Diagnosing bowel cancer

Colorectal cancer, also known as bowel cancer, is one of the most common forms of cancer in many countries, including Germany. The term "colorectal cancer" is used to describe bowel cancer that begins in the colon or rectum. Colorectal cancer is the second most common cause of cancer death, estimated to be responsible for nearly 935,000 cancer deaths [1]. It is one of the cancers with increasing incidence worldwide, accounting for 11% of all cancer diagnoses. Bowel cancer diagnosis is one of the key challenges of modern oncology, as the disease often develops gradually and without pronounced symptoms of bowel cancer, which leads to delayed medical attention. Timely and accurate diagnosis of bowel cancer significantly increases the chances of survival and allows for the use of less aggressive treatment methods. Unfortunately, in clinical practice there are still cases of bowel cancer delayed diagnosis, which directly affects the prognosis and life expectancy of patients [5].

The main aim of the specialists in the field of oncology is to ensure an early bowel cancer diagnosis and appropriate staging in colorectal cancer. That is why patients and general practitioners now have more information about widespread cancer symptoms, early warning signs, and symptoms of bowel cancer, which supports timely referral and accurate bowel cancer diagnosis.

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Symptoms of bowel cancer and first appointment

The role of patient awareness

The level of public awareness of symptoms of bowel cancer remains insufficient. Many people tend to ignore symptoms or postpone a visit to the doctor due to fear or shame, which significantly contributes to bowel cancer delayed diagnosis.

It is important to understand that symptoms of bowel cancer do not always correlate with the stage of the disease – even early tumors can bleed, while late symptoms of bowel cancer are often associated with more advanced disease and poorer outcomes.

The difference between bowel cancer symptoms and rectal cancer symptoms

Colon cancer symptoms and rectal cancer symptoms overlap, but they have important differences. Colon cancer symptoms are more common with abdominal pain, bloating, and anemia, while rectal cancer is more common with bloody stools, tenesmus, and changes in stool shape. Patients with rectal cancer often experience a constant urge to defecate, even after a bowel movement.

Symptoms of bowel cancer in the early stages may resemble irritable bowel syndrome, hemorrhoids, or food intolerance, which often leads to late consultation with a doctor and even to a wrong diagnosis of colon cancer. The most successful bowel cancer diagnosis stories start from timely preventive examination and referral to oncologist. Symptoms of tumors in colon largely depend on the part of the colon where the tumor is located. Symptoms of tumors in colon on the right are often barely noticeable, while left-sided ones are more likely to cause obstructive manifestations. That is why instrumental and endoscopic methods, bowel cancer CT scan diagnosis and assessment are the basis of accurate bowel cancer diagnosis [2].

The main symptoms of bowel cancer

In many cases, patients complain not of pain but of general abdominal discomfort. These bowel cancer symptoms are often underestimated, especially in younger people, despite the increasing incidence of early forms of the disease. This frequently leads patients to overlook early warning signs and delay medical consultation, raising the question of what are symptoms of colon cancer that should prompt timely evaluation. That is why timely recognition of these signs is critical for early bowel cancer diagnosis.

There are the main colorectal symptoms that should make you visit your general practitioner in order to give a correct bowel cancer diagnosis:

• Constant chronic pain or expressed discomfort in different parts of abdomen or anus
• Unexplained change in bowel habits (diarrhea or constipation up to bowel blockage by a tumor)
• Feeling of not empty bowel after defecation
• Acute rectal bleeding, presence of blood in stools or on the toilet paper
• Weight loss despite normal feeding
• Fatigue, shortness of breath and dizziness (due to anemia)

Nevertheless, all the above symptoms are not unique just for bowel cancer and require a test for bowel cancer, so you should not be scared in advance.

For example, such colorectal symptom as rectal bleeding may accompany numerous non-cancer conditions such as:

• Hemorrhoids (usually you know about this diagnosis, so you should plan regular visits to your proctologist)
• Anal fissures (this condition is usually accompanied by acute pain, you will need an urgent consultation in the surgical department)
• Infections and inflammatory diseases of the bowel
• Acute and chronic ulcers, especially in the left part of the bowel
• Diverticular disease of the bowel (this is usually a congenital condition)
• General problems with blood vessels and blood coagulation

Late symptoms of bowel cancer usually indicate advanced or locally advanced disease. These include intestinal obstruction, severe abdominal pain, vomiting and significant weight loss. In such cases, diagnosis of bowel cancer should be urgent [2].

