The symptoms of benign prostate enlargement are caused by the enlarged prostate placing pressure on the bladder and urethra (which carries urine from the bladder to the penis).
This can affect urination in a number of ways. For example, it can:
make it difficult for you to start urinating
weaken the flow of urine or cause ‘stopping and starting’
cause you to strain to pass urine
cause you to need to urinate frequently
cause you to wake up frequently during the night to urinate
cause a sudden urge to urinate, which can result in urinary incontinence if you can’t find a toilet quickly enough
cause you to not be able to empty your bladder fully
cause blood in the urine (haematuria)
In the later stages, benign prostate enlargement can cause urine retention and other complications such as bladder stones, bladder infections and kidney damage.
You’ll be asked to complete a questionnaire to assess your symptoms. Each question has 5 possible answers that carry a score, and your overall score is used to assess the severity of your symptoms.
The checklist includes the following questions.
Over the past month, how often:
have you had the sensation of not completely emptying your bladder after urinating?
have you had to urinate again less than 2 hours after finishing urinating?
have you found that you stopped and started again when urinating?
have you found it difficult to postpone urination?
have you had a weak stream of urine?
have you had to push or strain to begin urinating during the course of one night?
have you had to get up during the night to urinate?
After your GP has assessed the severity your symptoms, they’ll aim to rule out other conditions with similar symptoms using certain tests.
The cause of prostate enlargement is unknown, but most experts agree that it’s linked to hormonal changes that occur as a man gets older.
Read more about the causes of benign prostate enlargement
The exact cause of benign prostate enlargement is unknown, but research suggests that hormones probably play an important role in the condition’s development.
Hormones are powerful chemicals that can have a wide range of effects on the cells of the body.
One theory is that as some men and anyone with a prostate gets older, the levels of a type of hormone called dihydrotestosterone (DHT) increases, which may stimulate the growth of the prostate.
Another theory suggests that two hormones, testosterone and oestrogen, play a role. Younger men and anyone with a prostate produce high levels of testosterone and much smaller levels of oestrogen. But as they get older, levels of testosterone decrease, which means they then have a higher proportion of oestrogen in their body. It’s been suggested that the relative increase in oestrogen may stimulate prostate growth.
If your GP suspects that you have an enlarged prostate, you’ll be asked to complete a questionnaire to assess your symptoms.
Each question has 5 possible answers that carry a score, and your overall score indicates the severity of your symptoms.
Your GP will also want to rule out other conditions that cause similar symptoms to prostate enlargement.
You may have a number of standard tests, such as urine tests, plus some more specific tests, such as a blood test that measures PSA.
Read more about diagnosing benign prostate enlargement
To find out whether your prostate gland is enlarged, you’ll need to have a few tests.
Some tests will be carried out by your GP and others will be carried out by a urologist (a doctor who specialises in urinary problems).
First, your GP will ask about your symptoms. If it seems that you have symptoms of benign prostate enlargement, the next stage is to calculate your International Prostate Symptom Score (IPSS).
Treatment for an enlarged prostate is determined by the severity of your symptoms.
If you have mild to moderate symptoms, you won’t receive any immediate medical treatment, but you’ll have regular check-ups to carefully monitor your prostate.
You’ll probably also be advised to make lifestyle changes, such as limiting your caffeine and alcohol intake, and exercising regularly, to see if they improve your symptoms.
As well as lifestyle changes, medication is usually recommended to treat moderate to severe symptoms of benign prostate enlargement. Finasteride and dutasteride are medications that are commonly used. They block the effects of a hormone called dihydrotestosterone (DHT) on the prostate gland, which can reduce the size of the prostate and improve associated symptoms.
Alpha blockers may also be prescribed. They help to relax your bladder muscles, making it easier to pass urine. Tamsulosin and alfuzosin are two alpha blockers commonly used to treat benign prostate enlargement.
Surgery is usually only recommended for moderate to severe symptoms of benign prostate enlargement that have failed to respond to medication.
