Early Bowel Cancer

• A persistent change in bowel habit (such as ongoing diarrhoea, constipation, or looser, more frequent stools).
• Blood in the stool or rectal bleeding sometimes noticed on the paper or in the pan.
• Abdominal pain or cramping, which may come and go.
• Unexplained weight loss or reduced appetite.
• Fatigue or low energy, sometimes related to anaemia.

These symptoms can be caused by many conditions, but it’s important not to ignore them, especially if they persist. Fast, accurate diagnosis allows us to plan the right treatment without delay.

Typical diagnostic steps include:

• Colonoscopy —a camera test that allows us to see the inside of the bowel, biopsy any suspicious areas, and sometimes remove polyps during the same procedure.
• CT and MRI scans — to determine the stage and check whether the cancer has spread; for rectal cancers, pelvic MRI provides crucial detail.
• Blood tests — including checks for anaemia and the CEA tumour marker, which can help with baseline assessment and later monitoring.

Once the diagnosis is confirmed, we move promptly to treatment. Additional scans, endoscopic assessments, or surgical consultations can be arranged quickly—often within days—so you are never left waiting or wondering what comes next.

You may have received a faecal immunochemical test (FIT) home kit that checks for tiny traces of blood in your stool. A positive FIT doesn’t mean you definitely have cancer, but it does mean you should have prompt investigation—most often a colonoscopy. If your FIT is positive, or if you have symptoms despite a negative FIT (for example blood in the stool/poo, a persistent change in bowel habit, abdominal pain, irondeficiency anaemia, or unexplained weight loss), the surgeons I work with can arrange rapid investigation, including colonoscopy or CT colonography. We coordinate everything quickly, and work with all major UK insurers to ensure you’re not left waiting or worrying.

For most early-stage bowel cancers, surgery is the main treatment. Modern laparoscopic (keyhole) and robotic techniques allow removal of the tumour with precision while aiming for faster recovery, smaller scars, and fewer complications. The exact operation depends on the tumour’s location (for example, right hemicolectomy, left hemicolectomy, sigmoid resection, or low anterior resection). At HCA Harborne hospital the team uses enhanced recovery pathways so you are up and walking quickly, eating sooner, and home as safely as possible.

A key surgical principle is achieving clear margins (no cancer at the edges of the removed tissue) and removing the appropriate lymph nodes for accurate staging. Your surgical plan will be explained in detail, including whether a temporary stoma might be advisable to protect a new join between two pieces of bowel either side of the tumour (anastomosis). Many people do not need a permanent stoma; where a temporary stoma is used, we plan reversal as soon as it’s safe.

For rectal cancers—especially those lower in the rectum or close to other organs—we often start with combined radiotherapy and chemotherapy before surgery (this is called neoadjuvant treatment). The goal is to shrink the tumour, reduce pelvic recurrence, and increase the chance of preserving the back passage so you can avoid a permanent stoma (bag). We will discuss whether a long-course (chemoradiotherapy) or short-course (radiotherapy) approach is right for you, based on stage, position, and your overall health.

Organ preservation

In carefully selected patients who have an excellent response to neoadjuvant therapy, it may be possible to avoid surgery. This strategy—often called “watch and wait”—requires close surveillance with regular MRI scans, endoscopic checks, and blood tests (including CEA). The team I work with has been closely involved in developing and delivering organ-preserving approaches through clinical trials, and we will explain clearly whether this is a safe and realistic option in your case.

After surgery, some patients with higher-risk features—such as lymph node involvement or certain features under the microscope—may benefit from chemotherapy to reduce the risk of the cancer returning. This may be with tablets, intravenous treatment, or a combination, depending on your pathology and overall health. We focus on starting promptly once you’ve recovered from your operation, balancing effectiveness with quality of life.

Large clinical studies have shown that outcomes are best when chemotherapy is started promptly — ideally within 6 to 8 weeks of the operation. Beyond this window, the benefit begins to fall, as any microscopic cancer cells left behind after resection have more time to recover and multiply. Starting treatment soon after surgery, once you are fit and recovered enough, gives the chemotherapy the greatest chance of eliminating residual disease and maximising long-term survival.

Every case is discussed at a multidisciplinary team (MDT) meeting that includes leading surgeons, radiologists, pathologists, and oncologists. We agree a plan that reflects the latest evidence, your cancer’s exact stage and location, and your personal circumstances—fitness, medical history, and most importantly, your goals and preferences. Your treatment plan is then delivered with precision and continuity.

We know there is more to getting through treatment than just having surgery and chemotherapy: lifestyle measures such as nutrition, exercise, sleep and supplements also have an important role to play. This is something I take a particular interest in and will discuss with you in detail when the time is right.