Additional late symptoms of bowel cancer may include palpable masses in the abdominal cavity or signs of metastasis, such as liver enlargement. Unfortunately, many patients present with these late symptoms of bowel cancer, which highlights the need for early bowel cancer diagnosis programs.

After the initial conversation and clinical examination the doctor will give you a short conclusion about the disease and further recommendations. You will receive information about your general state, presumable diagnosis (if it is possible at this point) and the next diagnostic steps, including an explanation of how is bowel cancer diagnosed in your specific case. If it is necessary, ask to explain your situation in simple words, so that you`ll be able to understand everything perfectly.

According to the primary results, investigations for confirming or excluding diagnosis of bowel cancer may include such outpatient and inpatient procedures:

• Laboratory test for bowel cancer (colon cancer blood test)
• Endoscopic examination (colonoscopy)
• Different types of CT/MRI
• Biopsy with histological and immunohistochemical study
• Genetic test for bowel cancer

Causes of bowel cancer

The development of colorectal cancer is associated with a number of factors, many of which are directly relevant for timely bowel cancer diagnosis. Studies have shown that the risk of developing this disease is higher in people who have a strong family history of cancer, have had colon polyps, have inflammatory bowel disease, have diabetes, or have had a cholecystectomy.

Lifestyle factors also play a significant role in the formation of colon cancer symptoms. In particular, an increased risk is associated with excess body weight and obesity, low levels of physical activity, smoking, alcohol consumption, and an unbalanced diet. The latter includes a diet with insufficient fiber, fruits, vegetables, calcium, and dairy products, combined with excessive consumption of red and processed meat.

In addition, the likelihood of developing colon cancer symptoms is influenced by the characteristics of the intestinal microbiome, age, gender, race, and socioeconomic conditions. Awareness of these factors is essential for risk stratification, screening planning and accurate bowel cancer diagnosis.

Bowel cancer is a multifactorial disease: its development is rarely due to only one cause. The likelihood of developing a tumor is influenced by genetic characteristics, chronic diseases, lifestyle and age-related changes, all of which must be considered during effective bowel cancer diagnosis. Understanding key risk factors allows you to identify high-risk groups in a timely manner, choose the optimal screening strategy and significantly increase the chances of early detection of the disease.

The main risk factors for colon cancer:

• Family history and hereditary syndromes (Lynch syndrome, familial adenomatous polyposis) – significantly increase the risk due to genetic disorders of DNA repair.
• Inflammatory bowel diseases (ulcerative colitis, Crohn's disease) – chronic inflammation contributes to malignant transformation of cells.
• Adenomatous polyps of the colon – the main source of development of most cases of colorectal cancer.
• Metabolic disorders (type 2 diabetes, obesity) – accompanied by chronic inflammation and hormonal imbalance.
• Unbalanced diet – excess of red and processed meat and deficiency of fiber, vegetables, calcium and vitamin D.
• Harmful habits and sedentary lifestyle – smoking, alcohol consumption and physical inactivity increase the carcinogenic effect.
• Disruption of the intestinal microbiota – contributes to chronic inflammation and DNA damage.
• Age, gender, and socioeconomic factors – the risk increases after age 50, is higher in men, and depends on access to screening [2].

The diagnosis of bowel cancer

The question of how is bowel cancer diagnosed is key for patients who are first faced with suspected bowel cancer. Modern bowel cancer diagnosis is based on a step-by-step algorithm: from the initial assessment of symptoms to confirmation of the diagnosis using instrumental and endoscopic methods. Diagnosis of bowel cancer is based on a combination of clinical vigilance, careful history taking and the use of modern screening and instrumental methods. The process usually begins at the primary care level and continues in specialized gastroenterology centers. It is important to understand that the diagnosis of bowel cancer is not one test, but a complex of examinations, each of which complements the previous one.

Primary stage: visit to the primary care physician

Any bowel cancer diagnosis begins with a visit to a family doctor or therapist. It is at this stage that bowel cancer symptoms, family history and the patient's general condition are analyzed. The presence of colorectal symptoms or a combination of several alarming signs is the basis for further examinations.

The doctor assesses whether the complaints may be associated with functional disorders, or whether a targeted test for bowel cancer is needed. This approach allows you to minimize cases of wrong diagnosis of colon cancer and refer the patient to specialized diagnostics in a timely manner. An important role is played by the detection of alarming signs, such as anemia, abdominal pain, changes in the nature of stool or palpable masses.