Read more about treating benign prostate enlargement
See your GP if you notice any problems with, or changes to, your usual pattern of urination. Even if the symptoms are mild, they could be caused by a condition that needs to be investigated.
Any blood in the urine must be investigated by your GP to rule out other more serious conditions.
The treatment for an enlarged prostate gland will depend on how severe your symptoms are.
The 3 main treatments are:
lifestyle changes
medication
surgery
If your symptoms are mild to moderate, you may not receive any immediate medical treatment, but you’ll have regular check-ups to carefully monitor your prostate gland. This is often referred to as ‘watchful waiting’.
You may also be advised to make lifestyle changes to see whether they improve your symptoms.
Benign prostate enlargement can sometimes lead to complications such as a urinary tract infection (UTI) or acute urinary retention. Serious complications are rare.
Read more about the complications of benign prostate enlargement
Benign prostate enlargement can sometimes lead to complications, such as a urinary tract infection or acute urinary retention.
In most cases, there are no signs of bile duct cancer until it reaches the later stages, when symptoms can include:
jaundice – yellowing of the skin and the whites of the eyes, itchy skin, pale stools and dark-coloured urine
unintentional weight loss
abdominal pain
Speak to your GP if you have signs of jaundice or are worried about other symptoms. While it is unlikely you have bile duct cancer, it is best to get it checked.
Read more about the symptoms of bile duct cancer
Bile duct cancer doesn’t usually cause any symptoms until the flow of bile from the liver is blocked.
In most cases, the condition is at an advanced stage by this time.
The blockage will cause bile to move back into the blood and body tissue, resulting in symptoms such as:
jaundice – yellowing of the skin and whites of the eyes, itchy skin, pale stools and dark-coloured urine
unintentional weight loss
abdominal pain – most people feel a dull ache in the upper right-hand side of their abdomen (stomach)
high temperature (fever) of 38C (100.4F) or above and shivering
loss of appetite
The exact cause of bile duct cancer is unknown. However, some things may increase your chances of developing the condition. The most common include being over 65 years old or having a rare chronic liver disease called primary sclerosing cholangitis (PSC).
Read more about the causes of bile duct cancer
The exact cause of bile duct cancer is unknown, although some things can increase the risk of developing the condition.
Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour.
If left untreated, cancer can grow and spread to other parts of your body, either directly or through the blood and lymphatic system.
Cancer of the bile duct can be difficult to diagnose, so you may need several tests, including:
blood tests
ultrasound scans
computerised tomography (CT) scans
magnetic resonance imaging (MRI) scans
For some of these tests, you may need to be injected with a special dye that highlights your bile ducts.
You may also need a biopsy. This involves removing a small sample of tissue so it can be studied under a microscope. However, in some cases, your surgeon may prefer to remove the suspected tumour based on the results of your scans alone.
Read more about diagnosing bile duct cancer
Bile duct cancer can be a challenging condition to diagnose. You usually need several different tests before an accurate diagnosis can be made.
In bile duct cancer, the cancerous cells may release certain chemicals that can be detected using blood tests. These are known as tumour markers.
However, tumour markers can also be caused by other conditions. A positive blood test does not necessarily mean you have bile duct cancer, and a negative blood test does not always mean you don’t.
Cancer of the bile duct can usually only be cured if cancerous cells haven’t spread. If this is the case, some or all of the bile duct may be removed.
Only a small proportion of bile duct cancer cases are diagnosed early enough to be suitable for surgery. This is because symptoms usually develop at a late stage.
Despite this, treatment such as chemotherapy can relieve the symptoms of bile duct cancer and improve the quality of life of people in the advanced stages of the condition.
Read more about treating bile duct cancer
Always visit your GP if you have jaundice. While jaundice is unlikely to be caused by bile duct cancer, it could indicate an underlying problem with the liver, such as hepatitis.
Most cases of bile duct cancer cannot be cured. Instead, treatment is most commonly used to relieve symptoms.
Due to the rarity of bile duct cancer, you are likely to be referred to a specialist hepatobiliary unit with experience in treating the condition.
