The Colorectal Navigators
As Colorectal navigators we will be a point of contact for any questions or concerns you have in relation to your referral, hospital appointment and investigations.
As part of the triage of referrals, our colorectal consultants will triage each individual referred from the GP. The consultant will then allocate you as suitable as straight for test or for review in the surgical clinic outpatient clinic.
Straight to Test
You will be eligible for straight to test if you are under the age of 75 and normally fit and well.
The consultant will send you straight for:
-
Flexible Sigmoidoscopy
-
Colonoscopy
-
CT Colonoscopy
-
CT Chest Abdomen and pelvis
If the consultants refer you straight to test I will send you an information pack in the post which will contain my contact details. The Colorectal navigator aims to support you through your investigations and procedures.
Surgical Outpatient Clinic
The consultants may wish to see you in clinic first to review your symptoms and assess fitness, in particular over the age of 75.
At the time of this consultation we will be able to discuss which investigations we feel are relevant and why. They could include:
-
Flexible Sigmoidoscopy
-
Colonoscopy
-
CT Colonoscopy
-
CT Chest Abdomen and pelvis
The Colorectal navigators will aim to meet you in clinic, face to face and direct you through your investigations and procedures and act as a point of contact for you and your family.
Referral to hospital
Your GP may refer you to see a colorectal specialist at the hospital for more tests. You will get an urgent referral, which means you should get an appointment to either see a specialist or have more tests within two weeks.
This doesn’t mean that you have cancer – most people who are referred to hospital don’t have cancer. But acting quickly will give you the best chance of successful treatment if you do have cancer.
If you don’t get a specialist appointment within two weeks, please ask your GP to check for you. Don’t worry about wasting your GP’s time – remember that your GP is there to help you and to make sure you get the right care at the right time.
You may wish to ask your GP
-
If they are sending an urgent or non-urgent referral request
-
Why they have chosen this referral type
-
How long they think it will be before you hear from the hospital
You will get an appointment for an outpatient clinic where the specialist may decide you need one or more of the following tests:
-
Endoscopy (usually flexible sigmoidoscopy or colonoscopy)
-
Virtual colonoscopy (CT colonography)There may be a number of reasons why you have been referred for further investigations. You may have gone to your GP with symptoms, or had an ‘abnormal’ result via the screening programme, or you may have a family history of bowel cancer. Whatever the reason, the specialist will choose from the range of investigations detailed below and explain why the test chosen is best for you and any possible risks.
An endoscopy is a test which uses a small thin tube with a camera to look inside the body. There are lots of different types of endoscopy, but usually you will have either a flexible sigmoidoscopy or a colonoscopy to look inside your bowel.
Flexible sigmoidoscopy looks inside the rectum (back passage) and the lower part of the large bowel (sigmoid colon). This is where the majority of polyps (non-cancerous growths) and bowel cancers start. During this procedure, if the doctor or nurse sees anything that needs further investigation, samples (biopsies) can be taken for examination in the laboratory.
A colonoscopy is an examination to look at the lining of your whole large bowel, to see if there are polyps or a cancer within any part of it. A long flexible tube with a bright light and a tiny camera on the end is inserted through your back passage and enables the doctor or nurse to get a clear view of the bowel lining. During the test, if the doctor sees anything that needs further investigation, photographs and samples (biopsies) can be taken. Simple polyps can be removed during a colonoscopy.
The most important part of preparation is bowel cleaning. When the bowel is cleaned out properly, there is a better chance of seeing the bowel wall clearly to spot any changes.
Before having a sigmoidoscopy you will need to have some kind of bowel preparation, to make sure the doctor or nurse can see the bowel lining clearly. The bowel preparation for a sigmoidoscopy is usually an enema (medicine given straight into the back passage) on the day of the test.
Before having a colonoscopy you may be seen by the colorectal navigator, have a telephone call or be sent instructions in the post. You should be asked about any medical conditions to make sure it’s safe for you to have both the preparation and the test. Bowel preparation usually involves a combination of medicine to drink and a temporary change in your diet.
You will be sent bowel preparation instructions with your appointment letter. Contact your endoscopy unit if you have any questions about this.
If you are anxious about the procedure, talk to the doctor or nurse about your concerns and ask whether you can have sedation. If you have problems lying flat, or being able to curl up on your side to have the test done, let the nurse know straight away so that alternative arrangements can be made if necessary.
After a colonoscopy, the gas that was used to inflate the bowel can sometimes cause discomfort in your abdomen or shoulders for a short time. Peppermint chewing gum or warm peppermint tea, massaging your abdomen or walking about can help to relieve this and help the gas pass out of your body.
Virtual colonoscopy (also known as CT colonography) involves using a CT scanner to produce two and three dimensional images of the large bowel and rectum. This can be used for patients who are not suitable for regular colonoscopy due to other medical reasons.
It is sensitive enough to detect shape changes such as polyps within the bowel. However, it can’t easily detect flat areas of inflammation or change in the lining of the bowel, take samples or remove polyps in the same way as flexible sigmoidoscopy or colonoscopy, so you may still need to have this too.
During the procedure, gas is used to inflate the bowel via a thin flexible tube placed in your back passage. CT scans are then performed with you lying on your back, and then on your front, to enable the doctors to get a clear set of scans of your bowel. You will be asked to hold your breath for approximately 20 seconds in both positions.
Ask the doctor or specialist nurse when you can expect to find out the results and whether it will be via a clinic appointment, a phone call, or a letter. If you do have bowel cancer, your doctor and specialist nurse will talk to you about what happens next.
If your test results show that you do not have bowel cancer, you will either be referred back to your GP, or if other tests or treatments are needed for a problem unrelated to cancer, these can be arranged by the hospital doctor or via your GP.
For any questions or concerns please contact the Colorectal Navigators on 01270 278393
The Colorectal Navigators work Monday- Friday 08:30-16:30.
Information retrieved from Bowel Cancer UK. 2020