Screening programs

A separate way to detect bowel cancer is screening, which plays a crucial role in early bowel cancer diagnosis. Many countries have organized or opportunistic programs, which usually cover people aged 50-75 years. The main goal of screening is to detect the disease before colorectal symptoms appear. The most common tests used are fecal occult blood tests, but the level of population participation in such programs remains variable. Also colonoscopy provides the highest accuracy in confirming or ruling out colorectal cancer.

Endoscopic diagnostics

Endoscopic methods – colonoscopy, sigmoidoscopy and rectoscopy – are the basis for confirming the diagnosis of bowel cancer. They allow direct examination of the mucosa, detection of polyps or tumors and biopsy for histological confirmation. Colonoscopy remains the "gold standard" for both diagnosis and prevention, as it allows the removal of precancerous lesions.

Additional clinical features

In patients with suspected colorectal cancer, doctors also pay attention to signs of a widespread process – peripheral lymphadenopathy, liver enlargement, ascites, or palpable tumor masses in the abdominal cavity, as these findings may indicate advanced disease and significantly influence bowel cancer diagnosis and further clinical decision-making.

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Main tests for bowel cancer diagnosis

Laboratory tests for bowel cancer diagnosis

The doctor will elaborate an individual diagnostic plan for your case, taking into account the symptoms of bowel cancer, so you will go through most informative procedures. The first traditional diagnostic step is the laboratory examination. Some analyses will be performed repetitively, to track the dynamics during the course of bowel cancer treatment.

Recommended laboratory tests will include 2 main blocks of analysis:

1. General tests to check your overall state of health and body function.
2. Tests to find cancer and determine the tumor type.

Laboratory tests are performed as an outpatient procedure. In order to receive reliable results you`ll need to fast for 9 hours before specimens of your blood and urine will be taken.

When preparing for fecal occult blood test (FOBT) you should pay attention to the following:

• Don`t take non-steroid anti-inflammatory drugs three days before the test
• Avoid excessive amounts of vitamin C three days before the test
• Avoid raw fruits and vegetables three days before the test
• Restrict amount of lamb, beef and blood products in your diet three days before the test (you may eat chicken and pork instead)

The main general laboratory tests used for the diagnosis of bowel cancer include:

• Complete blood count (colon cancer blood test). This general test may reveal anemia (low amounts of hemoglobin connected with loss of blood) and a high erythrocyte sedimentation rate (ESR). These signs are not unique for colon cancer diagnosis, but give useful additional information and influence the treatment plan. In patients with distal tumors, these results are often considered as part of the initial evaluation when determining how is rectal cancer diagnosed.
• Biochemical blood test. This test includes several aspects and reflects protein metabolism, blood lipid picture, functions of the liver and kidneys. It is important to perform biochemical blood test before the start of treatment so you`ll be able to track changes in the liver and kidneys function.
• Fecal immunochemical test (FIT). One of the most common methods of initial assessment is a test for bowel cancer in the form of a stool test for occult blood. If the patient has a FIT test positive, the patient is necessarily referred for further examination, as this may be an early sign of a tumor process. Many patients are interested in the next question: can a blood test detect bowel cancer? It is important to emphasize: a standard blood test does not confirm cancer, but can detect anemia or inflammatory changes, which become the basis for further bowel cancer diagnosis. In clinical practice, a colon cancer blood test is also used, but it has an auxiliary value and does not replace instrumental methods. Understanding how to test for bowel cancer, helps patients to consciously undergo examination and not to postpone the next steps after suspicious results.
• Fecal occult blood test (FOBT). This test is a part of a widespread screening program. Many bowel cancer diagnosis stories started from the positive result of a screening test. FOBT reveals the tiniest, invisible amounts of blood in the stool and helps to find the disease during the early stages. FOBT is also useful for detecting non-cancer background conditions, such as polyps. The important point is you should follow all recommendations of your general practitioner and prepare for this test properly. Proper preparation and adherence to medical recommendations are essential, especially when FOBT is used as an initial step before determining how is rectal cancer diagnosed.
• Fecal calprotectin test. Calprotectin is a protein, produced by white blood cells (leukocytes). Production of this protein is mainly stimulated by inflammation in the digestive tract. Oncological process damages the wall of the intestine and the level of calprotectin in the stool increases dramatically. You may not go through this additional test in case FOBT gives a strong positive result.

