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Bowel cancer screening tests are used to identify the presence of blood in the stool, which may be a symptom of bowel cancer.
Blood may be present in the stool for a variety of reasons including:
- Bowel cancer
- Crohn’s disease
- Ulcerative colitis
- Gastroenteritis
- Anal fissures
- Haemorrhoids
Opening the consultation
Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
Explaining the screening programme
In England, Wales and Scotland bowel cancer screening is recommended every two years for men and women aged between 50 and 74 years. Patients 75 years and older can request a test from the free bowel cancer screening helpline.
The bowel cancer screening test involves a kit that the patient uses at home.
The kit currently used in England, Wales and Scotland is the faecal immunochemical test kit (known as the FIT kit).
The FIT kit includes a plastic sample bottle, an envelope and instructions on how to do the test.
The FIT kit requires the collection of a single stool sample into the plastic sample bottle, which is then posted back to a laboratory for testing.
Example explanation
“The bowel cancer screening test for people aged 50 or over is a kit you use at home. It involves collecting a single sample of poo into a small plastic sample bottle and then posting this back to a laboratory for testing. This sample is used to check for tiny amounts of blood in your poo. It does not diagnose bowel cancer, but it’s a simple way to find out if you need further tests.”
Stool sample collection
The following steps describe how to collect a stool sample using the FIT kit:
1. Write the date on the sample bottle using a ballpoint pen.
2. Use a container or layers of toilet paper to catch the poo sample and don’t let the poo touch the toilet water.
3. Twist the cap to open the sample bottle and remove the lid, which has a sample stick attached to it.
4. Collect a sample by scraping the stick along the poo until all grooves are covered. Only a small amount of poo is required for the test.
5. Push the stick back into the sample bottle and click the cap to close it tightly. Do not reopen the bottle after use.
6. Wash your hands.
7. Put the sample bottle in the supplied return envelope.
8. Seal the envelope and post it back to the laboratory. Postage is free and you will not need a stamp.
Results
Results are posted back to the patient within 2 weeks of the sample being sent, but sometimes it can take longer.
Normal result
A normal result means there was no blood identified in the stool sample and therefore no action is required. The patient will be invited to do another screening test in 2 years, as long as they are aged between 50 and 74.
Around 98 in 100 people receive a normal result.
However, even if the FIT is negative, it does not always mean the patient does not have bowel cancer. Any relevant signs and symptoms must also be taken into account.
Abnormal result
An abnormal result means that blood was identified in the stool sample. The patient will be offered an appointment with the specialist team to discuss further tests, which may include a colonoscopy, to further assess for evidence of bowel cancer.
Advise patients that a positive test result does not necessarily mean that they have bowel cancer, it simply means that blood has been detected in the stool which may be due to a large number of conditions, many of which are easily treated.
Around 2 in 100 people receive an abnormal result.
Example explanation
“Your result should be posted to you within 2 weeks of sending off your kit.”
“A normal result means that no blood was found in your poo sample and therefore you do not need to do anything else. You’ll be invited to do another screening test in 2 years (if you’re still under 75 by then). Around 98 in 100 people receive a normal result.”
“An abnormal result means that blood was found in your poo sample, but this does not necessarily mean you have bowel cancer, as the blood may be due to other conditions such as piles. You’ll be offered an appointment with the specialist team, where a test called a colonoscopy to check for signs of bowel cancer will be discussed. A colonoscopy involves the insertion of a thin tube with a camera at the end into your bottom.”
Closing the consultation
Summarise the key points back to the patient.
Ask the patient if they have any questions or concerns that have not been addressed.
Offer the patient some leaflets on the bowel cancer screening programme and direct them to some reliable websites which they can use to gather more information (e.g. NHS.uk).
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Reviewer
Dr Latha Bonthala
General Practitioner
References
- National Health Service (NHS). Bowel Cancer Screening. Available from: [LINK].
- Oxford University Hospitals NHS Foundation Trust. Bowel Cancer Screening. Available from: [LINK].
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