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Thread: Standard Colorectal Diagnostic Pathway

  1. #1
    Super Moderator Top User Baz10's Avatar
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    Standard Colorectal Diagnostic Pathway

    Following is a generalised approach by medical professionals applied in the diagnosis of possible Colorectal cancer.

    Obviously the approach taken by doctors may and will vary depending upon both the doctor and the health system where one is located.

    Also, how a doctor approaches the potential for colorectal (CRC) depends on your previous medical history and the symptoms you present with over what period.

    Just thought I would add this.
    Talking with my GP's they tell me that one of the first questions they ask their patients is
    What does Google say you have. They are aware that many if not the majority have researched their symptoms and come to a conclusion they have XYZ type of cancer before going to them.

    I would suggest that Googling general symptoms will inevitably lead to a self cancer diagnosis.
    Mostly I add they are wrong.

    Where the Internet is most useful is researching options after a positive diagnosis has been made, then and only then can specifics be researched.



    The facts are that most patients diagnosed with CRC have been to their doctors on a number of occasions, possibly many times with the same or increasing symptoms.

    Personal experience to me suggests for obvious reasons that doctors are always initially reluctant to refer to a specialist or for tests and scans with the exception of front line blood tests.

    Generally they prefer to recognise that other digestive problems are the cause and treat with medication for IBS, Ulcerative colitis, etc along with standard blood test to identify possible haematological variances and look for a raised CEA.

    This course of treatment generally lasts for at least 1 month and hopefully the patient improves, if there are no improvements then there can be a number of options.
    Continue with the existing medication
    Change the medication in the hope the symptoms improve.
    Carry out a DRE and palpate the abdomen to attempt to locate a tender area or a lump.
    OR
    Be proactive and refer to a specialist or order a colonoscopy or other diagnostic tests such as

    Barium X Rays
    Ultrasound scan
    MRI scan
    CT scan.

    Meanwhile at least 2 or 3 months if not longer has passed and this is certainly the case where blood tests show no variances and no raised CEA.

    Most certainly in the UK at least, unless your GP listens and frankly many don't or is switched on it can take many, many months to even get to see a specialist let alone start diagnostic testing.

    My reasoning as to why a diagnosis takes so long is
    In the UK if cancer in any form is suspected a referral must be made and one must be seen by a specialist within 2 weeks.
    The mention of potential cancer immediately puts both your GP's and the NHS under extreme pressure to meet the national guidelines which are:-

    Suspected CRC or any cancer, One must be seen within 14 days of referral by a specialist.

    To give you some insight in my case.
    Following 10 months of classic CRC symptoms a referral was made to the GI consultant.
    I was seen by a member of the GI team some 4 weeks later, who within 5 minutes and without even reviewing my medical history pronounced it was diverticulitis, but would order a colonoscopy just to be certain and booked a repeat appointment 1 month later.
    I had the colonoscopy and was told immediately after the procedure they had found a mass, samples had been taken for biopsy and the doctor would call me as soon as he had the biopsy results.
    6 days later i got The Call at nearly 7pm telling me it was cancer and I would be contacted by the Colorectal Cancer Team immediately.
    Well surprise, surprise this didn't happen and i then attended the follow up appointment with the GI team who had ordered the colonoscopy, even more of a surprise he didnt know I had CRC, hadn't been informed and asked why i was not under treatment for surgery or chemotherapy, frankly I did lose my cool with him for his offhand manner and initial guessing.

    I learned from this experience to be far less tolerant and I will not accept being fobbed off again.

    If the specialist considers cancer is or possibly a factor then diagnostic testing must be completed within a further 14 days.

    If a cancer diagnosis is made then the results are discussed my a Multi Disciplinary Team (MDT) who collectively formulate a treatment plan.

    If a decision to treat is reached then the patient is asked to attend the hospital where the proposed treatment is discussed with time scales.

    Now in the UK treatment must commence within 31 days of a decision to treat being reached.
    In most cases this guideline target is met, unfortunately in many cases it is not.

    Instead of 31 days I would have been more than 180 days had I not been forced to have elective private surgery for which the hospital officially apologised.

    Yet I hear of more and more patients where their GP's do not act despite repeated attendances with the same or increasing symptoms.
    I'm not suggesting all GP's don't care or don't act, but it appears they are reluctant to consider CRC as a possibility despite the rising incidence of this disease worldwide.
    I'm not apologising for being blunt or direct as it is every individual's decision to seek medical advice or not.