More specific for the diagnosis of bowel cancer tests include tumor markers analysis. There are two main types of tumor markers. The first one is produced by the tumor or is a part of the tumor. The second one is produced by the human body as a response to the cancer process.

Currently healthcare professionals give preference to the following analysis:

• Carcinoembrionic antigen (CEA), blood test. CEA is a protein, normally produced in the gastrointestinal tract of the fetus. In adults CEA level remains low, except for certain types of cancer. More than 60 % of patients with the diagnosis of bowel cancer have high levels of CEA during laboratory examination. Nevertheless, CEA test is mainly used not for establishing primary diagnosis, but for the assessment of treatment quality, making prognosis regarding expectancy of life and early revelation of cancer relapses. Also we should notice that CEA test may give false-positive results in case of smoking or pregnancy.
• Cancer antigen 19-9 (CA 19-9), blood test. This test is helpful when the doctor is suspicious regarding both bowel cancer and pancreatic cancer. The level of CA 19-9 is elevated in case of pancreatic cancer, this marker is not typical for the diagnosis of bowel cancer.

In addition to standard tests, modern diagnostics also use the Multitarget Stool DNA Test (mt-sDNA). This is a non-invasive stool test that combines the detection of occult blood with the analysis of specific DNA markers of tumor cells exfoliated from the intestinal mucosa [6].

Modern science is still looking for a precise blood screening test for bowel cancer diagnosis. At this point the most successful variant is a blood test by biomedicine company Universal Diagnostics. The test estimates about 30-40 parameters – both biomarkers released by cancer cells and specific changes in protein/fat/carbohydrates metabolism related to the oncological process.

Instrumental examination for bowel cancer diagnosis

The next set of diagnostic tests includes instrumental examination. Usually you will need more than one investigation to receive a comprehensive clinical picture. The doctor will explain to you the necessity of each procedure and its possible risks, particularly when clarifying how is rectal cancer diagnosed and which methods are most informative in a specific clinical situation. Most instrumental investigations of the abdomen require preliminary bowel preparation. This ensures the possibility of receiving more reliable results and improving their quality significantly.

Below you can find the most effective ways of bowel preparation:

• Diet. Three days before the examination is done you should avoid high-fiber foods (raw vegetables and fruits, seeds, cereals).
• Fermentative drugs intake. Drugs that contain gastro-intestinal enzymes will ease the process of food digestion, reduce the amount of food remaining in the bowel and suppress excessive formation of intestinal gas.
• Laxative drugs. The doctor may recommend you to take this kind of drug 12-18 hours before the test. Laxative drugs cause watery diarrhea and clear the bowel content this way. To make the period of active drug action more comfortable, you should plan your time and stay at home. You should also drink a lot of clear fluids to prevent dehydration (pathologic water loss).
• Enema. During this procedure a small amount of special liquid is put in your rectum to clear the lower part of the intestine before the examination for bowel cancer diagnosis.

Imaging techniques play an important role in the diagnosis of bowel cancer. Bowel cancer CT scan diagnosis is used to assess the extent of the tumor, lymph node involvement, and possible metastases. Bowel cancer CT scan diagnosis is usually not the primary method for detecting a tumor, but is critically important after it is confirmed [7].

In clinical guidelines, bowel cancer CT scan diagnosis is also used for treatment planning and monitoring response to therapy. That is why this method is an integral part of modern bowel cancer diagnosis.

The most simple and non-invasive way to assess the state of abdomen organs (especially colon cancer diagnosis) is ultrasound (US) examination. In the US, this examination is an outpatient procedure. You should prepare your bowel in advance according to doctor`s recommendations and fast for 9-12 hours. In the US scans show the tumor itself or reveal indirect signs of an oncological process. The doctor (sonographer) should be qualified enough to perform the procedure in a proper way, as US examination is quite subjective. If the doctor suspects colorectal cancer, he may perform rectal ultrasound with the help of a special probe.

CT and MRI scans with contract (dye substance) give your doctor information about general state of abdominal organs, localization and size of the tumor and spreading of the oncological process (presence of metastases). Also CT/MRI of the chest may be required for the assessment of cancer spreading. CT and MRI in terms of bowel cancer diagnosis have all the usual limitations; don`t forget to inform your doctor about an allergy, pregnancy, diabetes mellitus or problems with kidneys and liver.

