Problem addressed, background and strategic significance

Bowel cancer can arise from polyps, which can become cancerous. Polyps are little outgrowths within the lining of the bowel (similar to skin warts). Dependent on size and cancerous potential, these can cause bleeding. It is not known which polyps harbour cancerous potential, thus, at present, all patients undergo a colonoscopy to identify and remove any polyps. However, not all patients who undergo a colonoscopy (camera examination of the large bowel) will have polyps. In addition, colonoscopies are invasive and disruptive to patients especially time-consuming bowel preparation.

We propose non-invasive stool and urine tests to identify patients at risk of polyps and if they have potential to become cancerous. Only those with a positive stool or urine test suggesting risk of polyps will undergo a colonoscopy.

Method(s) used

We will use a test that measures blood in the stool (known as FIT test) as well as urine test (volatile markers; chemicals produced by the body in disease) to identify the accuracy of these tests in diagnosing bowel polyps. Stool FIT test is already in use in patients with symptoms of bowel cancer and will be introduced in the UK bowel cancer screening programme in 2019. Urine volatile markers have shown promise in our earlier published studies but require further confirmation.

Hoped for results of this research

Our early results (94 patients) have shown that both stool testing using FIT and urine volatile markers can detect a significant number of patients with bowel polyps. In this study, we seek to confirm our findings in a larger group of 354 patients

What this research is expected to add to the knowledge of bowel disease and what is the impact you hope to achieve for patients?

Results will provide the evidence base required for use of non-invasive stool and urine testing to accurately identify those at risk of bowel polyps with cancerous potential. This can then be incorporated within clinical practice thereby benefiting patients through early detection and avoiding unnecessary invasive tests.