    I wished I had pushed my case and probably saved myself a huge amount of anguish and pain, let alone the anxiety my family went through.


    What is paramount is the patient MUST be a advocate for their own health.
    Don't just sit back and put up with the symptoms, don't be fobbed off with a doctor "Guessing" one has IBS, Diverticulitis, Chrohn's disease or some other problem or at worst your diarrhoea, stool changes blood in stools etc is down to diet or a stomach bug.
    Certainly if you've had it for 3 weeks or more, it won't be a stomach bug or dietry related unless you have a food intolerance.

    [B]And please don't take the macho approach
    Heh I can handle this, it's just a one off, I don't have time to get to the docs, it will pass (if the symptoms have lasted more than 3 weeks they don't pass), I'll buy some Rennies, Antacids, Immodium etc that'll sort it.

    Swallow your pride, lose your embarrassment forget the macho approach and STOP making EXCUSES.

    My docs say the worst problem they face are patients putting off attending, ignoring the symptoms, far too busy, it will go away, don't want to worry my wife or husband or the kids. The list is endless.

    Getting in early, pushing your case and getting something done can be the difference between frankly life or death.
    this also applies to many different cancers not just CRC.

    Your decision
    You choose

    Barry
    Last edited by Baz10; 09-05-2014 at 04:36 AM. Reason: addition
    Diagnosed stage 3 March 011
    Radical resection April 011
    Restaged 2b April 011.
    12/09 Colonoscopy clear but picked up hospital infection.
    Aorta & femoral arteries occluded.
    Clot buster drugs put me in ICU with internal bleeding. 9 blood units later they got it under control.
    Aortobifemoral surgery 5th May. yughh.
    PET scan indicates clear
    DEXA bone scan clear
    13/5 CT showed "unknown" but no concern from docs.
    Inguinal lymph nodes and severe groin pain.
    Ultrasound and MRI show no nasties. Pheww
    Groin pain and enlarged lymph nodes still there.
    October -still the same pains but under semi control.
    Additional chest CT scan ordered for 11th November prior to surgery.
    Sinus surgery done and dusted.
    July 2014 PSA at 5.10. 2months of antibiotics in case of UTI, jan 2015 PSA at 7.20.
    Prostate Cancer confirmed Gleason 3+3.
    Active surveillance for time being.
    Just a little recurrence and another 20 cm of colon vanished under the knife.

    Not all's rosy in the garden, but see following.
    Stop grumbling Baz, your still alive and kicking so far.
    Age and illness doesn't define who we are, but more what we are able to do.
    Motto
    Do what I love doing, when I can until I can't.
    and dodging bullets in the meanwhile.

  2. #2
    Well said!
    Hubby diagnosed in 2005 with Stage IV, January...Journey on this road has had some major obstacles ..... God continues to help us endure each one.... enjoying life and doing as much as possible!

    My Carolina Cowboy gained his angel wings in August, 2017, 11 1/2 years with Stage IV. It was an amazing journey on this bumpy road. His attitude in fighting this beast was like no other. He did not want anyone's sympathy or pity so much that a lot of our friends did not even know he was in this battle. Many, many thanks to our super oncologist, surgeons, radiologists, staff, and etc. Most thankful to our God above for letting my soulmate be with me all this time! Amazingly, most of the time in this fight was great! We enjoyed trail riding every chance we had to go and so many other things that life offered to us. Even took a few rides with a 5FU pack. My cowboy was a tough one, John Wayne had nothing on him!

    Don't give up! Keep the fighting attitude!! Blessings to all!! May a cure be found!!

  3. #3
    Super Moderator Top User Baz10's Avatar
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    I'm going to hammer this home so as many that read this take note.

    The following is what happens when you ignore symptoms, no apologies it is meant to shock some that put off going to see their doctor.
    Actual scenario all the following is fact, there is not a single word that is not true.
    2011 I was diagnosed with CRC, after successful surgery and some let's say more than interesting events which I never would wish on any enemy, I have suggested, shouted and published if one has symptoms see your doc.

    Guess what a close family member who lives hundreds of miles from me has just been diagnosed with Stage IV colon cancer, metastised to liver.

    He knew what I went through, yet chose to ignore symptoms, in fact he never mentioned to his partner about diarrhoea or constipation he was having, nor abdominal pain and was buying OTC medication for both constipation and or diarrhoea.
    I spent some time when he asked 3 years ago what symptoms I had.
    OK water under the bridge, he completely ignored everything.