One of the most specific investigations is FDG-PET (fluorodeoxyglucose-positron-emission-tomography). Before FDG-PET you will take substance with special modified glucose molecules. Glucose is the main source of energy for most cells. Oncological cells have very active metabolism and thus cumulate a significant number of contrast substance. Due to modification glucose molecules are perfectly seen on the PET scan, their focuses reflect presence, localization and size of the tumor.

Endoscopic examination for bowel cancer diagnosis

Endoscopic examination is the central stage of bowel cancer diagnosis, since it allows you to directly examine the mucous membrane of the colon and detect pathological changes. The most informative method is considered to be colonoscopy, which covers the entire colon and is one of the main colon cancer diagnosis tests.

In clinical practice, diagnosis of bowel cancer using endoscopy is carried out in patients with symptoms of bowel cancer, colorectal symptoms or after screening results such as FIT test positive. It is colonoscopy that allows you to accurately localize the lesion, assess its extent and determine further tactics.

Another procedure, aimed to confirm or exclude the diagnosis of colorectal cancer, is proctoscopy. It gives the possibility to examine rectum and lower part of the colon (sigmoid colon) directly. Proctoscopy is performed with the help of a proctoscope, a metal or plastic hollow tube about 15-25 cm long with a small light bulb at the end. At the beginning of the manipulation; lubricated proctoscope is placed into the rectum and a small amount of the air is pumped inside to enlarge the rectum. During the procedure your doctor will carefully examine the intestinal wall and take a biopsy from the suspected areas, if necessary. Proctoscopy is a little bit uncomfortable, but a well tolerated procedure. It is performed as an outpatient procedure and doesn`t require anesthesia.

Flexible sigmoidoscopy is widely used for bowel cancer diagnosis, as it helps to examine the rectum and lower part of the large bowel in greater detail. The majority of polyps with increased oncological alertness are located exactly in these areas. Sigmoidoscopy requires proper preparation, including special diet, drugs and enema, which is essential for accurate diagnosis of bowel cancer. The procedure is performed with the help of a long flexible tube with a small camera and light. Your doctor sees the intestine wall on the monitor, in addition he is able to take a biopsy from the suspicious areas, if indicated clinically. It is important to tell your doctor about all possible contraindications to biopsy taking (for example, blood clotting disorders) before the procedure is started. Sigmoidoscopy is quite uncomfortable, so the anesthesia may be administered. Nevertheless, the procedure takes only about 15-20 minutes and you may go home immediately after everything is finished.

Colonoscopy is a more advanced endoscopic examination as it covers the entire large bowel. In general, the technique is similar to sigmoidoscopy; the main difference is in the length of sigmoidoscope and colonoscope. When we talk about colonoscopy, thorough preparation is really significant, as a poor state of the bowel may cause serious mistakes (for example, missing small polyps, etc.). The procedure is comprehensive in establishing diagnosis of bowel cancer, that is why colonoscopy usually takes about an hour and requires sedation. Your doctor will check if you tolerate the anesthetic well and give you all the necessary medications. During colonoscopy the doctor examines the state of the bowel wall, makes photos and takes a biopsy. If necessary, dye may be sprayed onto the bowel wall – this shows abnormal and suspicious areas. Colonoscopy is an outpatient procedure, you will be able to go home once the effect of anesthesia wears off [8].

Patients often wonder how long does a colonoscopy take, especially if the procedure is repeated. In most cases, the answer to the question how long does a colonoscopy take is about 40-60 minutes, depending on the scope of the study and the need for additional manipulations.

Due to its accuracy, colonoscopy is considered one of the best colon cancer diagnosis tests and a key tool in understanding how to test for bowel cancer.

If medical contraindications are present, colonoscopy may be substituted with similar non-invasive examination – computed tomography (CT) colonography. Another name of this investigation is virtual colonoscopy. Preparation for the procedure includes the same measures as preparation for the colonoscopy. In addition, you will take the contrast substance (gastrografin) which enhances efficiency of the investigation. During the CT colonography your bowel will be filled with gas, after that doctor will get a series of a few images from your back and front. On the basis of this information a 3D picture of your bowel will be constructed.

CT colonography is not used often due to a few reasons:

• Procedure includes exposure to the radiation
• Procedure has lower accuracy in comparison with colonoscopy
• It is impossible to take biopsy during the investigation
• Procedure is not available in all hospitals

Once you go through all recommended investigations, your doctor will tell you all the results and explain them in simple words.

