Colonoscopy

[mummyh2016]

Does anyone know if you've been referred for a colonoscopy for suspected cancer you would normally have it within 2 weeks?
DH has had IBS for years (his medical records with his GP state crohns but he's never been verbally told he has it). He was under a gastro specialist, DH fell through the cracks during Covid and hasn't been seen since 2020. He ended up contacting the department around a month back who asked him to send a sample in. He has done so and today has had an appointment come through for an colonoscopy. Preop on 31st of this month with procedure on 6th June. DH has called the PA at the hospital today as the letter stated you could request a CT scan instead (DH had a capsule endoscopy back in 2016 and he struggled with the movicol so wanted to avoid this). PA rang back and said they want the colonoscopy as his sample showed signs of inflammation so they want to do a biopsy. If it was cancer they are worried about would you expect the endoscopy to be done quicker than 3 weeks? I'm panicking as I see biopsy and i immediately think cancer. Majority of symptoms of bowel cancer are the same that DH experiences day to day due to his IBS/crohns.

I was referred on the 2 week suspected cancer pathway for colonoscopy and GP told me when he was doing the referral that actually it would more likely be 6 to 8 weeks due to wait lists etc. He did say that much longer would likely not make any difference to outcomes but encouraged me to call the hospital if things worsened (I was actually seen 4 weeks to the day I initially went to the doc with the problem).

Forgot to add, totally understand why you're worrying and hope your dh's outcome is a good one

I had blood in poo .
Had colonoscopy.. was just polyps.( Had biopsy .. you can't feel the " nip" he took biopsy and cut the polyps.. never felt a thing)
I was on 2 week pathway.. had it done in withing 22 days).
( l have IBS and diverticulitis and bowel adhesions).
If he can't take the sachets in water ask for the pills.
Hope all goes well.

I was referred for a colonoscopy a few months ago after having a positive FIT test. The doctor told me that they always take biopsies during the procedure so I think it’s routine.

Thanks everyone. I think he was hoping they were going to say because it had been 7 years since the capsule endoscopy they just wanted another look but that doesn't seem to be the case. I know he's lucky in the sense that if he does have questions he can ring the PA but then she has to go back to the dr to ask. We were supposed to be booking our summer holiday tonight as well which we now can't do until he has his results. I know it's a trivial problem in the grand scheme of things but still. If it is the dreaded C word I presume we'd likely hear back within a couple of weeks?

I work in endoscopy and also consent patients for their procedures.
One of the things I always say is "biopsy always sends people thinking the worst but it's a hugely useful tool for us to check inflammation and see the cells of that area of bowel. We have amazing cameras on the end of our scopes but they're not microscopes, they can't see everything. By taking a small sample of tissue, we can diagnose and rule out so many different causes of inflammation, including infection and bowel disease."

I know it sounds scary, we are always taught that we biopsy cancer! But honestly it's more about seeing those cells and any microscopic inflammation that the scopes don't see. Especially in the case of IBS/IBD. It's very standard practice so please try not to worry!

Also, in every single department I've worked in, a suspicious lesion or evident cancer is ALWAYS discussed with the patient there and then, with the proviso of "we will wait to see what the biopsy says however we do believe at this time that it's a cancer"

You can always ask your admitting nurse whether they give the report the same day.

I know it all seems huge but honestly I see hundreds of patients come through our department and for a multitude of reasons. One of the top ones being IBD diagnosis/management/surveillance.

If he's on a 2 week wait cancer pathway he should have been made aware of this and be seen within that time frame. Obviously that isn't always the case, sadly, but he'd be informed of this information.

@FlakyAquaQuoter thank you! The PA did say yesterday the doctor had sent a letter out explaining why it had been arranged which we haven't received yet. She did read parts out to him about the inflammation however I do understand if she chose to omit mentioning cancer over the phone! Would it be mentioned in the letter when it comes if it has been ordered due to suspected cancer?

I used to work in this field too. It’s important to note CT colon usually involves clearing the bowel so he’d still need prep.
I would wonder if maybe his sample had traces of blood in it? The colonoscopy is the best approach because if they find anything they can usually handle it there, whereas if he had a CT and they saw anything he’d then need the colonoscopy anyway. It was standard practice where I worked to do biopsies for anyone with colitis/suspected colitis because of possible microscopic changes as FlakyAqua mentioned. Also yes 2ww ideally but during COVID our department was shut aside from emergency in patient care and we did get a back log, depends on the trust as to the wait. Hope it goes okay for him.