    Right now and for the past week he has been bedridden, has pulminary ascites, a lung infection ???? Or worse they can't get the pain under control, can't eat and is on morphine and Tramadol mixes.

    Surgical intervention, NOT POSSIBLE, LIVER Resection NOT POSSIBLE, CHEMO may be possible but sees the oncologist Monday.

    All this because he chose to ignore his symptoms.
    Prognosis, marginal at best due to the extent of lymph and organ involvement.

    Folks this isn't remotely exaggerated Nor do I find this easy to put in words.
    It is fact and the FACT IS
    IGNORE SYMPTOMS AT YOUR PERIL.
    He did and his future is short and extremely painful.

    NOW STOP PUTTING OFF.
    I don't like funerals especially family.
    Barry
    Diagnosed stage 3 March 011
    Radical resection April 011
    Restaged 2b April 011.
    12/09 Colonoscopy clear but picked up hospital infection.
    Aorta & femoral arteries occluded.
    Clot buster drugs put me in ICU with internal bleeding. 9 blood units later they got it under control.
    Aortobifemoral surgery 5th May. yughh.
    PET scan indicates clear
    DEXA bone scan clear
    13/5 CT showed "unknown" but no concern from docs.
    Inguinal lymph nodes and severe groin pain.
    Ultrasound and MRI show no nasties. Pheww
    Groin pain and enlarged lymph nodes still there.
    October -still the same pains but under semi control.
    Additional chest CT scan ordered for 11th November prior to surgery.
    Sinus surgery done and dusted.
    July 2014 PSA at 5.10. 2months of antibiotics in case of UTI, jan 2015 PSA at 7.20.
    Prostate Cancer confirmed Gleason 3+3.
    Active surveillance for time being.
    Just a little recurrence and another 20 cm of colon vanished under the knife.

    Not all's rosy in the garden, but see following.
    Stop grumbling Baz, your still alive and kicking so far.
    Age and illness doesn't define who we are, but more what we are able to do.
    Motto
    Do what I love doing, when I can until I can't.
    and dodging bullets in the meanwhile.

  4. #4
    Top User Doug K's Avatar
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    Dec 2014
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    Columbus, OH
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    501
    Quote Originally Posted by Baz10 View Post
    I'm going to hammer this home so as many that read this take note.

    The following is what happens when you ignore symptoms, no apologies it is meant to shock some that put off going to see their doctor.
    Actual scenario all the following is fact, there is not a single word that is not true.
    2011 I was diagnosed with CRC, after successful surgery and some let's say more than interesting events which I never would wish on any enemy, I have suggested, shouted and published if one has symptoms see your doc.

    Guess what a close family member who lives hundreds of miles from me has just been diagnosed with Stage IV colon cancer, metastised to liver.

    He knew what I went through, yet chose to ignore symptoms, in fact he never mentioned to his partner about diarrhoea or constipation he was having, nor abdominal pain and was buying OTC medication for both constipation and or diarrhoea.
    I spent some time when he asked 3 years ago what symptoms I had.
    OK water under the bridge, he completely ignored everything.

    Right now and for the past week he has been bedridden, has pulminary ascites, a lung infection ???? Or worse they can't get the pain under control, can't eat and is on morphine and Tramadol mixes.

    Surgical intervention, NOT POSSIBLE, LIVER Resection NOT POSSIBLE, CHEMO may be possible but sees the oncologist Monday.

    All this because he chose to ignore his symptoms.
    Prognosis, marginal at best due to the extent of lymph and organ involvement.

    Folks this isn't remotely exaggerated Nor do I find this easy to put in words.
    It is fact and the FACT IS
    IGNORE SYMPTOMS AT YOUR PERIL.
    He did and his future is short and extremely painful.

    NOW STOP PUTTING OFF.
    I don't like funerals especially family.
    Barry
    Barry, sorry that you are facing this future with your family member. Damnů how is it that those close to you don't check this stuff out! Wishing your family member well, but as you observe, options at this point are slim!

