Bowel Screening
More treatment needed after an initial colonoscopy
If polyps are found in the bowel they are often removed during the initial colonoscopy but sometimes the doctor removes small tissue samples for analysis without removing the polyps. If the tissue samples are found to be benign, and major surgery is not needed, the doctor may ask the patient to return for another colonoscopy so that the polyps can then be removed.
Tissue samples from his polyps were found to be benign (non-cancerous). He needed another colonoscopy so that the polyps could be removed.
Tissue samples from his polyps were found to be benign (non-cancerous). He needed another colonoscopy so that the polyps could be removed.
And he went away with the examination and he found, he found a large polyp on the bend of the bowel and he found a small one underneath. So he told me he'd taken some [tissue samples] away for examination and I would have to go back again to see what the tests were. So I went back again to see the nurses at the centre and they told me it was benign and that he was going to take the polyps away. So I had to go back again the next Tuesday and I had to have the polyps taken away.
He told me the one polyp, which was a large one they were, he said he was going to get behind it. He said it was very awkward to get at and he'd got to get behind it he said with a loop and he said he was going to take it away with a loop. What a loop is I don't know, I've never seen a loop but I should imagine it's like a lasso, you know, the end and they just put it on, cut, and take it away. I should imagine that is the, what they do.
And how did that feel?
I didn't feel nothing, I don't, you don't feel nothing. You don't feel nothing. All you feel is when you, all you feel when you go in is a prick of the needle in your hand or you arm, after that you don't feel anything.
Did you watch the polyp being removed on the screen?
No, no.
So they removed one polyp or more than one?
They removed two, there was, there was two polyps, there was a large one on the bend of the bowel and there was another one below it, which as I've told you was being taken away from tests. So he removed the two and he decided to have another further investigation while you know, the situation was good for it. So he had another examination around the bowel and then he found two, another two small polyps at the base of the bowel. And he took, he took them away you know with, because he said in the first place, in his experience and what he could see, there was no disease, this is what he told me all along. He said, “As far as the naked eye is concerned there's no disease.” So he decided to take these two small ones away and send them away for tests. And they was benign as well.
Benign.
Yeah.
Good.
If the tissue samples are found to be cancerous, or if the doctors think that the polyps are potentially malignant, or if the bowel wall looks diseased, more extensive surgery may be needed. This woman had had part of her bowel removed because her polyps seemed to go deep into the bowel wall and would probably become malignant (cancerous) within five years. She had a right hemi-colectomy (part of the bowel was removed and the two ends of the bowel then joined together).
Other people had further treatment because the tissue samples clearly showed cancer. The three main treatments for bowel cancer are surgery, chemotherapy and radiotherapy. The main treatment is surgery, but if the cancer is not detected at an early stage two or more of these treatments may be used together, or in sequence (the 'Bowel Cancer' part of our website has much more detail).
Before surgery people were told what might happen. Some were warned that they might need a colostomy (stoma) bag, at least temporarily, to allow the bowel to heal. They were also admitted for a 'pre-operation assessment' and various investigations, such as a CT scan. They also received instructions about pre-operative food restrictions.
He was fully informed, went into hospital for a 'pre-operation check', and was very impressed with members of the pilot scheme team.
He was fully informed, went into hospital for a 'pre-operation check', and was very impressed with members of the pilot scheme team.
I had been fully informed about the operation, the procedure, was told that half the large intestine would be taken away, shown diagrammatically what part would be removed, and how the jointing would be, would be made, had been told again a list of risks, so I had a full knowledge of the risks involved. And being of, a person of my generation, I was, I don't take any of that into consideration, I'm just happy to put my hands in, put myself into the hands of the medical team and take their advice.
The next day, the next morning which was the Saturday, after visiting on the Friday, at breakfast time, the post plopped through the letter box and I opened the, the medical letter that had come, the letter from the hospital. And it said that I had to go for a pre-op visit to the hospital on the following Thursday. And the operation would be on the week beginning the first of August. And I was expecting; they were hoping that it would be Tuesday of that week. So I was totally, you know, amazed at that, and was very, very impressed by the response that had been made to my particular need [surgery before term started in October]. And I went in for, for that pre-operation check, and met various members of the team, including the anaesthetist.
