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MBChB PhD FRCS

FAQs

Consultant Laparoscopic Colorectal and General Surgeon

FAQs

What’s the latest on bowel cancer screening

The faecal immunochemical test (FIT), a greatly improved test kit for people to use at home to screen for bowel cancer, has now been approved and adopted for use in the UK. The new test is already available and people all over the country who are eligible for bowel cancer screening will be getting the new kit as we go through 2016 and into 2017. Find out more…

Gallstones and cholesterol – what’s the link?

Most gallstones are are made up of cholesterol. It’s less common for stones to contain pigment molecules and some are formed from a mixture of cholesterol and pigment.

Is there any way of finding out what type of gallstones someone has without removing them?

Mr Jonathan Wilson

“It is not possible to tell what type someone has before their gallbladder is actually removed. More than 80% of all gallstones are not visible in an ordinary X-ray – so this is not really a good diagnostic technique for gallstones. Ultrasound and CT scanning is used in preference and most stones look identical in scans.”

Some researchers are working on ultrasound techniques that can pick up slightly different patterns from cholesterol stones to differentiate them from other types but this is not really that useful for someone who experiences symptoms from their gallstones.

Treatment for someone with symptomatic gallstones is the same no matter what the composition of their stones – the gallbladder needs to be removed surgically, usually by a keyhole cholecystectomy.

Why do people develop cholesterol stones – is it related to having high cholesterol?

As far as we know, gallstones tend to form when the bile, the fluid inside the gallbladder, becomes loaded with cholesterol. This crystalises and forms tiny solid lumps, which then attract more solidifying cholesterol and the stones enlarge.

We have quite a lot of evidence that having high blood cholesterol, being overweight or obese and developing insulin resistance (a step towards type 2 diabetes) does make it more likely that you will develop gallstones. Remember though that although its common to have gallstones as you get into late middle age, most people never develop symptoms. You can be perfectly well and have gallstones for many years. It’s only when they start to cause problems that you need to have treatment.

Can drug treatment to reduce cholesterol prevent gallstones?

Some people think that if high cholesterol is associated with gallstones, statin treatment could help. Statins and a drug called ezetimibe, which are used to treat high cholesterol have been show to change the composition of bile and to reduce the rate at which cholesterol stones form. Two large population s tudies have shown that statins given to people to prevent heart attacks did also reduce their risk of having to have surgical gallbladder removal. However, although other controlled trials were done to find out if statins could prevent the formation of gallstones, these produced conflicting results.

Mr Jonathan Wilson“More research is needed but for the moment the best medical advice is that you should take statins to reduce your risk of heart attack and stroke if you need to and maybe benefit from the reduced risk of gallstones as a secondary effect. They are not prescribed to prevent gallstones if you don’t have a high risk of cardiovascular disease.”

Is flexible sigmoidoscopy used for bowel screening?

Not yet but it will be soon. As of autumn 2013, six centres in the UK are running a pilot for bowel screening using flexible sigmoidoscopy. Adding flexible sigmoidoscopy at the age of 55 to the National Bowel Screening Programme should help detect more cases of bowel cancer early.

The NHS bowel scope screening pilot started in March 2013 and has been set up in six areas of England:

  • Guildford in Surrey
  • West Kent and Medway
  • Norwich
  • Queen Elizabeth and South Tyneside
  • Wolverhampton
  • London (St Marks)

If you live in these areas and you are around 55 years old, you may receive an invitation to have a flexible sigmoidoscopy.

Mr Jonathan Wilson, Colorectal Surgeon“A lot of research has been done to establish ways to detect bowel cancer but that are affordable in the current economic climate. There will be a lot of people tested whose results come back completely normal, or who have problems that are not cancer. It’s the few people whose cancer is picked up early that benefit: screening does certainly save lives.

Adding flexible sigmoidoscopy to faecal occult blood testing for people over 55 is a major step forward in this country and when the combination is fully rolled out to all regions, it is likely to continue to chip away at the death rate from colon cancer, which is still the second most common cause of cancer death, claiming 16,000 lives each year.”

What is the NHS bowel screening programme?

This is a national screening programme now running all over the country to detect early signs of bowel cancer:

  • People aged between 60 and 69 (this will soon be extended up to age 74) are contacted to let them know they are eligible for screening.
  • They are then sent a kit to test if their faeces contain any blood.
  • The screening kit, known as the Faecal Occult Blood (FOB) test, is used at home. The small faecal samples are collected on cards that are sealed and posted to be tested in the lab.
  • The results come through in two weeks. If the test is normal, there is nothing to worry about but it’s important to carry on doing the test every two years.
  • If there is a problem, you may need to repeat the test and you may then need a colonoscopy.
  • A pilot is currently running to see if more lives can be saved by having a flexible sigmoidoscopy at the age of 55 years. If it does, flexible sigmoidoscopy could be added to the NHS bowel screening programme in the future.

Mr Jonathan Wilson, Colorectal Surgeon

“If you are sent an invitation to have bowel cancer screening, do take it up. One of the earliest signs of bowel cancer is blood in poo – if this is detected earlier it can mean an early diagnosis. The earlier the better as treatments are much more effective when performed on small tumours that haven’t yet spread.”

What is flexible sigmoidoscopy?

It’s a type of endoscopy, a bit like a colonoscopy but it doesn’t examine as much of your bowel. The test is done using a flexible sigmoidoscope.This flexible tube has a camera inside it and it is very thin – thin enough to be passed through the anus into the rectum and first part of the large bowel without causing too much discomfort.

Small instruments can be passed through a tiny channel in the scope to either remove a polyp or take a small sample (biopsy) of bowel tissue- both of these manoeuvres are pain free. This tissue is examined later under a microscope by a histologist to find out if there are any cancerous cells.

The UK is planning to introduce flexible sigmoidoscopy as a one-off test for people aged between 55 years and 60 years to detect more cases of bowel cancer early. This screening program is known as ‘Bowel Scope’.

What’s it like to have a flexible sigmoidoscopy?

 

  • It’s not that bad – having a bowel scope examination takes about 10 minutes and it’s only mildly uncomfortable.
  • You don’t need to prepare by using a laxative the day before and you won’t need a sedative. This is not as extensive as a colonoscopy.
  • You will have an enema just before to empty the lower bowel, and then lie on a couch on your side. The flexible sigmoidoscope is inserted through the anus and into the rectum and the lower part of the large bowel.
  • Some air is usually passed into the bowel to make the test easier and to produce clearer images of the wall of the large bowel. A sample may be taken but this will not cause you any pain.
  • These ‘bowel scope’ appointments are often scheduled in the evening to fit in around your work and you can drive there and home.

 

Mr Jonathan Wilson, Colorectal Surgeon

“If you have symptoms, such as passing blood when you open your bowels, the scope test should show what is causing that so its worth the minor discomfort and time to have it done. It may be that you have internal haemorrhoids, or a polyp or polyps that need to be treated. It may detect an early stage cancer that can then be treated early, giving you the best chance of having it cured by surgery and follow up treatment.”