A multidisciplinary team (MDT) made up of different specialists will help you decide on your treatment, but the final decision will be yours. Your MDT may include:
a liver surgeon – a specialist in treating cancers of the liver
a medical or clinical oncologist – a specialist in the non-surgical treatment of cancer using techniques such as radiotherapy and chemotherapy
a pathologist – a specialist in diseased tissue
a radiologist – a specialist in radiological diagnosis and intervention
a cancer nurse – who usually acts as the first point of contact between you and the rest of the care team
a gastroenterologist – a specialist in the medical management of liver and biliary disease
Before going to hospital to discuss your treatment options, you may want to write a list of questions to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.
Your recommended treatment plan will be determined by your general health and the stage the cancer has reached.
In cases of stage 1 and stage 2 bile duct cancer, a cure may be possible by surgically removing the affected part of the bile duct, and possibly some of the liver or gallbladder.
In cases of stage 3 bile duct cancers, the chances of achieving a successful cure will depend on how many lymph nodes have been affected. A cure may be possible if only a few nodes have cancerous cells in them, or it may be possible to slow the spread of the cancer by surgically removing the lymph nodes.
In cases of stage 4 bile duct cancer, achieving a successful cure is highly unlikely. However, stenting, chemotherapy, radiotherapy and surgery can often be used to help relieve the symptoms.
Your treatment plan may also be different if you have intrahepatic bile duct cancer, as this is usually treated in a similar way to liver cancer. Read more about treating liver cancer.
A number of experimental treatments may be available as part of a clinical trial.
The treatments for bile duct cancer are not as effective as treatments for other types of cancer. Therefore, a number of clinical trials are being conducted to find better ways of treating the condition.
For example, ongoing trials are looking at new combinations of chemotherapy medicines, which may help extend the lifespan of someone with bile duct cancer.
Targeted therapies
Another promising field of research involves using targeted therapies to treat bile duct cancer. Targeted therapies are medications that target the processes that cancerous cells need to grow and reproduce.
In studies for some cancers, a medication called sorafenib has proved reasonably effective. Sorafenib works by blocking a protein that cancerous cells need to create a blood supply. However, sorafenib is not currently used as a routine treatment for bile duct cancer.
As bile duct cancer is a rare condition, there is a possibility you may be invited to take part in a clinical trial looking at the use of these types of experimental treatments.
All clinical trials are carried out under strict ethical guidelines based on the principles of patient care. However, there is no guarantee that the treatment you receive during a clinical trial will be more effective, or even as effective, as existing treatments.
Read more about clinical trials and clinical trials for bile duct cancer
There are no guaranteed ways to avoid getting bile duct cancer, but you can reduce your chances of developing it.
The most effective ways of achieving this are reducing your alcohol intake, as cirrhosis is a risk factor, and trying to ensure that you don’t become infected with hepatitis B or hepatitis C.
Read more about preventing bile duct cancer
There are no guaranteed ways to avoid getting bile duct cancer, although it is possible to reduce your chances of developing the condition.
The 3 most effective steps to reduce your chances of developing bile duct cancer are:
giving up smoking (if you smoke)
drinking alcohol in moderation
minimising your exposure to the hepatitis B and hepatitis C viruses
The main sign of binge eating disorder is someone bingeing on a regular basis.
Signs that an episode of overeating is actually a binge, include:
eating much faster than normal
eating until you feel uncomfortably full
eating a large amount of food when you’re not hungry
eating alone or secretly due to being embarrassed about the amount of food you’re consuming
having feelings of guilt, shame or disgust afterwards
If you feel like you have to purge what you’ve eaten after a binge to avoid gaining weight, you may have symptoms of bulimia.
If binges don’t happen regularly, and your weight is very low, you may have symptoms of anorexia.
There are some treatments available for binge eating disorder.
Guided self-help
The main type of psychological treatment for binge eating disorder is guided self-help. Guided self-help is where you work through information and activities on your own. You’ll also have regular support sessions with a professional (usually a psychologist).
Cognitive behavioural therapy (CBT)
Another treatment is cognitive behavioural therapy (CBT), either individually or as part of a group. CBT starts with the idea that thoughts, feelings, and behaviour are linked and affect one another.