Biopsy for bowel cancer diagnosis

A definitive diagnosis of bowel cancer is not possible without histological confirmation. Samples obtained during colonoscopy are analyzed by a pathologist to determine the type of tumor and its biological characteristics. Biopsy with histological and immunohistochemical study remains golden standard in establishing the diagnosis of bowel cancer and helps to avoid wrong diagnosis of bowel cancer. Laboratory tests, endoscopic and visualizing techniques give the doctor important information during diagnosis of bowel cancer, but the biopsy is an obligatory option when it concerns cancer. This is particularly important when clarifying how is rectal cancer diagnosed, as visual assessment alone cannot reliably distinguish benign from malignant rectal lesions. Results of the biopsy are the basis for choosing a treatment regimen and making individual prognosis.

Tissue samples for histological and immunohistochemical study may be taken:

• During endoscopic examination (proctoscopy, sigmoidoscopy, colonoscopy)
• During surgery (express biopsy) or after the completion of surgical intervention
• In certain cases – via fine needle biopsy with CT or ultrasound control

Biopsy allows to distinguish benign and malignant changes, to avoid colon cancer delayed diagnosis and to prevent erroneous clinical decisions. In patients with early bowel cancer symptoms or late symptoms of bowel cancer, histological confirmation is crucial for further treatment planning [9].

The results of the biopsy form the basis for staging in colorectal cancer, since the type of tumor, the degree of differentiation and invasion directly affect the prognosis. It is at this stage that the diagnosis of bowel cancer moves from suspicion to a confirmed clinical diagnosis.

During genetic testing doctor investigates peculiarities of the tumor and possible problems in your genome, such as:

• DNA ploidy – this is an amount of genetic material in oncological cells
• P53 gene – this gene is often absent or broken in cancer cells
• Ras gene – this gene is often damaged in colorectal cancer
• Genetic testing for FAP (familial adenomatous polyposis) – this condition is often connected with the colorectal symptoms and diagnosis of bowel cancer [10]

Unlike laboratory tests and instrumental investigations, results of biopsy and genetic testing are ready in 2 weeks or even later. When medical reports are ready, your doctor will contact you immediately and discuss further diagnosis of bowel cancer and treatment plan.

What happens after the tests?

If the diagnosis is confirmed, a bowel cancer CT scan diagnosis is used to assess the extent of the tumor and perform staging in colorectal cancer. This allows the doctor to explain to the patient how bowel cancer is diagnosed in a particular case and what prognostic factors are important. The results of blood tests, FIT-test and imaging studies are usually discussed by a family doctor or gastroenterologist as a part of initial bowel cancer diagnosis. If the indicators are within the normal range, the patient is recommended for routine observation or repeated screening.

If formations are detected during colonoscopy, a biopsy is performed. The histological conclusion is a key document that confirms or excludes a malignant process. The results are reported during a separate consultation with a detailed explanation.

After completing all examinations – endoscopy, biopsy, imaging – the patient moves on to the final stage of bowel cancer diagnosis, which includes interpreting the results and determining further steps. It is here that it becomes clear whether it is an early form of the disease or an advanced process.

If cancer is confirmed, the bowel cancer diagnosis is followed by a multidisciplinary team. An oncologist, surgeon, gastroenterologist, radiologist, and pathologist are involved in treatment planning. This allows for a personalized treatment plan to be formed. The doctor explains in detail the stage of the disease, possible treatment options, their effectiveness, risks, and expected results.

Based on all the data, an individual bowel cancer treatment plan is formed. If the test results are contradictory, additional test for bowel cancer or repeated colon cancer diagnosis tests may be prescribed. This step-by-step approach minimizes the risk of errors and ensures the most accurate diagnosis of bowel cancer.

In the early stages, surgical removal of the tumor or endoscopic removal of early lesions is often sufficient. The prognosis is favorable in most cases. For locally advanced cancer, combined treatment is usually used: surgery in combination with chemotherapy, and for rectal cancer, also with radiation therapy. For advanced or metastatic cancer, the mainstay of treatment is systemic therapy (chemotherapy, targeted therapy, and immunotherapy). Surgical interventions may be used to control colorectal symptoms or in certain clinical situations.

It is important to understand that after diagnosis, not only the stage of the disease plays a decisive role, but also the quality and timeliness of treatment. Modern oncology centers in Germany combine highly accurate diagnostics, the work of multidisciplinary teams and access to the latest surgical, drug and radiation treatment methods, which directly affects the survival rates and life expectancy of patients.

