A study to determine whether colonoscopies should remain the first test offered to patients referred for bowel cancer investigation or whether a less invasive scan would suffice in more cases has won funding from North West Cancer Research and Rosemere Cancer Foundation to give it the green light to go ahead.
The study, “Evaluating the role of CT Colonography as a primary investigation in patients referred through 2ww lower GI pathway” aims to try and identify patient-specific factors that will help determine the likelihood of bowel cancer and consequently, the most appropriate diagnostic procedure.
Currently, most patients referred for hospital investigation by their GP because they have presented with symptoms such as spotting blood in their poo, have had a positive FIT (Faecal Immunochemical Test) result or have noticed changes to their bowel habits will undergo a colonoscopy.
A colonoscopy is a camera test through the back passage that assesses the entire large bowel. Patients are required to follow a special diet for a number of days beforehand and then take laxatives prior to the procedure, which is invasive, uncomfortable, costly and carries risks including that of bowel perforation.
It has the additional benefit though of enabling tissue samples to be taken for further testing and any large polyps, which can be a cause of bleeding and which although usually benign can become cancerous over time, to be removed.
CT colonography, which is currently only offered to patients who are deemed not fit for colonoscopy, have previously undergone a failed colonoscopy or by request, is much less invasive and more comfortable. However, if an area of abnormal tissue is detected, the patient would then need a colonoscopy for a tissue sample to be taken.
Dr Mariam Gaddah, who is based at Royal Lancaster Infirmary, is leading on the study having won £20,000 of funding - £10,000 each from Rosemere Cancer Foundation and North West Cancer Research – in a “Dragon’s Den” style pitch before a judging panel at the fourth annual Surgery in Lancashire and South Cumbria Conference (SILASC).
Dr Gaddah explained: “Patients presenting with symptoms that could suggest bowel cancer are currently referred for investigation on the Urgent Suspected Cancer pathway, which is also known as the two week wait pathway.
“They will almost all undergo a colonoscopy, which is invasive, costly and time-consuming. The alternative is CT colonography. Research has shown colonography is just as effective and accurate as colonoscopy in identifying and ruling out bowel cancer and polyps. It is better tolerated by patients and according to a Manchester study undertaken last year, is currently being underused.”
Dr Gaddah continued: “The aim of our study is to develop and evaluate a scoring system to predict the probability of colonography in ruling out bowel cancer without further investigation.
“We want to produce a set of parameters to help identify patients with a lower bowel cancer risk, who would benefit from investigation by colonography alone so that colonoscopies would then become the diagnostic procedure for those presenting as being at higher risk of the disease.”
Dr Gaddah added: “Our method for doing this is by analysing the records of local patients referred for bowel cancer diagnosis between 2019 and 2023.”
Dan Hill, head of Rosemere Cancer Foundation and one of the SILASC panel judges, said: “This is a really novel piece of work that will hopefully ultimately lead to less invasive investigations for many more patients referred for bowel cancer diagnosis and also, contribute to larger national initiatives to support the use of colonography, saving the NHS money.”
Fellow judge Alastair Richards, of North West Cancer Research, said: “As a charity rooted in the North West, we are committed to funding research that delivers tangible benefits for patients and services in our region. This study has the potential to improve the diagnostic pathway for bowel cancer locally by reducing unnecessary invasive procedures and improving the patient experience. By supporting innovative, clinician-led research like this, we aim to drive improvements in cancer outcomes for people across the North West and contribute research that can inform practice on a wider, national scale.”
It is hoped the study’s preliminary findings will be ready for publication early next year.
Rosemere Cancer Foundation works to bring world class cancer treatments and services to cancer patients from throughout Lancashire and South Cumbria being treated at Rosemere Cancer Centre, the region’s specialist cancer treatment and radiotherapy centre at the Royal Preston Hospital, and also at another eight local hospital cancer units across the two counties.
The charity funds cutting-edge equipment, clinical research, staff training and innovative services and initiatives that the NHS cannot afford in order to make patients’ cancer journey more effective, comfortable and stress-free. For further information on its work, including how to make a donation, visit www.rosemere.org.uk
North West Cancer Research is an independent charity dedicated to putting the region’s cancer needs first by funding life-saving research and education to tackle the cause, improve the care and find the cause of cancer. For further information on its work, visit www.nwcr.org