If problems in your life are causing you to binge eat, CBT helps you to reduce bingeing. It helps to identify the underlying issues so you’re less likely to binge in the future.
Learn more about talking therapies
Antidepressants
Antidepressants may be used alongside other treatments for binge eating disorder.
Bipolar disorder is characterised by extreme mood swings. These can range from extreme highs (mania) to extreme lows (depression).
Episodes of mania and depression often last for several weeks or months.
The exact cause of bipolar disorder is unknown, although it’s believed a number of things can trigger an episode. Extreme stress, overwhelming problems and life-changing events are thought to contribute, as well as genetic and chemical factors.
The exact cause of bipolar disorder is unknown. Experts believe there are a number of factors that work together to make a person more likely to develop the condition.
These are thought to be a complex mix of physical, environmental and social factors.
If your GP thinks you may have bipolar disorder, they’ll usually refer you to a psychiatrist (a medically qualified mental health specialist).
If your illness puts you at risk of harming yourself, your GP will arrange an appointment immediately.
Depending on your symptoms, you may also need tests to see whether you have a physical problem, such as an underactive thyroid or an overactive thyroid.
If you have bipolar disorder, you’ll need to visit your GP regularly for a physical health check.
Treatment for bipolar disorder aims to reduce the severity and number of episodes of depression and mania to allow as normal a life as possible.
If a person isn’t treated, episodes of bipolar-related mania can last for between three and six months. Episodes of depression tend to last longer, for between six and 12 months.
However, with effective treatment, episodes usually improve within about three months.
Most people with bipolar disorder can be treated using a combination of different treatments. These can include one or more of the following:
medication to prevent episodes of mania, hypomania (less severe mania) and depression – these are known as mood stabilisers and are taken every day on a long-term basis
medication to treat the main symptoms of depression and mania when they occur
learning to recognise the triggers and signs of an episode of depression or mania
psychological treatment – such as talking therapies, which help you deal with depression and provide advice on how to improve relationships
lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, and advice on improving your diet and getting more sleep
Read more about living with bipolar disorder
Most people with bipolar disorder can receive most of their treatment without having to stay in hospital.
However, hospital treatment may be needed if your symptoms are severe, or if you’re being treated under the Mental Health Act, as there’s a danger you may self-harm or hurt others.
In some circumstances, you could have treatment in a day hospital and return home at night.
Some people find psychological treatment helpful when used alongside medication in between episodes of mania or depression. This may include:
psychoeducation – to find out more about bipolar disorder
cognitive behavioural therapy (CBT) – this is most useful when treating depression
family therapy – a type of psychotherapy that focuses on family relationships (such as marriage) and encourages everyone within the family or relationship to work together to improve mental health
Psychological treatment usually consists of around 16 sessions. Each session lasts an hour and takes place over a period of six to nine months.
Blood in your urine is the most common symptom of bladder cancer.
The medical name for this is haematuria and it’s usually painless. You may notice streaks of blood in your urine or the blood may turn your urine brown. The blood isn’t always noticeable and it may come and go.
Less common symptoms of bladder cancer include:
a need to urinate on a more frequent basis
sudden urges to urinate
a burning sensation when passing urine
If bladder cancer reaches an advanced stage and begins to spread, symptoms can include:
pelvic pain
bone pain
unintentional weight loss
swelling of the legs
Most cases of bladder cancer appear to be caused by exposure to harmful substances, which lead to abnormal changes in the bladder’s cells over many years.
Tobacco smoke is a common cause and it’s estimated that half of all cases of bladder cancer are caused by smoking.
Contact with certain chemicals previously used in manufacturing is also known to cause bladder cancer. However, these substances have since been banned.
Read more about the causes of bladder cancer and preventing bladder cancer
Bladder cancer is caused by changes to the cells of the bladder. It’s often linked with exposure to certain chemicals, but the cause isn’t always known.
If you have symptoms of bladder cancer, such as blood in your urine, you should speak to your GP.