I had a very comprehensive package of information, became even more impressed with the, the pilot scheme and the, the team that were behind it as I met person after person involved with that. And eventually went into, on that first week of August, went into hospital. Before going in I had to go through a regime of no food for the prescribed time, and before the operation I needed to have an enema, and these processes had already occurred at the, the surgical investigation [the colonoscopy] so I was getting a bit blas' about these by now.
He was told that he might need a stoma bag for a few months but in the end he didn't.
He was told that he might need a stoma bag for a few months but in the end he didn't.
Did he [the surgeon] give you plenty of information at that stage about what was going to happen?
He did tell us that the outcome of the operation, he said you'll have so much of the bowel removed, and it's a possibility you'll have to end up with a stoma bag for a few months. Which he said, 'They pull a bit of the small intestine out, and connect it to the bag, which is on a belt around you.' And then he said, 'After the bowel has calmed down, they will reverse that,' ...which you know, after the operation I had, I didn't have a stoma. So I was quite happy about that really, it didn't work out that way for me.
Once in hospital some people were given laxatives to prepare the bowel for surgery; others were given an enema.
She was given an enema on the day of the operation to prepare the bowel for surgery.
She was given an enema on the day of the operation to prepare the bowel for surgery.
No, it was a week on the Friday.
Oh.
A week on the Friday.
Oh that's right, and she explained everything.
She explained everything, she told me what she was going to do.
Before the operation did you have to go through all the same preparation again, with the laxatives?
No they gave me an enema [laughs].
When you went into the hospital?
When I went in to have the operation they gave me an enema. Because I said to the, because they'd been calling other people in, to go down to theatre, I was the last, because she came in to see me, the consultant came to see you, and I said, 'Where am I on your list?' and she says, 'I'm afraid you're last.' I thought, 'Oh dear, I've got to sit here and watch everybody else go down.' She said, 'Because yours is going to be the longest operation,' she says, 'So we'll leave you till last.'
And, then they gave me an enema, and then when they came to fetch me, I said, 'I haven't had my pre-med.' And she said, 'Oh, you've had an enema, that'll do.'
So you didn't have to have any laxatives at home the night before, like you did with the colonoscopy.
No, no, no.
People who don't know what an enema is, do you mind explaining what an enema is.
It's a solution, I would think myself it's a salty solution that they pour into your bowel, and then its about 10 minutes, I think it'll, they advise you not to move far away from a toilet. Its not really unpleasant, it's just the fact that people are messing with your body parts all the while really. But'
Were you lying on the bed while they do this?
Lying on the bed, yes. And they just insert a tube up your back passage and just, it's in a bottle about that big.
And that makes you go to'
That makes you go to the toilet yeah.
Some of the people we talked to described what happened on the day of their operation. They recalled quite major surgery. Some described a drip in the arm, drains from the wound and a catheter. One man mentioned the colostomy (stoma) he had to have for a few months. (For more on experiences of stoma see 'Bowel cancer').
He found the surgery 'devastating' and was in hospital for three weeks. He needed a temporary colostomy (stoma).
He found the surgery 'devastating' and was in hospital for three weeks. He needed a temporary colostomy (stoma).
Yes, the surgeon said that he would need to have me into hospital within three weeks. It was indeed only 16 days when I went into hospital. It seemed a very short period when I got notification that I could go and I'd just have to phone up for a bed which was available straight away. So once I'd gone into hospital, still not believing fully that there was something wrong, but having to accept the information that I'd been given, I went on the Saturday night and on the Sunday I had a preparation on the Monday morning. There was simply no turning back unless I was prepared to jump off the trolley and run away. I was in their hands.
And I went in feeling quite well but for the next two weeks I didn't feel at all well. I couldn't sit up or anything. You know the surgery had been quite devastating really. It had, well any surgery but I was informed that the surgery that I was going to have was major but I didn't realise that major surgery [laugh] meant immobilising me completely.
And you had part of the bowel removed and a stoma created?
