Saving lives: detecting bowel cancer early with FIT testing

Bowel cancer is one of the most commonly diagnosed cancers in the UK. Most people that are diagnosed are aged 60 or over, but younger people can still develop the disease.

Screening tests for bowel cancer are an effective way of detecting this type of cancer early. The earlier bowel cancer is detected, the higher the chances of receiving successful treatment. In the UK, the NHS offers a particular type of bowel cancer screening test called a faecal occult blood (FOB) test, every two years to all adults aged 60 to 74 years old.

However, the faecal immunochemical test (FIT) is a newer, more advanced type of screening for bowel cancer compared to the older FOB test. Both tests can be easily carried out at home, following a simple step-by-step guide.

Here, King Edward VII’s Hospital consultant in gastroenterology, Dr Edward Seward explains why bowel cancer screening is so important, and how you can be tested with the FIT test.

Who is most affected by bowel cancer?

Bowel cancer, also known as colorectal cancer, is one of the most common cancers in people living in the UK.

Those who are aged 60 and older are more at risk of developing bowel cancer. According to the NHS, one in 20 people in the UK will develop bowel cancer. For every 20 cases of bowel cancer, 18 of them will be in people aged 60 and above.

If a close relative (parent or sibling) developed or develops bowel cancer before they’re 50 years old, it can also increase your chances of developing bowel cancer.

Having a bowel condition, such as Crohn’s disease or ulcerative colitis, with extensive or severe symptoms, can also increase your risk of the disease.

If you’re concerned about bowel cancer, then it’s important to speak to your GP.

What are the signs and symptoms of bowel cancer?

There are three main symptoms of bowel cancer:

  • Regular blood in your stools.
  • Changes in your bowel habits — either becoming constipated, or more commonly, having frequent diarrhoea.
  • Pain and/or bloating in your lower abdomen after eating.

You may also lose your appetite or lose a significant amount of weight in a short time, without dieting. Blood loss can also make you anaemic, even if you don’t see the blood in your poo.

These symptoms do not necessarily mean that you have bowel cancer. Often, they can be attributed to something else. For example, finding blood in your stools can mean that you have haemorrhoids (piles). Having stomach pain and diarrhoea could mean that you’ve eaten something that hasn’t agreed with you and constipation could mean that you’re lacking fibre in your diet, or you’re dehydrated.

However, if you’re experiencing these symptoms on a regular or persistent basis and simple treatments such as laxatives for constipation haven’t worked, then it’s important to speak to your GP.

If you start to experience the following symptoms, it could mean that you have a bowel obstruction, which can be caused by a bowel cancer tumour preventing food and waste moving along the digestive tract:

  • Severe pain in the lower abdomen after eating.
  • Vomiting.
  • Bloating or swelling in the lower abdomen.
  • Rapid weight loss.
  • A bowel obstruction is a serious medical condition that requires urgent treatment — if you’re experiencing what you think could be a bowel obstruction, seek medical help or visit your nearest A&E immediately.

What are the causes of bowel cancer?

Bowel cancer usually develops inside small, fleshy lumps called polyps that can form on the lining of the inner part of the bowel. Having polyps doesn’t definitely mean that you have bowel cancer, as only some polyps turn into cancerous lumps.

Despite extensive research, doctors and scientists are still unsure of the exact cause of polyps and bowel cancer. But there are a number of factors that can increase your risk of developing bowel cancer.

These include:

  • Eating a diet high in processed meats (ham, sausages, bacon, burgers, pâté etc) and red meats (beef, lamb, pork etc). The NHS has valuable advice on how much meat is too much, and how to cut down on processed and red meats.
  • Not eating enough fibre, which is required for moving food along the digestive tract and for regular bowel movements. Aim to eat wholegrain (not white) bread, cereals, pasta and rice, plus plenty of fruit and vegetables to increase your fibre intake.
  • Being very overweight or obese, especially if you’re male. 11% of bowel cancers are linked to carrying excess weight.
  • Living a sedentary life with little physical activity or exercise.
  • Drinking excessive amounts of alcohol, and not having three or four alcohol-free days a week.
  • Smoking.

How does the NHS FOB test for bowel cancer work?

