any concerns, please talk to the team who will be considerate of your decisions and wishes.

Information for professionals

Referral information 

Sources of referrals to the colorectal and anal cancer teams are as follows:

  • The two week wait pathway from the GP
  • The national bowel cancer screening programme
  • In-patient referrals via the MDT co-ordinator
  • Tertiary referrals – from other Trusts