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Key points

  • It is important that patients are aware of the reasons for referral
  • It may be useful to direct patients to reliable sources of information such as Macmillan, Cancer Research UK or Bowel Cancer UK

Student Information

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Key points when explaining a colonoscopy


  • Gain consent
  • Laxatives to be taken beforehand to improve view of bowel


  • Patients will be awake during the procedure, and are offered sedatives and pain relief
  • Long, thin tube with a small camera is inserted up the back side to visualise bowel.
  • Air is pumped into bowel to help see. This may make patient feel bloated o Biopsies or polyps can be removed and further investigated


  • Bloated and cramping sensation is common for a few hours post procedure
  • Bleeding from bottom in small amounts is also common
  • Unable to drive home if intravenous sedative given


  • Bleeding
  • Perforation
  • Infection – although this is uncommon

Red flags:

  • If severe pain, fever, heavy bleeding following colonoscopy seek urgent medical attention


  • Initial results are explained to patients following the procedure
  • If biopsied, results may take 2-3 weeks and depending on findings will be followed up with specialists

What is a colonoscopy?, NHS (2019)


Multidisciplinary team approach

Resection of the area of malignancy is the only curative option. The procedures include:

Site of cancer Type of resection
Caecum, ascending and proximal transverse colon Right hemicolectomy
Distal transverse and descending colon Left hemicolectomy
Sigmoid colon High anterior resection
Rectum Anterior resection
Anal verge Abdomino-perineal excision of rectum


In some cases, treatment may be endoscopic (for example, some sigmoid colectomies can be performed laparoscopically).

Chemotherapy, radiotherapy and palliative care are also options for treatment.

Patients are regularly followed up for CEA blood tests and CT scans.


An abdominal stoma is an opening between the skin and bowel, this provides a diversion of faeces into a stoma bag to be removed. These are the following types:


  Colostomy Ileostomy
Origin Made from large intestine – colon Made from the small intestine – ileum
Location Left iliac fossa (most commonly) Right iliac fossa
Contents Formed stools as water
Absorption has occurred
Faecal matter in a liquid consistency
Association to skin Flushed to the skin Sprouted – as enzymes and faecal contents are irritative to skin
Types Permanent end – Post abdomino-perineal excision of rectum
Temporary end – Post emergency surgery to provide bowel with rest (e.g. due to bowel obstruction)
Loop – Has 2 openings, protects distal anastomosis following removal surgery 
Permanent – Post removal of entire colon, rectum, and anal canal (panproctocolectomy). This can be done in Familial adenomatous polyposis patients
Temporary end – e.g. post emergency surgery to provide bowel with rest (e.g. due to a bleed)
Loop – Has 2 openings , protects distal anastomosis following removal surgery

What is a stoma?, Bladder & Bowel Community [online]

SPIKES model used in breaking bad news

S – setting (location, time, place, rapport building)
P – perception (gain understanding of patients current knowledge)
I – invitation (confirm patient is ready to receive news)
K – knowledge (provide information in steps with pauses)
E – empathy (validate patients thoughts and feelings and provide support)
S – summary (ensure full understanding)

Breaking bad news, Medical Defence Union (2019)
Dealing with angry patients – Tips

  • Listen to the patient and validate their feelings
  • Highlight to them what your role is and what your are able and not able to do
  • If you are unable to help, refer them to the correct person or pathway
  • Do not take the anger personally or reply in a similar manner
  • Discuss and reflect on the encounter with your supervisor/member of team/portfolio

Managing angry patients, British Medical Association (2022)

Test yourself

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