Yes, I had the colon, part of the colon removed and then they had to put a temporary stoma bag on so that I could clear my bowels which I kept for five months.
How did you find managing that?
At first it was difficult but as time when on I started to come to terms with it and once I'd got fit we walked the Cotswold Way and I didn't have any problem with walking the Cotswold Way with it. But servicing it could sometimes be a bit frustrating. It wasn't quite the same as normal motions. So you had to find some way you could, you could service it yourself. But no I didn't find a problem and I've talked to a lot of people who've got permanent ones and they are great people. They soon come to terms with it after about a year I think they are perfectly adept to working with it and it never seems to bother them at all.
After the operation he was in the high dependency unit for about 12 hours, then in an ordinary ward for two weeks before going home.
After the operation he was in the high dependency unit for about 12 hours, then in an ordinary ward for two weeks before going home.
During sedation therefore one really doesn't, doesn't know just exactly what is taking place. You're obviously out to the world. I'd no idea how long the operation took. No doubt, no doubt that's a variable thing depending on, on the seriousness or the size of the tumour. In my case I was fairly fortunate in as much that they appear to have been able to cut out all of the tumourous material before it had sort of I can only say gone on the march. The first thing that happens to you after you've had the operation is that you, you go into a heavy dependency unit which is a, if you like a phase, a stage down from intensive care. But it is, to give you the initial care after you've had the operation. I think I was in there for something like twelve hours and then from that point I then went into a ward and I was in there for two weeks prior to coming home. When I got home arrangements were made for nurses to come in and attend to the wound, which you've obviously got when they've been operating. The other pleasant surprise was the, my GP actually turned up the same morning to see me. That came as a big surprise I was most impressed.
Did you have to have a stoma for a while or not?
No I, I was extremely fortunate in the sense that the, the polyp was, as I say in that bottom section of the colon. The only sort of if you like challenge to the surgeons there is, is whether they've got enough bowel when they've removed the tumour to be able to stretch your intestine to sort of join up with your rectum. I mean there's a possibility that they can't, there's always a possibility that they can't do that. But no I, I mean I must be an extremely lucky chap.
However, one man seemed surprised that the operation to remove a cancerous growth from part of his bowel seemed relatively minor. He had to have the surgery postponed because when he was anaesthetised he developed atrial fibrillation (an abnormal heart beat), but after taking medication for his heart he was able to have the operation. He only had a small incision, did not need a drain or a temporary colostomy, and was only in hospital for a week after the operation.
He had a right hemi-colectomy to remove part of the bowel. When he woke up he felt no pain because he had had an epidural as well as a general anaesthetic.
He had a right hemi-colectomy to remove part of the bowel. When he woke up he felt no pain because he had had an epidural as well as a general anaesthetic.
Well they put me on medication for my atrial fibrillation and it must've helped somewhat. They just, you know probably had the courage to say we're going to do it [the operation] because if one doesn't kill you the other one will anyway so we'd best have a go and it turned out brilliant.
So what was the operation called, did you say?
A right hemicolectomy.
Can you explain to people what that is?
I would imagine myself it cuts part of your large bowel away and reconnects it. I didn't have to have a stoma so that was, that was a plus. Most people in, when, who were in with me had stomas and they found them very difficult.
And since then did you have to have any other treatment?
No, I didn't have to have any other treatment because he explained to me the surgeon, the tumour hadn't grown through the outside, into the outside skin, it was only on the inside so he felt that it was, it would be no point having treatment. I've been screened for liver to see if it had affected my liver in between, which to say is most likely the next part it would attack.
But it hasn't?
It hasn't no, so I'm now coming up for my five year colonoscopy and hopefully, fingers crossed, that may turn out to be okay.
That's wonderful.
Yes.
So what was it like recovering from the operation?
It was brilliant, I had no pain whatsoever. I had no stitches, you couldn't believe it, it was unbelievable.
How did they do it then, did they do it from all inside?
I think they removed the large bowel and just cut the piece and re, resection it and put it back in and just, it's just a small wound.
Oh just a small wound.
Yes.
In your stomach?