    Thanks for posting, hope it is helpful to someone!

    doug
    MyJourney:
    August 2004 Colonoscopy Clear
    June-July 2013 Abdominal Discomfort Upper Abdomen X-ray, UltraSound, CTScan all clear
    August 23, 2013 Diagnosed 5cm tumor on rectum wall: adenocarcinoma @age 66
    August-Sept2013 Met with Surgeon,Hematologist and Radiation oncologist
    Oct.-Nov.: Xeloda concurrent with radiation: 25 doses
    November CTScan, MRI and surgeon scoped: Tumor gone, scar tissue
    Jan.6, 2014 Surgery LAR: Rectum removed, sphincter remains: Pathology: no lymph node,
    Tumor downgraded from Possible T3 to T2.
    Feb. - April Chemo:5 FU and Oxilaplatin:6 infusions over 14 weeks
    Sept. 4, 2014 ColonoscopyClear,CT Clear
    Dec. 2014 Follow up BlWk good,CEA .9
    Mar.2015Follow up BlWk continues good, CEA .6
    June 2015 Follow up BlWk good, CEA .7
    Sept2015Followup BlWkgood CEA .7 CT ScanClear NED
    Dec2015SurgicalHerniaRepair surgery, recovering.
    Sept2016Followup BlWkGood CEA .7 CTScanClear NED
    Continue ColoRectal Support Group monthly.

  5. #5
    Super Moderator Top User Baz10's Avatar
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    Doug, thanks pal although it doesn't make it easier, whichever route he is offerred is going to be one heck of a battle.
    Painful and probably too late to learn the lesson.
    Localised CRC is generally treatable, CRC that has spread will kill you.
    AGAIN
    EVERYONES CHOICE
    IGNORE SYMPTOMS AT YOUR PERIL.
    Diagnosed stage 3 March 011
    Radical resection April 011
    Restaged 2b April 011.
    12/09 Colonoscopy clear but picked up hospital infection.
    Aorta & femoral arteries occluded.
    Clot buster drugs put me in ICU with internal bleeding. 9 blood units later they got it under control.
    Aortobifemoral surgery 5th May. yughh.
    PET scan indicates clear
    DEXA bone scan clear
    13/5 CT showed "unknown" but no concern from docs.
    Inguinal lymph nodes and severe groin pain.
    Ultrasound and MRI show no nasties. Pheww
    Groin pain and enlarged lymph nodes still there.
    October -still the same pains but under semi control.
    Additional chest CT scan ordered for 11th November prior to surgery.
    Sinus surgery done and dusted.
    July 2014 PSA at 5.10. 2months of antibiotics in case of UTI, jan 2015 PSA at 7.20.
    Prostate Cancer confirmed Gleason 3+3.
    Active surveillance for time being.
    Just a little recurrence and another 20 cm of colon vanished under the knife.

    Not all's rosy in the garden, but see following.
    Stop grumbling Baz, your still alive and kicking so far.
    Age and illness doesn't define who we are, but more what we are able to do.
    Motto
    Do what I love doing, when I can until I can't.
    and dodging bullets in the meanwhile.

  6. #6
    Super Moderator Top User Baz10's Avatar
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    I'm going to add a rider to the above.
    From finally going to his GP through diagnosis to burial
    10 weeks.
    Go figure out what happens if one sticks ones head in the sand or more fundamentally up your own rectum.
    He leaves a devastated partner who he withheld all symptoms from and this after he knew what I went through.
    I hate to use the word "stupid" he being a family member.
    Sometimes the end can't be avoided, but in this case it was avoidable as when he finally sought help it was already too late.
    A lesson for those undecided.
    Please, go get checked out.
    Barry
    Diagnosed stage 3 March 011
    Radical resection April 011
    Restaged 2b April 011.
    12/09 Colonoscopy clear but picked up hospital infection.
    Aorta & femoral arteries occluded.
    Clot buster drugs put me in ICU with internal bleeding. 9 blood units later they got it under control.
    Aortobifemoral surgery 5th May. yughh.
    PET scan indicates clear
    DEXA bone scan clear
    13/5 CT showed "unknown" but no concern from docs.
    Inguinal lymph nodes and severe groin pain.
    Ultrasound and MRI show no nasties. Pheww
    Groin pain and enlarged lymph nodes still there.
    October -still the same pains but under semi control.
    Additional chest CT scan ordered for 11th November prior to surgery.
    Sinus surgery done and dusted.
    July 2014 PSA at 5.10. 2months of antibiotics in case of UTI, jan 2015 PSA at 7.20.
    Prostate Cancer confirmed Gleason 3+3.
    Active surveillance for time being.
    Just a little recurrence and another 20 cm of colon vanished under the knife.

