The main method currently used to diagnose colorectal cancer is optical colonoscopy. Approximately 440,000 procedures are carried out in the UK each year, requiring specialist input from gastroenterologists and surgeons. This is an invasive procedure, and there are considerable capacity issues in the UK, with patients commonly waiting between four and six weeks for a colonoscopy.
Within Guy’s and St Thomas’ Trust, colon cancer is one of the two most difficult areas in terms of delivering cancer targets. Furthermore, new NICE guidelines published in June 2015 have broadened the inclusion criteria for urgent cancer referrals for patients who are symptomatic for colon cancer. This means an increased number of urgent ‘2 Week Wait’ referrals to the Trust.
TOHETI is changing the current diagnostic pathway for symptomatic patients, by replacing colonoscopy with a non-invasive procedure - CT colonography imaging (CT enema) as the first-line test.
It is anticipated that CT colonography will enable an accurate and quicker diagnosis and if needed, move to subsequent treatment. Patients referred for a CT colonography under the new pathway will meet the same revised clinical inclusion criteria as those set by NICE.
Proposed benefits to patient outcome/experience:
‘It is well established in the literature that CT colonography has an equivalent diagnostic accuracy to optical colonoscopy in the detection of medium sized polyps and cancers in the large bowel. At present it is an underutilitised resource in our trust. This study will offer improved access to CT colonography as a non-invasive first line test for patients with large bowel symptoms. The outcome of this study will then help facilitate discussions on a revised Colon Cancer pathway in our trust, which should be more cost effective, with improved patient experience, and reduced waiting times.’ Nyree Griffin, Consultant Radiologist, Gastrointestinal imaging