Yes correct. You had no stitches at all. I had no drains, no.
How was it held together did they…?
I don't know.
Can you say a little bit more why you found the operation painless?
Put my glasses away. Well it was the form of anaesthetic. The anaesthetist asked me what kind of pain killing and relief I wanted and I left it to him. So what he done was wonderful.
Did he give you an epidural?
An epidural yes and that, I believe it's the reason it's not used more intensively is people aren't trained on the wards and they only can do it in the intensive care.
So when you had your surgery for the bowel cancer you had an epidural?
I had.
And that made it fairly pain free afterwards?
It did, it did, I couldn't believe it. The first thing I done was put my hand down to see [laughs] you know had I got a huge wound or pain and there was nothing.
Oh that's good.
Many people described the care they received in hospital as excellent.
He thought the nurses were 'wonderful'. They worked hard under difficult conditions.
He thought the nurses were 'wonderful'. They worked hard under difficult conditions.
Was it clean? Was the cleaning okay?
I was, I was happy, I had, I had no problems with the cleanliness of the hospital.
Everyone praised the care provided by the nurses involved in the screening programme and the specialist cancer nurses, but some people criticised the nursing care they received on the wards after their operations. One woman, for example, commented on the excellent continuity of care provided by the specialist cancer nurses but said she was disgusted by the dirty hospital and lack of nursing care on the ward. She developed a wound infection and had to stay in hospital for 10 days. After she got home the wound was treated by the district nurses, who were also excellent.
The specialist cancer nurse provided excellent continuity of care. She visited her in hospital and was there again when she saw the surgeon after the operation.
The specialist cancer nurse provided excellent continuity of care. She visited her in hospital and was there again when she saw the surgeon after the operation.
And then would you mind saying a little bit more about what happened when you went into the hospital to have the operation?
Well that was very good. Again they had a group of nurses I think they were, three or four nurses who are cancer nurses and one nurse was in there when I went to see the surgeon and I saw her all the way through and she came to visit me in the hospital. That was a very good service and I got to know her personally and so I felt I could ask her anything. And she actually came into the hospital when I was going to have the operation to mark me where they were going to do the operation and so that was a good contact for me as well, a good support, yeah. And I saw her after the operation and I saw her when I went to see the surgeon again after the operation for him to give me the results.
So really good continuity?
Very good continuity and they sent me a letter where if I wanted to contact them at any time then I could. And so, and she was always there when I went to see, I went to the surgeon two or three times after the operation to see him and to be checked on and she was always there. Always the same nurse which was very good for me, good support yeah.
The operation went well, but being in hospital was not pleasant and nursing care was inadequate.
The operation went well, but being in hospital was not pleasant and nursing care was inadequate.
Could you say a little bit about what happened on the day of the operation please?
Oh well I'd been admitted to the hospital the day before and on the morning of the operation I was due to go to surgery at 12.30 and had a shower and had a pre-med and put quite trendy white woolly socks on [laughs] and loaded up and went down. Well before I went for the operation actually I had a scan on the morning, morning of the operation I had a scan which is when they discovered the liver thing. And but then they just took me down to the operating theatre, half past 12 and really I don't remember anything else until possibly late that evening. And my daughter was there waiting for me to come out of the operating theatre apparently, and I'd had the operation, I'd gone into intensive care immediately afterwards and but then I was back on the ward that evening. I'd had the operation at half past 12 and I was on the ward that evening. And I have to say I didn't have any pains at all and; it wasn't very pleasant the sight of the scar but other than that there was nothing.
Where was the scar exactly?
Down the middle of my tummy, yeah.
How long did you have to stay in hospital?
Ten days, I was in hospital ten days and, until my bowels were functioning normally again and then I came out, ten days.
So can you explain a bit what it was like during those ten days, what happened exactly?
