1. Initial investigation and referral
If you are over 50 years old, you can participate in the National Bowel Cancer Screening Program every two years using a faecal occult blood test (FOBT). This is a simple test you can do at home that looks for the early signs of bowel cancer.
If you have blood in your faeces, a change in bowel habit, an unexplained abdominal pain or mass, or unexplained weight loss, tell your general practitioner (GP) as soon as possible. Your GP will assess your symptoms, conduct a physical examination and arrange any blood tests needed.
Your GP should also discuss your needs (including physical, psychological, social and information needs) and recommend sources of reliable information and support.
Potential tests you may have:
- Physical examination (may include digital rectal examination): The doctor inserts a gloved finger in the anus and checks for problems in the anus and rectum.
- Blood tests: You may have a blood test to assess your general health and to look for signs that you are losing blood in your stools.
If bowel cancer is suspected, you will be referred to a specialist for further testing within four weeks. Your GP will provide the specialist with information about your medical history, whether there is a history of cancer in your family, and your test results.
It can be helpful to bring a family member or friend with you to your appointments.
2. Diagnosis and staging
The specialist will conduct a colonoscopy.
A test done under anaesthetic used to examine the whole length of your large bowel. Your doctor will discuss the preparation required.
After the colonoscopy, the specialist may conduct further tests to find out whether cancer is present and, if it is, its stage of development and if it has spread.
3. Further referral and testing
Further tests you may have:
Computed tomography (CT) scan
Computer technology and x-rays are used to create detailed images of the bowel.
Magnetic resonance imaging (MRI) scan
In an MRI scan magnetic fields and radio waves are used to take pictures of inside the body.
This uses high-frequency sound waves to make an image of a person’s internal body structures.
It can also be helpful to contact bowel cancer peer support groups and support groups for carers.
Here is a list of questions to ask your doctor.
To ensure you receive the best care, your specialist will arrange for a team of health professionals to plan your treatment based on your preferences and needs.
The team will be made up of health professionals who have experience managing and supporting a person with bowel cancer. Your specialist will tell you when the team will be discussing your case.
Your team should discuss the different treatment options with you including the likely outcomes, expected timeframes, possible side effects and the risks and benefits. Your doctor may also suggest you consider taking part in a clinical trial. You may want to ask for more time before deciding on your treatment, or ask for a second opinion.
Let your team know about any complementary therapies you are using or thinking about trying.
Some therapies may not be appropriate, depending on your medical treatment.
There are a number of ways to treat bowel cancer including surgery, radiation therapy and chemotherapy or drug therapy. In some cases more than one type of treatment may be used to get the best outcome.
Surgery is the most common treatment for bowel cancer.
Radiation therapy (also called radiotherapy) before surgery may benefit you if you have a rectal tumour or if surgery is not suitable.
Chemotherapy or drug therapy
Chemotherapy or drug therapy may be given to you before or after surgery with or without radiation therapy.
For more information about treatment and treatment side effects ask your doctor or visit our treatment section.
Your doctor should discuss your needs with you during and after treatment (including physical, psychological, social and information) and may refer you to another service or health professional for different aspects of your care.
5. After treatment
After treatment for bowel cancer, many people find that they need to adjust to changes to their digestion or the way their bowel functions. Sometimes a stoma, which is a surgically created opening to the outside of the body to allow waste to pass through to a bag, is required. A stomal therapy nurse/dietitian should provide you with information about surgery and adjusting to life with a temporary or permanent stoma.
Fortunately, there are many ways to reduce or manage the side effects of treatment, and most people are able to continue to lead active lives after their treatment.
After your treatment is completed, your doctor should provide you with a treatment summary with details of the care you received including:
- diagnostic tests that were performed and their results
- types of treatment used and when they were performed
- treatment plans from other health professionals
- supportive care services provided to you.
To monitor your health, and to make sure the cancer has not returned, you will need regular check-ups.
You and your GP should receive a follow-up care plan that tells you about:
- the type of follow-up that is best for you
- care plans for managing any side effects of treatment should they occur
- how to get specialist medical help quickly if you think the cancer has returned or got worse.
Your doctor should:
discuss your needs with you and refer you to appropriate health professionals and/or community organisations, if support is required
provide information on the signs and symptoms to look out for that might mean a return of the cancer
provide information on prevention and healthy living
6. If cancer returns
Sometimes bowel cancer can come back after treatment. This is why it is important that you have regular check-ups. Usually this will be detected at your routine follow-up appointments or if you notice symptoms are coming back.
7. Living with cancer
Some people experience side effects (for example, tiredness) that continue beyond the end of treatment. Sometimes side effects don’t begin until months after treatment has finished. For more information about side effects ask your doctor.
Advance care plan:
Your doctor may discuss with you the option of developing an advance care plan. An advance care plan is a formal way of setting out your wishes for future medical care. For more information about advance care planning ask your doctor or visit advancecareplanning.org.au.
This type of treatment could be used at different stages to help you with pain relief, to reduce your symptoms or help improve your quality of life. For more information about palliative care ask your doctor or visit palliativecare.org.au.
8. Questions of cost
There can be cost implications at each stage of the cancer care pathway, including costs of treatment, accommodation and travel. There can be substantial out-of-pocket costs if you are having treatment in a private health service, even if you have private health insurance.
You can discuss these costs with your doctor and/or private health insurer for each type of treatment you may have. If you are experiencing financial difficulties due to your cancer treatment you can contact the social worker at your local hospital.
For more information visit costs of treatment.
For more information about accommodation and travel costs visit our support section.
9. Further support
Bowel cancer support
Call Bowel Cancer Australia on 1800 555 494 for information about bowel cancer or to speak to specialised bowel cancer nurses or visit bowelcanceraustralia.org.
Also, specially trained staff at Cancer Council can answer your questions about the effects of cancer, explain what will happen during treatment and link you to support groups and other community resources. Call Cancer Council 13 11 20.
If you need an interpreter, call TIS (the Translating and Interpreting Service) on 13 14 50.
For support and advice for carers, call the Carers Association on 1800 242 636.
More support options
beyondblue: the national depression initiative
Information on depression, anxiety and related disorders, available treatment and support services
• Telephone: 1300 22 4636
• Website: www.beyondblue.org.au
Bowel Cancer Australia
Information about bowel cancer prevention, diagnosis and treatment.
• Website: www.bowelcanceraustralia.org/bca
Information on cancer prevention, screening, diagnosis, treatment and supportive care for Australians affected by cancer, and their families and carers
• Telephone: 1800 624 973
• Website: www.canceraustralia.gov.au
Care Search: Palliative Care Knowledge network
Information for patients and carers on living with illness, practical advice on how to care, and finding services
• Telephone: (08) 7221 8233
• Website: www.caresearch.com.au
National Health Services Directory
A directory providing information on local hospital and community services
• Website: www.nhsd.com.au
National Bowel Cancer Screening Program
Information about the National Bowel Cancer Screening Program
• Website: www.cancerscreening.gov.au
NEMICS A common path: Colorectal cancer
Videos offering support and advice from people who have been through cancer.
• Visit: www.youtube.com/c/ACommonPathCancersupportandadvice
Clinical versions of the optimal care pathways have been developed for clinicians and general practitioners here.