Your GP may ask about your symptoms, family history and whether you’ve been exposed to any possible causes of bladder cancer, such as smoking.
In some cases, your GP may request a urine sample, so it can be tested in a laboratory for traces of blood, bacteria or abnormal cells.
Your GP may also carry out a physical examination of your rectum and vagina, as bladder cancer sometimes causes a noticeable lump that presses against them.
If your doctor suspects bladder cancer, you’ll be referred to a hospital for further tests.
In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of bladder cancer and refer people for the right tests faster. Find out who should be referred for further tests for suspected bladder cancer.
In cases of non-muscle-invasive bladder cancer, it’s usually possible to remove the cancerous cells while leaving the rest of the bladder intact.
This is done using a surgical technique called transurethral resection of a bladder tumour (TURBT). This is followed by a dose of chemotherapy medication directly into the bladder, to reduce the risk of the cancer returning.
In cases with a higher risk of recurrence, a medication known as Bacillus Calmette-Guérin (BCG) may be injected into the bladder to reduce the risk of the cancer returning.
Treatment for high-risk non-muscle-invasive bladder cancer, or muscle-invasive bladder cancer may involve surgically removing the bladder in an operation known as a cystectomy.
When the bladder is removed, you’ll need another way of collecting your urine. Possible options include making an opening in the abdomen so urine can be passed into an external bag, or constructing a new bladder out of a section of bowel. This will be done at the same time as a cystectomy.
If it’s possible to avoid removing the bladder, or if surgery is not suitable, a course of radiotherapy and chemotherapy may be recommended. Chemotherapy may sometimes be used on its own before surgery or before being combined with radiotherapy.
After treatment for all types of bladder cancer, you’ll have regular follow-up tests to check for signs of recurrence.
Read more about treating bladder cancer
If you ever have blood in your urine – even if it comes and goes – you should speak to your GP, so the cause can be investigated.
Having blood in your urine doesn’t mean you definitely have bladder cancer. There are other, more common, causes including:
a urinary tract infection, such as cystitis
a kidney infection
kidney stones
urethritis
an enlarged prostate gland, in men
The treatment options for bladder cancer largely depend on how advanced the cancer is.
Treatments usually differ between early stage, non-muscle-invasive bladder cancer and more advanced muscle-invasive bladder cancer.
It’s not always possible to prevent bladder cancer, but some risk factors have been identified, which may increase your risk of developing the condition.
A diagnosis of bladder cancer, and some treatments for the condition, can have a significant impact on your life.
Sepsis can cause a variety of symptoms.
Temperature
over 38C (babies under 3 months)
over 39C (babies aged 3 to 6 months)
below 36C – check 3 times in a 10-minute period
a high temperature in a child who can’t be encouraged to show interest in anything
Breathing
difficulty breathing – this looks like hard work
grunting with every breath
struggling to speak more than a few words at once (for older children who normally talk)
breathing that obviously “pauses”
Eating and drinking
no interest in feeding (child under 1 month)
not drinking for more than 8 hours (when awake)
black, green or bloody vomit
Body
a soft spot on a baby’s head that bulges
“sunken” eyes
a baby that’s floppy
a child that can’t be encouraged to show interest in anything
weak, whining or continuous crying in a younger child
confusion in an older child
irritableness
unresponsive
stiffness in the neck, especially when trying to look up or down
not had a wee or wet nappy for 12 hours
Go to A&E or call 999 if your child:
is very lethargic or difficult to wake
feels abnormally cold to touch
is breathing very fast
has a rash that does not fade when you press it
has a fit or convulsion
Trust your instincts and phone 111 if your child’s symptoms are getting worse or they are sicker than you’d expect (even if their temperature falls).
Early symptoms of sepsis may include:
a high temperature (fever) or low body temperature
chills and shivering
a fast heartbeat
fast breathing
In some cases, symptoms of more severe sepsis or septic shock (when your blood pressure drops to a dangerously low level) develop.