I've had to have a colonoscopy under the two week suspected cancer, and yes, the letter I got about this did mention the possibility of cancer. Mine turned out to be bile acid malabsorption and diverticulitis . Biopsies are also very normal when they do scopes.

As your husband has inflammation, this will be why they want to do scopes. It will show whether crohns or colitis [ or something else ] . As he has had a capsule endoscopy before, they probably want to check whether his crohns is now in other places.

My son had a capsule endoscopy and this showed crohns in his small bowel. He already had it in his large bowel, but scopes can't reach the small bowel, which is why they do the capsule endoscopy.

Yes, it should be mentioned. The GPs do tend to be very transparent with this. Has he been told he's on a 2 week cancer wait?

@FlakyAquaQuoter no but it wasn't his GP that arranged the sample it was his gastro specialist. He hasn't spoken to anyone from gastroenterology since 2021 apart from the PA. DH didn't sleep well last night and did say something along the lines of he's sorry I married such a fuck up. If the letter when it comes does mention cancer god knows how he's going to get through the next month or however long it will be until he gets the results.

From what you've said, it really does sound like they just want to check for inflammation linked to the IBD and take biopsies to assess the microscopic inflammation that may or may not be present to get a clear picture of the current stages. Of course, cancer is a huge worry whenever people are referred for these tests, but by no means does it suggest they expect to find something along those lines. In fact, diagnosis and assessment of IBD along with a host of other things is the more common reason behind referral.
I'm sorry he's not coping too well with it, it sounds like it'll be a difficult time for you both while you wait. Hopefully you'll get some answers on the day.

@FlakyAquaQuoter thank you for your advice it is honestly calming me down a bit.

My DH has had both CT first and then a colonoscopy, the latter he was told straight away that they didn’t find any noticeable cancer, but he does have colitis, they did a couple of biopsies at the same time and his gastroenterologist team rang him about a week later with results saying no cancer and a medication route for the colitis. After suffering pain, poo and mucus for over 2 years, he’s now managing his condition quite well, so although it’s not a nice procedure and the prep (for my DH) was awful, it’s worth it to get the correct diagnosis. My DH tells me regularly how sorry he is being stuck with him, but if the role was reversed I know he would be supportive.

Thank you. I think DH is feeling like this because it is out of the blue, he does manage his IBS/crohns (whatever it is he has) well, he is bad every morning but within an hour he's okay so has just got used to it. I've been nagging for the last couple of years for him to chase up the hospital as he'd not heard anything, the only reason he finally did is because he saw something on TikTok about other symptoms such as fatigue, bad skin etc which he also suffers with.

We've just had the letter come through. It states: your recent stool sample results suggest there is now evidence of active inflammation in the bowel. I am therefore referring you for a colonoscopy and MRI scan of the small bowel and if both of these are normal then we may need to consider repeating a capsule endoscopy. I will write to you once I have the results.

Am I right to think I can calm down a little now? Or could they still be checking for cancer and deciding not to say.

I’d say that with his history they are assuming it’s inflammatory bowel, but these tests will confirm it and rule out any other causes (such as polyps and possible cancer). He’s also likely to need treatment if it is IBD and these tests will inform that care.

Just wanted to update, DH had it done yesterday. They said everything looks relatively normal. Biopsies were done but based on what they said yesterday I don't feel as concerned. We are waiting for a date for a CT scan to come through (was supposed to be an MRI but DH met a couple of the starred conditions on the appointment letter so he's been switched to a CT) and I presume he will now have to have another capsule endoscopy at some point.

That’s good news! I’m glad it’s reassuring.

DH was due to have his CT scan next week but we have cancelled it, he has been really poorly since his colonoscopy (not linked I think he just picked up a virus or infection whilst at the hospital). Anyway he spoke to the secretary this morning explaining why he had cancelled it, and he's asked if we can wait for the results of the biopsy and a face to face appointment before any further tests. The secretary mentioned they received the results 2 days ago but she couldn't disclose anything as the dr hadn't looked at them yet and she's not clinically trained. DH is now panicking. I'm not because if anything showed up on the biopsy (I'm thinking along the lines of cancer) I can't see it being something they would sit on for days on end. I suppose my question is if the biopsy did show cancer is it a case of they would send the results to the doctor as high importance or is it a case of he still checks them in date order as and when they come in regardless?

Sorry to hear DH has been unwell! It may differ from trust to trust but for mine, standard practice is that results indicating a cancer etc would be called through. Also, unless a suspicious mass was biopsied (which he would have been told on the day) then they're looking for inflammation. For which the results would be either yes or no.