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Bowel Disorders Message Board

Bowel Disorders Board Index

Thanks so much for even bothereing to write Quincy, you have been a massive help. I am in the UK where the health service is free, I also have private medical cover. The doctor is taking one step at a time.

[B]This is what the Cancer UK site says.[/B]

(Colorectal cancer) : About bowel cancer

Sould I see a bowel cancer specialist?

Who should see a specialist: T he NICE guidelines
Who needs to see a specialist urgently
Who should see a specialist

It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much more minor that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better or respond to treatment such as antibiotics. If GPs referred everyone who came to see them to a specialist immediately, the system would get jammed and those needing urgent appointments wouldn't be able to get them.

Bowel symptoms are very common. Usually, they are related to a something less serious than cancer. But there are particular combinations of symptoms that mean your GP should refer you to a specialist straight away.

[B]The NICE guidelines[/B]

NICE (the National Institute for Health and Clinical Excellence) have produced guidelines for GPs to help them decide which patients need to be seen urgently by a specialist. These Government guidelines on referrals for bowel cancer were updated in June 2005. They say that a specialist should ideally see you within 2 weeks of going to the GP, if you are having these symptoms for the first time. NICE have included the phrase 'for the first time' because non cancerous bowel problems are often chronic conditions. They are telling the GP to use his judgement. If you have been having the same symptoms on and off for years, have been investigated and found not to have cancer, your GP should not be expected to refer you as an urgent case each time the same symptoms come back.

[B]The guidelines are also divided by age. Bleeding from the back passage is very common in people in their 30's and is nearly always caused by piles. In fact, it is so common that if you have bleeding from the back passage, you are less likely to have cancer than someone in their 60's with no symptoms at all. [/B] This is because bowel cancer is very rare under 40 and much more common in people over 60. Again, it really isn't right for doctors to refer everyone with piles urgently to a specialist and the system would not be able to cope. Piles are nearly always accompanied by itching and soreness. So if you are young and have these symptoms, you are much more likely to have piles than bowel cancer.

[B]The guidelines point out that people who have the following symptoms, but do not have any lump in the abdomen, are very unlikely to have cancer[/B]

Bleeding from the back passage, with soreness, itching and pain
A change in normal bowel habits to harder less frequent stools
Pain in the abdomen without any evidence that there is a blockage

[B]Urgent referral at any age[/B]

According to Department of Health guidelines, you should ideally get an appointment within 2 weeks for an urgent referral. The symptoms that may need urgent referral for possible cancer of the bowel or back passage (rectum) at any age are

A lump that the GP can feel in the right side of your abdomen
A lump that the GP can feel in your rectum (not your pelvis)
A type of anaemia (low red blood cells) called iron deficient anaemia without a known cause

[B]Urgent referral over 40[/B]
If you are over 40 and have all these symptoms, your GP should consider referral to a specialist within 2 weeks

Change in normal bowel habits towards looser or more frequent stools, or both, that has lasted for 6 weeks or more

Bleeding from the back passage (rectum)

[B]Urgent referral over 60[/B]

If you are over 60 and have these symptoms, your GP should consider referral to a specialist within 2 weeks

A change in normal bowel habits towards looser or more frequent stools, or both, that has lasted for 6 weeks or more without bleeding from the back passage (rectum)

Persistent bleeding from the back passage without any signs of piles (haemorrhoids), such as itching, pain or discomfort in the back passage
If you do have symptoms and are concerned that your GP is not taking them as seriously as you think he or she should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.

Cancer Research UK
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Last updated 09 February 2007

CancerHelp UK is not designed to provide medical advice or professional services and is intended to be for educational use only. The information provided through CancerHelp UK is not a substitute for professional care and should not be used for diagnosing or treating a health problem or a disease. If you have, or suspect you may have, a health problem you should consult your doctor.

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