These can include:
feeling dizzy or faint
a change in mental state – like confusion or disorientation
diarrhoea
nausea and vomiting
slurred speech
severe muscle pain
severe breathlessness
less urine production than normal – for example, not urinating for a day
cold, clammy and pale or mottled skin
loss of consciousness
Phone 999 or go to A&E if:
you’ve recently had an infection or injury and you have possible signs of sepsis
you think you or someone in your care has severe sepsis or septic shock
Don’t be afraid to ask the healthcare professional ‘is this sepsis?’.
The immune system usually keeps an infection limited to one place. This is called a localised infection. To do this, the body produces white blood cells.
White blood cells travel to an infection site to destroy the germs causing the infection. This triggers tissue swelling, known as inflammation. This helps to fight the infection and prevent it from spreading.
However, an infection can spread to other parts of the body if the immune system is weak or an infection is severe.
Widespread inflammation can damage tissue and interfere with blood flow. When blood flow is interrupted, blood pressure can drop dangerously low. This stops oxygen from reaching the organs and tissues.
Sepsis is often diagnosed by testing your:
temperature
heart rate
breathing rate
blood
Other tests can help determine the type of infection, where it’s located and which parts of the body have been affected. These include:
urine or stool samples
a wound culture – where a small sample of tissue, skin or fluid is taken from the affected area for testing
respiratory secretion testing – taking a sample of saliva, phlegm or mucus
blood pressure tests
imaging studies – like an X-ray, ultrasound scan or computerised tomography (CT) scan
Treatment for sepsis varies, depending on the:
area affected
cause of the infection
organs affected
extent of any damage
If you have the early signs of sepsis, you’ll usually be referred to hospital. You’ll then be given a diagnosis and treatment.
You’ll need emergency treatment, or treatment in an intensive care unit (ICU), if:
the sepsis is severe
you develop septic shock – when your blood pressure drops to a dangerously low level
ICUs can support body functions like breathing that are affected by sepsis. This allows the medical staff to focus on treating the infection.
Sepsis is treatable if it’s identified and treated quickly. In most cases it leads to full recovery with no lasting problems.
If a source of the infection can be identified, like an abscess or infected wound, this will also need to be treated.
For example, any pus may need to be drained away. In more serious cases, surgery may be needed to remove the infected tissue and repair any damage.
You may require additional treatments like:
corticosteroids
insulin medication
a blood transfusion
mechanical ventilation – where a machine is used to help you breathe
dialysis – where a machine filters your blood to copy the function of your kidneys
These treatments are mostly used in ICUs.
Bone cancer can affect any bone, but most cases develop in the long bones of the legs or upper arms.
The main symptoms include:
persistent bone pain that gets worse over time and continues into the night
swelling and redness (inflammation) over a bone, which can make movement difficult if the affected bone is near a joint
a noticeable lump over a bone
a weak bone that breaks (fractures) more easily than normal
If you or your child are experiencing persistent, severe or worsening bone pain, visit your GP. While it’s highly unlikely to be the result of bone cancer, it does require further investigation.
Read more about the symptoms of bone cancer
Bone pain is the most common symptom of bone cancer. Some people experience other symptoms as well.
Some people also experience swelling and redness (inflammation) or notice a lump on or around the affected bone. If the bone is near a joint, the swelling may make it difficult to use the joint.
In some cases, the cancer can weaken a bone, causing it to break (fracture) easily after a minor injury or fall.
Less common symptoms can include:
a high temperature (fever) of 38C (100.4F) or above
unexplained weight loss
sweating, particularly at night
In most cases, it’s not known why a person develops bone cancer.
You’re more at risk of developing it if you:
have had previous exposure to radiation during radiotherapy
have a condition known as Paget’s disease of the bone – however, only a very small number of people with Paget’s disease will actually develop bone cancer
have a rare genetic condition called Li-Fraumeni syndrome – people with this condition have a faulty version of a gene that normally helps stop the growth of cancerous cells
Read more about the causes of bone cancer
Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.
