All nurses have a role in detecting bowel cancer

Nurse Jennie Burch says bowel cancer screening is working – but we must maintain the momentum

Nurse Jennie Burch says bowel cancer screening is working – but we must maintain the momentum

The current bowel screening kit will soon be replaced with a simpler test, shown above.

Bowel screening may not be the most glamorous of topics, but it's essential that we talk about it if we want to reduce bowel cancer incidence and mortality in the UK.

At present, about one in 20 people in the UK will get bowel cancer during their lifetime. Many nurses specialise in the care of people with colorectal cancer, including Macmillan nurses, stoma nurses and colorectal nurses.

But nurses in all settings can help patients who have or may have bowel cancer – and this starts with an understanding of the signs and symptoms, and where to go to seek further help. 

Making sense of symptoms 

The three common symptoms of bowel cancer are a change in bowel habit (stool that is looser or harder than usual, for example), rectal bleeding and abdominal discomfort.

However, as these symptoms are often associated with other less serious conditions and can be caused by something other than cancer, it is important that nurses reassure patients that having one or more of these symptoms does not necessarily mean they have bowel cancer.

‘As bowel cancer can be difficult to diagnose by symptoms alone, screening is an essential part of the diagnosis toolkit’

For example, a change in bowel habit could be caused by irritable bowel syndrome (IBS), a combination of symptoms that includes diarrhoea or constipation and can usually be resolved or ameliorated. 

Similarly, abdominal discomfort could be caused by trapped wind, and rectal bleeding is more commonly due to haemorrhoids, which can often be self-treated with topical medication available from a pharmacist.

But if bleeding is severe or persistent, further investigations should be carried out. Just because the symptoms of bowel cancer can often be attributed to other conditions, this does not mean patients should ignore them when they present. 

A simpler home testing kit

As bowel cancer can be difficult to diagnose by symptoms alone, screening is an essential part of the diagnosis toolkit.

Screening can help detect bowel cancer at an early stage, when it is easier to treat, and can also be used to check for polyps, which can turn into cancer over time.

The NHS bowel cancer screening programme currently uses two types of test. A bowel scope – an examination of the bowel lining of the rectum and distal colon using a flexible sigmoidoscope – and a home testing kit, known as the faecal occult blood (FOB) test.

All men and women aged 60 to 74, who are registered with a GP in England, are automatically sent an FOB testing kit every two years. This test is effective, but can be quite complex; it involves taking two stool samples on three separate occasions, and then sending them back in a sealed envelope for laboratory testing.

To help improve compliance with completing screening, the FOB test is being replaced in 2019 with a simpler test, known as the faecal immunochemical test (FIT). Whereas the FOB test requires six samples, the FIT test only requires one.

Although the new test is more expensive, improving screening compliance will enable more bowel cancers to be detected early, and it is important for nurses to encourage patients to participate in screening programmes and have a basic understanding of what is involved. 

Success is in the figures

The good news is that the NHS bowel cancer screening programme has helped reduce bowel cancer incidence from the third most commonly seen cancer in the UK to the fourth.

But the UK still falls behind many Western countries, and we need to do everything in our power to reduce bowel cancer rates even further.

Nurses are invaluable in providing support and advice, irrespective of their role. Being vigilant of the symptoms of bowel cancer and ensuring patients are being screened really can help save lives.

Jennie Burch is head of gastrointestinal nurse education at St Mark’s Hospital in London

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