That is why many patients choose treatment in Germany – a country with clear clinical protocols, an individual approach and the opportunity to receive optimal therapy even in complex clinical cases. Such an approach gives not only a chance to control the disease, but also to preserve the quality of life, which is no less important for the patient and his family.

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A Medical Journey: Every Step of the Way With Booking Health

Finding the best treatment strategy for your clinical situation is a challenging task. Being already exhausted from multiple treatment sessions, having consulted numerous specialists, and having tried various therapeutic interventions, you may be lost in all the information given by the doctors. In such a situation, it is easy to choose a first-hand option or to follow standardized therapeutic protocols with a long list of adverse effects instead of selecting highly specialized innovative treatment options.

To make an informed choice and get a personalized cancer management plan, which will be tailored to your specific clinical situation, consult medical experts at Booking Health. Being at the forefront of offering the latest medical innovations for already 12 years, Booking Health possesses solid expertise in creating complex cancer management programs in each case. As a reputable company, Booking Health offers personalized bowel cancer treatment plans with direct clinic booking and full support at every stage, from organizational processes to assistance during treatment. We provide:

• Assessment and analysis of medical reports
• Development of the medical care program
• Selection of a suitable treatment location
• Preparation of medical documents and forwarding to a suitable clinic
• Preparatory consultations with clinicians for the development of medical care programs
• Expert advice during the hospital stay
• Follow-up care after the patient returns to their native country after completing the medical care program
• Taking care of formalities as part of the preparation for the medical care program
• Coordination and organization of the patient's stay in a foreign country
• Assistance with visas and tickets.
• A personal coordinator and interpreter with 24/7 support
• Transparent budgeting with no hidden costs

Health is an invaluable aspect of our lives. Delegating management of something so fragile yet precious should be done only to experts with proven experience and a reputation. Booking Health is a trustworthy partner who assists you on the way of pursuing stronger health and a better quality of life. Contact our medical consultant to learn more about the possibilities of personalized treatment with innovative methods for bowel cancer with leading specialists in this field.

Fighting Cancer Together: Treatment Journeys with Booking Health

Jared Todd M. (USA), February 2026

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Emmanuel K. (USA), January 2026

Peter H. (United Kingdom), January 2026

Patrick D. (Ireland), December 2025

Ronald C. (Canada), November 2025

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David D. (United Kingdom), September 2025

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Amanda Louise C. (Australia), July 2025

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Authors:

This article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova, and Dr. Daria Sukhoruchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

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Sources:

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[4] Sanower Hossain, Hidayah Karuniawati, Ammar Abdulrahman Jairouncz et al. Colorectal Cancer: A Review of Carcinogenesis, Global Epidemiology, Current Challenges, Risk Factors, Preventive and Treatment Strategies. Journals Cancers 2022, Volume 14, Issue 7. doi: 10.3390/cancers14071732. [DOI]

[5] Melina Arnold, Mónica S Sierra, Mathieu Laversanne et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017 Apr;66(4):683-691. doi: 10.1136/gutjnl-2015-310912. Epub 2016 Jan 27. [DOI] [PubMed]

[6] Raquel Gómez-Molina , Miguel Suárez, Raquel Martínez et al. Utility of Stool-Based Tests for Colorectal Cancer Detection: A Comprehensive Review. Healthcare (Basel). 2024 Aug 18;12(16):1645. doi: 10.3390/healthcare12161645. [DOI] [PMC free article]

[7] Joshua D Angrist, Peter Hull. Instrumental variables methods reconcile intention-to-screen effects across pragmatic cancer screening trials. Proc Natl Acad Sci U S A. 2023 Dec 15;120(51):e2311556120. doi: 10.1073/pnas.2311556120. [DOI] [PMC free article]

[8] Seung Wook Hong, Jeong-Sik Byeon. Endoscopic diagnosis and treatment of early colorectal cancer. Intest Res. 2022 Jul 26;20(3):281–290. doi: 10.5217/ir.2021.00169. [DOI] [PMC free article]

[9] Mona Mlika, Mohamed Majdi Zorgati, Imen Ben Ismail, Sarra Cheikhrouhou, Chadli Dzir. The diagnostic value of the liquid biopsy in the colon cancer. Future Sci OA. 2025 Nov 18;11(1):2590381. doi: 10.1080/20565623.2025.2590381. [DOI] [PMC free article]

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