The exact reason why this happens is often not known, but certain things can increase your chance of developing the condition, including:
previous radiotherapy treatment
other bone conditions, such as Paget’s disease of the bone
rare genetic conditions, such as Li-Fraumeni syndrome
a history of certain other conditions, including retinoblastoma and umbilical hernia
If you’re experiencing bone pain, your GP will ask about your symptoms and examine the affected area, before deciding whether you need to have any further tests.
They will look for any swelling or lumps, and ask if you have problems moving the affected area. They may ask about the type of pain you experience – whether it’s constant or comes and goes, and whether anything makes it worse.
After being examined, you may be referred for an X-ray of the affected area to look for any problems in the bones. If the X-ray shows abnormal areas, you’ll be referred to an orthopaedic surgeon (a specialist in bone conditions) or bone cancer specialist for a further assessment.
If the results of the biopsy confirm or suggest bone cancer, it’s likely you’ll have further tests to assess how far the cancer has spread. These tests are described below.
MRI scan
A magnetic resonance imaging (MRI) scan uses a strong magnetic field and radio waves to produce detailed pictures of the bones and soft tissues.
An MRI scan is an effective way of assessing the size and spread of any cancerous tumour in or around the bones.
CT scan
A computerised tomography (CT) scan involves taking a series of X-rays and using a computer to reassemble them into a detailed three-dimensional (3D) image of your body.
CT scans are often used to check if the cancer has spread to your lungs. Chest X-rays may also be taken for this purpose.
Bone scans
A bone scan can give more detailed information about the inside of your bones than an X-ray. During a bone scan, a small amount of radioactive material is injected into your veins.
Abnormal areas of bone will absorb the material at a faster rate than normal bone and will show up as “hot spots” on the scan.
Bone marrow biopsy
If you have a type of bone cancer called Ewing sarcoma, you may have a test called a bone marrow biopsy to check if the cancer has spread to the bone marrow (the tissue inside your bones).
During the test, a needle is inserted into your bone to remove a sample of your bone marrow. This may be done under either local or general anaesthetic.
Being told you have bone cancer can be a distressing and frightening experience. Receiving that type of news can be upsetting at any age, but can be particularly difficult if you are still in your teenage years, or if you’re a parent of a child who has just been told they have bone cancer.
These types of feelings can cause considerable stress and anxiety, which in some cases can trigger depression. If you think you may be depressed, your GP may be a good person to talk to about support and possibly treatment.
You may also find it useful to contact the Bone Cancer Research Trust, which is the UK’s leading charity for people affected by bone cancer, if you need more information. If you’re a teenager you may want to contact the Teenage Cancer Trust, which is a charity for teenagers and young adults affected by cancer.
Read more about coping with a cancer diagnosis
Treatment for bone cancer depends on the type of bone cancer you have and how far it has spread.
Most people have a combination of:
surgery to remove the section of cancerous bone – it’s often possible to reconstruct or replace the bone that’s been removed, but amputation is sometimes necessary
chemotherapy – treatment with powerful cancer-killing medication
radiotherapy – where radiation is used to destroy cancerous cells
In some cases of osteosarcoma, a medication called mifamurtide may also be recommended.
Read more about treating bone cancer
Speak to your GP if you or your child experiences persistent, severe or worsening bone pain, or if you’re worried about any symptoms.
While it’s highly unlikely that your symptoms are caused by cancer, it’s best to be sure by getting a proper diagnosis.
Read more about diagnosing bone cancer
Previous exposure to high doses of radiation during radiotherapy may cause cancerous changes in your bone cells at a later stage, although this risk is thought to be small.
Treatment for bone cancer depends on the type of bone cancer you have, how far it has spread and your general health. The main treatments are surgery, chemotherapy and radiotherapy.
Your treatment should be managed by a specialist centre with experience in treating bone cancer, where you’ll be cared for by a team of different healthcare professionals known as a multi-disciplinary team (MDT).
Members of the MDT will include an orthopaedic surgeon (a surgeon who specialises in bone and joint surgery), a clinical oncologist (a specialist in the non-surgical treatment of cancer) and a specialist cancer nurse, among others.
Your MDT will recommend what they think is the best treatment for you, but the final decision will be yours.