Early bowel cancer may not cause any symptoms, so regular bowel cancer screening is the best way of detecting bowel cancer early. Getting an early diagnosis of bowel cancer also makes it easier to treat.

The FOB bowel cancer screening test offered to all UK adults aged 60 to 74 is easy to use at home. It looks for minute amounts of blood in the stools that isn’t necessarily visible to the naked eye. Blood in the stools, caused by bleeding bowel polyps, can be a sign of bowel cancer.

Each kit comes with a clear set of instructions and when you turn 60, you’ll be sent the FOB test kit in the post. You’ll continue to receive them every two years until your 74th birthday. After this time, you can request a kit by calling the free bowel cancer screening helpline.

To use the kit, you’ll need to take two small samples of your faeces on three different occasions and wipe them onto a card using a special tool. The card and the tool are both contained within the kit. You’ll then need to seal the card in the envelope provided and post it free of charge to the laboratory.

Your results will then be posted back to you within two weeks.

How does the FIT screening test for bowel cancer compare to the FOB test?

Unlike the FOB test, which requires six different stool samples, a FIT test only requires one sample. It’s collected in exactly the same way and everything you need is contained within the kit.

The FIT test still detects minute traces of blood, but only detects human haemoglobin, a protein found in blood. In contrast, the FOB test could pick up traces of animal blood, potentially present in your stools as a consequence of eating meat. FIT tests come complete with full, easy to follow instructions and is packaged and posted back to the laboratory in the same way as an FOB test.

Additionally, the FOB test relies on human analysis. The FIT test is analysed by a machine, reducing human error and making it a more advanced test.

How can I get a FIT testing kit?

The FIT test is not currently available on the NHS in England, although it’s expected to replace the FOB test in the spring or summer of 2019. It’s already available in Scotland on the NHS and is currently being rolled out in Wales. There are no current plans for the FIT test in Northern Ireland.

Also, if you’re under 60 years old, you won’t automatically qualify for bowel cancer screening stool tests on the NHS.

The NHS FIT test for bowel cancer screening has also been designed to be not as sensitive as it could be — in other words it will miss some of the cancers that are present. This is because the capacity for performing colonoscopy in the NHS is limited — they just don’t have the endoscopy units, nurses and doctors available to provide a colonoscopy for everyone that needs one. At King Edward VII’s hospital we don’t have this limitation — and so we are able to make the FIT test as sensitive as possible. This increases the chance of picking up polyps or cancer early.

You can order a FIT bowel screening test kit privately from the King Edward VII’s Hospital, at any age. You’ll receive your result from our Colorectal Clinical Nurse Specialist.

What happens after I get my results?

The vast majority of people get a normal result from bowel screening tests. This means that there was no blood detectable in your stool sample. You won’t need to do anything until you receive your next bowel screening kit in two years’ time (or you order another one privately), unless you begin to develop symptoms of bowel cancer, in which case you should speak to your GP.

If you receive an abnormal result, it means that blood was found in your stool sample. It does not necessarily mean you have bowel cancer.

Whether your abnormal result is from an NHS FOB testing kit, or a King Edward VII’s Hospital FIT testing kit, you’ll be invited to have a further test called a colonoscopy.

A colonoscopy procedure involves a specialist doctor passing a long, thin tube through your bottom and into your large bowel. You will be sedated throughout the procedure. The tube has a small camera attached to the end, and your doctor will be able to view the inside of your bowel on a TV screen, where they’ll be looking for the presence of polyps.

If polyps are found, during the same procedure, your doctor will be able to remove them for further testing. Most polyps are not cancerous.

If cancerous cells are detected, then you will be contacted for further scans and tests to enable doctors to put you on the best course of treatment.

The success of your treatment will depend on the severity of your cancer and full support will be given by your medical team throughout.

More information

  • If you’re experiencing symptoms of bowel cancer, speaking to your GP is a good place to start. (Don’t have a GP?)
  • A FIT bowel screening test kit can be ordered from the King Edward VII’s Hospital and costs £50.
  • If you’re worried about bowel cancer, or you’ve had an abnormal FIT or FOB test, the King Edward VII Hospital’s Urgent Bowel Cancer Service allows you to speak to a world-class colorectal specialist within 48 hours.