Symptoms and diagnosis

Many of the symptoms of bowel (colorectal) cancer (blood in the stools, a persistent change in bowel habit, unexplained weight loss, pain in the abdomen or back passage and a feeling that the bowels have not been entirely emptied), can also be symptoms of other, less serious illnesses. It is possible to have some rather than all the symptoms, or to have the disease for some time without noticing symptoms at all. This makes it hard to decide when to see a doctor. It also makes it hard for a doctor to know when to refer someone for further investigations. Since these interviews there have been new NICE guidelines which help GP’s make decisions about when to refer people to specialists when they present with symptoms that could be caused by cancer. See Cancerhelp UK -Should I see a bowel cancer specialist? for more information.

People who do not have classic symptoms or who are considerably younger than average when they develop the disease often experience misdiagnoses and delayed treatment. 

Some people are slow to seek attention because they feel unhappy about discussing their bowels or the prospect of an embarrassing examination. Some are simply frightened of what might happen. This woman explains how she delayed taking up her GPs referral until her daughter insisted on it. Another woman, who had seen a consultant once, felt embarrassed to go again about worsening symptoms. Many people assumed at first that their symptoms were due to stress, travel, or a change of diet. This man lists the many reasons he came up with to explain was happening to him. 

She delayed taking up her GP's referral for further tests because she was frightened.

Having seen a consultant once she was reluctant to go again.

Lists the reasons he invented to explain his symptoms.

The symptom that most often prompted people to see their doctor was rectal bleeding which could be slight or occasional or heavy and persistent. One man describes what he experienced and his GP's prompt response. Other people who received quick and appropriate attention from their GP's were invariably grateful. Other people were frequently misdiagnosed with piles (haemorrhoids) or irritable bowel syndrome. Some people were treated for constipation or diarrhoea for as long as 15 months before further investigations were pursued. A young woman whose symptoms developed while she was pregnant was offered a series of explanations and eventually realised what was wrong herself when she saw something about bowel cancer on the television.

He describes his classic symptoms and his GP's response.

She realised what was wrong when she saw a piece about bowel cancer on television.

Sometimes delayed diagnosis was unavoidable. One man underwent numerous tests over a period of 18 months but needed surgery to confirm his diagnosis because his tumour was 'hidden' and extremely difficult to detect by other means. 

Other people, and especially those who rarely went to the doctor, felt that delays had occurred because their GP or consultant had not acknowledged the persistence or severity of their symptoms or they were simply not being believed. A woman who felt that her consultant did not believe her started taking someone with her to appointments 'so as they could hear what he was saying'. A man, who was in 'a terrible state' with vomiting and severe constipation saw two different GPs who did not connect his symptoms to colorectal cancer. His son took him to hospital where he had surgery a few days later. 

Some patients felt that GPs were not communicating effectively with each other, or making effective use of medical records. One man believed that he had not been referred promptly for further investigation because of the cost. In a number of cases, difficulties reaching a diagnosis led to the breakdown of relations between doctor and patient.

She saw two GPs in the same practice who kept giving her the same tests.

He feels his GP did not make good use of his family history and medical records.

The advice consistently offered by patients to others experiencing possible symptoms of colorectal cancer was to seek immediate medical attention, to trust their instincts and to insist on further investigation if the problem persists and they still feel that something is wrong.

He urges people to seek advice early and to insist on further tests if no convincing diagnosis is made.