Well [laughs] it wasn't a pleasant experience I have to tell you that, I mean whether you use this or not I don't know but it was not a pleasant experience. The hospital was particularly filthy and the, the nursing was very minimum in the fact that I think I only saw two nurses as such, they were nearly all auxiliaries. And that was not a pleasant experience no, I wouldn't, I did not enjoy that. I'd have thought if I'd have had; I tried my very hardest to make light of it but it wasn't good, it wasn't good, no the hospital was bad, very bad. And funnily enough after, you know only back about ten days and they wrote me a letter to ask me what I thought of the you know hospital and the treatment and whatever so I was able to write back and tell them exactly you know what I thought and the areas of cleanliness and etc was just terrible, terrible.
And not enough nursing care you said?
No, no. They had auxiliaries taking blood tests and stuff and I didn't think that was right, I didn't think that was right. But I'd put that all to the hospital.
She thought the hospital was unhygienic and the nursing care on the ward was poor.
She thought the hospital was unhygienic and the nursing care on the ward was poor.
So the nursing was mainly changing the dressing every day was it?
Yes yeah and the other thing was, I thought was a bit odd was the; you know I mean really I think it was only two days after the operation that they actually washed you down and things. After that you were just left with a bowl and the soap to do it yourself. Which was a bit much after two days after having a big operation. I thought that was very bad.
How soon could you get out of bed?
Oh I think I got out of bed within two days yeah.
And how soon could you go and have a shower etc?
Oh well that was, as I say it was just this bowl of water appearing and that went on for about a week. That was very bad, very bad. And well as I'm saying it, I mean I wasn't going to bring this up but they, you had to have, obviously give a specimen of water, I suppose they were testing to see if there was blood in it or something and I said, 'Where shall I put this?' and they said, 'Put it into the,' where the toilet was. Well there's a largish toilet with a wash basin in and you used to have to clean your teeth in there, which again I thought was terribly unhygienic and wash yourself down as best you could. And there were two or three bowls with urine samples in and they were there for three days. And one of them was very bloodied, fortunately it wasn't mine, it was another lady in the ward. And we all complained to the nurse we said, 'You know those are not, what's the point of giving urine samples, I mean they've been there three days?'
And of course the smell and everything it was disgusting. And I actually did say to one nurse you know those samples have been in there three days,' she said, 'Oh I'll see that they're cleared away.' But they weren't.
So it was quite unpleasant?
Very unpleasant, very unpleasant.
Another woman said that she thought communication between hospital staff on the ward was poor, and a man said that some nurses seemed to have their minds on other things all the time.
A few people we talked to had also had some chemotherapy after their surgery. One man, for example had about eight inches of his bowel removed. Three months later he started weekly chemotherapy, which continued for thirty weeks.
He had chemotherapy after his surgery for bowel cancer.
He had chemotherapy after his surgery for bowel cancer.
To go back to the treatment. You said you had to have a little bit of chemotherapy just to make sure'
Husband' Chemotherapy yes.
'that they'd picked up everything. How long did you, when did you start that, after the operation? How many weeks?
Wife' About six months it was. No it wasn't as long as that. It was after we came back off our summer holidays, so it would be about July or August.
Husband' Right, July or August.
Wife' Of 2001.
Husband' Of 2001.
So what month was the operation?
Wife' April.
Husband' April.
April.
Wife' St. George's Day.
Okay, so it was just a few months later you started with chemotherapy?
Husband' That's right yes.
Do you mind saying a bit more about the chemotherapy?
Husband' The chemotherapy, it's straightforward. They put a, a shunt in the back of your hand, just like a saline drip they put into you, but obviously its not a saline, its some special fluid they, and it runs into the back of your hand for about fifteen to twenty minutes. A small bag. And that's all there is to it really.
Did you go as a day patient?
Husband' A day patient yes. I had'a half past nine slot on every Friday or something like that.
Every Friday?
Husband' Was it Friday?
Or once a week?
Husband' Once a week, yeah. Once a week for thirty weeks.
To go back again to the chemotherapy. Did you have any side effects of the chemotherapy?
Husband' It felt, you were a bit queasy with it, for two or three days, and I was a little bit sick for about'three times after it. Other than that I don't see any problems whatsoever.
For much more about experiences of bowel cancer, treatments (surgery, radiotherapy and chemotherapy) and living with stoma see the 'Bowel Cancer' part of our website.
Last reviewed May 2016.
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