    Not all's rosy in the garden, but see following.
    Stop grumbling Baz, your still alive and kicking so far.
    Age and illness doesn't define who we are, but more what we are able to do.
    Motto
    Do what I love doing, when I can until I can't.
    and dodging bullets in the meanwhile.

  7. #7
    Newbie Regular User
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    B.C.
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    10
    This one hits close to home. Well said Barry, and still there will be many that won't listen. My wife who has stage 4 CRC, with lymph nodes and one lung involved, told her girlfriend that the two of them would go get a scope...one of these days...for about ten years. Unfortunately it is now too late. She would have caught it if she had have been checked out earlier when she was actually thinking of going.

  8. #8
    Super Moderator Top User Baz10's Avatar
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    Belcoron,
    thanks for your response, unfortunately far to many still put off getting checked.
    in just over a year we lost my BIL who looked awful for two years before his diagnosis, result buried in 10 weeks, why ignored his symptoms and worse still hid them relying on over the counter pharmacy meds.
    We also lost one of our dearest and oldest friends Hilda, who thought she had piles, unfortunately despite chemo which nearly killed her she lost her battle with metastatic CRC far to soon.
    When ohh when will people ignore the symptoms, bury their heads frankly up their ass.
    I know it sounds harsh given your families situation, but do us all a favour and push any of your family and others to get checked.
    Barry
    Diagnosed stage 3 March 011
    Radical resection April 011
    Restaged 2b April 011.
    12/09 Colonoscopy clear but picked up hospital infection.
    Aorta & femoral arteries occluded.
    Clot buster drugs put me in ICU with internal bleeding. 9 blood units later they got it under control.
    Aortobifemoral surgery 5th May. yughh.
    PET scan indicates clear
    DEXA bone scan clear
    13/5 CT showed "unknown" but no concern from docs.
    Inguinal lymph nodes and severe groin pain.
    Ultrasound and MRI show no nasties. Pheww
    Groin pain and enlarged lymph nodes still there.
    October -still the same pains but under semi control.
    Additional chest CT scan ordered for 11th November prior to surgery.
    Sinus surgery done and dusted.
    July 2014 PSA at 5.10. 2months of antibiotics in case of UTI, jan 2015 PSA at 7.20.
    Prostate Cancer confirmed Gleason 3+3.
    Active surveillance for time being.
    Just a little recurrence and another 20 cm of colon vanished under the knife.

    Not all's rosy in the garden, but see following.
    Stop grumbling Baz, your still alive and kicking so far.
    Age and illness doesn't define who we are, but more what we are able to do.
    Motto
    Do what I love doing, when I can until I can't.
    and dodging bullets in the meanwhile.

  9. #9
    Newbie Regular User
    Join Date
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    B.C.
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    I first learned this lesson when I lost one of my best friends at the age of 52. He would have needed to be diagnosed when he was in his forties so...don't wait!
    I figure he saved mine as when he found out I went and got checked out and sure enough I had polyps and not benign either. I've had 5 scopes and in all but one they removed one or several polyps. My wife is younger than I am by 7 years so she waited thinking she was ok. I told her a number of times and she intended to get checked out but when the symptoms showed up it was wayyy to late. Don't wait!!! Women, get checked at 50, my wife is now 57 and may have 2 years to live. Don't wait!!!

  10. #10
    My story is different as I don't have crc but it also illustrated what can happen if you ignore symptoms even if it is not cancer. I ignored symptoms for a long timuntil I couldn't anymore (I have had mild flares for at least 10 years pre diagnosis but this time I went over 6 months of 30+ times a day, toilet bowl full of blood, pain, rapid and major weight loss, passing out- my serum iron was undetectable and basically all my numbers were horrible, tachycardia and many ither health isdues) . I had an emergency colonoscopy and luckily I didn't have cancer (I thought I did) but rather severe Crohn's colitis that involved my entire colon, rectum and perianal areas plus a huge perianal abscess that burst a month later causing multiple fistulas which required a total proctocolectomy with end ileostomy. I was hospitalized for over a month on TPN and lots of lovely drugs. I now have to be on biologics and immunosuppressants for the rest of my life to keep the disease in check.The Dr told me that if I had even waited another day I could have perforated. That colonoscopy saved my life. I am still kicking myself knowing I would still have all my body parts and not have an ostomy if I had only gone to the Dr when it first started and that i wouldn't be dependent on biologics which have scary side effects including possible terminal cancer. Everyone needs to get scoped especially if you have symptoms.

 

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