Under investigation for suspected diagnosis. What tests and/or procedures should I expect?

Hi everyone. I’m new to this forum and feel quite silly asking this as it is probably very obvious but I’m just so confused and don’t feel able to ask anyone else. 

I had a colonoscopy at the end of last year which was normal however my symptoms have got progressively worse. My consultant did an external exam last month and saw a fissure which hasn’t been responding to conservative treatment. She then did a digital rectal exam which really hurt but I didn’t tell her how painful it was because I didn’t want her to think I was overreacting. Anyway, she asked if this is the pain I get when I open my bowels and I said yes, but I didn’t tell her that sometimes it’s there. At the point I said it was the same type of pain she stopped. She told me to try the conservative treatment for a bit longer and then she said ‘we will then see where we go from there’. My GP said it is to rule out cancer. 

I’m really worried what she means by that and I’m confused because if my colonoscopy was normal eight months ago does that not mean this cannot be cancer? 

What sort of tests are needed or carried out to diagnose anal cancer? I’m so confused as to next steps as the conservative treatment just is not working and I’ve been on and off it since for three months. 

I’d really appreciate any advice or information and sorry if this sounds silly!

  • Hi Io, 

    Please don't ever worry about 'sounding silly' or being confused. This is not a journey anyone has practiced for!

    I had a colonoscopy about 6 months prior to my diagnosis which didn't show any problems, so while colonoscopies are good and helpful, they're no guarantee. Like you, my pain continued and escalated, so even though the gastro practice who did the colonoscopy said 'See you in 20 years' I persisted.

    This does NOT mean that, like me, you have anal cancer. But it does highlight, I think, the need to keep on advocating for yourself.

    I gently suggest that being your own advocate means being brutally honest with your medical personnel. Don't let yourself get fobbed off, but also don't sabotage yourself by downplaying your symptoms. I KNOW my wonderful gastroenterologist, the one who finally found the cancer, was annoyed by my 'over-reaction' to the digital exam and anoscopy. I couldn't handle the pain and had to get examined under anesthesia. But that was where the cancer was found. 


    We really can't blame them for not following up if they don't know there's a problem.

    Yours may well NOT be cancer. I hope and pray that it's not. But whatever it is needs to be diagnosed, and if it IS cancer, the sooner the better.

    In my case, Dr. Pierre took biopsies during the exam under anesthesia and that was how they found it. I was T2N0, so fortunately very early. The aggressive but effective treatment seems to have got it all, as I'm now a year and a half past treatment. My one year scans showed NED (no evidence of disease.)

    Please ask your GP to recommend a good gastroenterologist and be 100% honest with them. This is not the time to tough it out. If it's not cancer, great, but you still need and deserve a medical team that will work to find out why you are in pain.

    You do not have to suffer in silence.



  • Hi lo123 welcome to the group. It can be very frustrating when you leave the doctors feeling that you still haven’t had your worries covered. I cannot say about the colonoscopy but they are done usually to see if there’s a need to do follow up tests like scans when they are suspicious of anything abnormal. I do know about fissures as I developed one when I had chemo radiotherapy which caused constipation and literally split my anus. They are incredibly painful and I was given a diltiazem gel which I reacted quite badly to with migraines due to the get being a stimulant given to heart attack patients! It is used in gel form to relax the sphincter muscles. Your doctor probably advised you to not get constipated and eat plenty of stool softening foods and plenty of fluids every day. I ended up using baby Vaseline every time I opened my bowels. I do think you need to ask your doctor to clarify what she meant as I understand what she said about using conventional methods first for the fissure before resorting to the stronger stuff like the gel but not about the cancer as you wouldn’t just wait and see! My doctor would not do an internal as she could see it any didn’t want to cause more pain. I think you will have peace of mind to have your answers to your concerns than this stress it’s causing

  • Hello lo123

    I am so sorry you have this worry hanging over you, but I totally agree with the others in escalating your concerns with the consultant.  I have no personal experience of an anal fissure but I know they are extremely painful and it must be very hard for you to have it going on for so long.  I wouldn't downplay your symptoms at all when you see the consultant and completely share your concerns with her and tell her how painful it is.

    At a guess I would say the next move might be a biopsy of the area, but I have no medical experience, only what I have gained on here.  Is your consultant a colorectal surgeon?  I am sure she wouldn't be offended in the least if you asked her exactly what she means by 'we will see where we go from there'.  If you aren't due to see her very soon, you could ring her secretary with your questions.  

    I don't think you are being silly in the last, lo123.  Please come back and tell us how you get on.

    Irene xx

  • Hi there.  Slightly different experience. I’d had a routine colonoscopy which didn’t show anything.  I had been experiencing blood in my poo.  My GP insisted I had piles but the symptoms had gone on for too long. The GP was not happy that I doubted them when I requested a referral to a colorectal specialist.  At the time I had medical insurance via my employer.  August last year I had a digital rectal examination, quite unpleasant & painful.  The specialist told me there & then that he thought it was a rectal squamous cell carcinoma. He confirmed that I had a lump in my anus and this was not piles. Like you, I was asked about bowel motions, pain etc. You are not being silly at all. Please speak to your specialist & let them know your concerns & worries.  My specialist referred me to NHS cancer pathways & I was referred to an oncologist who referred me for a sigmoidoscopy where biopsies where taken which confirmed the diagnosis. A sigmoidoscopy looks at the lower part of your anus/rectal area.  This would rule out any lumps & bumps & confirm a fissure.  As Suz says, your symptoms do not mean that you have anal cancer.  Ask your GP for a referral to a colorectal specialist.  If cancer is ruled out,the specialist will let you know about any recommended treatment,  The oncologist referred for CT scan, MRI scan and PET scan.  I then underwent chemotherapy & radiotherapy. I have had follow up scans and in June this year I was told NED (no evidence of disease). I will have follow up CT scan in September & a follow up with the oncologist to discuss the results. If NED then yearly CT scans/consultations for 5 years.   Don’t get fobbed off.  You are entitled to a 2nd opinion.  Please let us know how you get on.   Love Karen.