Your recommended treatment plan may include a combination of:
surgery to remove the section of cancerous bone – it’s often possible to reconstruct or replace the bone that’s been removed, although amputation is occasionally necessary
chemotherapy – treatment with powerful cancer-killing medication
radiotherapy – where radiation is used to destroy cancerous cells
In some cases, a medication called mifamurtide may be recommended as well.
Bone cancer symptoms vary, and not everyone will feel the same. Many symptoms are similar to everyday aches and pains, so they can be mistaken for other things, like strains, sports injuries or growing pains.
The main symptoms are:
pain or tenderness – this may start as an ache that doesn’t go away and may be made worse by exercise or feel worse at night
swelling around the affected area of bone – swelling may not show up until the tumour is quite large and it isn’t always possible to see or feel a lump if the affected bone is deep inside the body
reduced movement – if the bone tumour is near a joint (like an elbow or knee), it can make it harder to move the joint; if it’s in a leg bone, it may cause a limp; if it’s in the backbone (spine), it may press on nerves and cause tingling and numbness in the legs or arms
a broken bone – a bone may break suddenly, or after only a minor fall or accident if the bone has been weakened by cancer.
There might also be other symptoms including:
tiredness
a high temperature
loss of appetite
weight loss
If you have any of these symptoms, or you are worried that you may have a bone tumour, you should get it checked by your GP. They can talk to you about your symptoms, and arrange tests if they feel they’re needed.
Remember – most people with these symptoms won’t have bone cancer.
The cause of bone cancer is unknown. Because it’s more common in young people, doctors think that it may be linked to the changes that happen when bones are growing. There is lots of ongoing research into the possible causes.
People often think a knock or injury might have caused bone cancer, but there’s no evidence for this.
Remember that nothing you’ve done has caused the cancer.
There are some tests you might have when you visit your GP or at the hospital. The tests will help the doctors see whether you have bone cancer.
If the tests show you have bone cancer, you might need a few more tests to check how your body is working in general:
blood tests
tests to check your heart is healthy
chest X-rays to check your lungs are healthy
tests to check your kidneys are healthy – you may need to give a sample of pee (urine) to be tested
This may seem like a lot of tests, but they’ll help the doctors plan the best treatment for you.
Having tests and waiting for the results can be an anxious time. Talking about how you feel and getting support from family, friends, your specialist nurse or your doctor can help.
We have more information about:
the bones
symptoms of bone cancer
treatment for bone cancer
life after bone cancer
If you’re looking for information about bone cancer in people of all ages, read our general bone cancer section.
The information on this page is about Ewing sarcoma and osteosarcoma. If you have a different type of bone cancer and want to know more, you can talk to Macmillan.
The 3 main treatments for bone cancer are chemotherapy, surgery and radiotherapy. Most people have a combination of these.
Your doctors will plan your treatment based on:
the type of bone cancer you have
where the cancer is
the stage of the cancer (this means whether it has spread outside the bone)
how fast-growing the cancer is
If you have any questions about your treatment, ask your doctor or nurse. They’ll be happy to help you understand what’s involved.
You may be offered the opportunity to take part in a clinical research trial. These trials help doctors find new and better treatments for people with bone cancer. If your doctor thinks you are suitable for a clinical trial, they’ll discuss this with you.
In this information we sometimes use the term ‘bone tumour’. This means the same as bone cancer.
This information is about life after having surgery for bone cancer.
The 3 main symptoms of bowel cancer are blood in the stools (faeces), changes in bowel habit – such as more frequent, looser stools – and abdominal (tummy) pain.
However, these symptoms are very common and most people with them do not have bowel cancer. For example, blood in the stools is more often caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is usually the result of something you have eaten.
As almost 9 out of 10 people with bowel cancer are over the age of 60, these symptoms are more important as people get older. They are also more significant when they persist despite simple treatments.
Most people who are eventually diagnosed with bowel cancer have one of the following combinations of symptoms:
a persistent change in bowel habit that causes them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools
a persistent change in bowel habit without blood in their stools, but with abdominal pain
blood in the stools without other haemorrhoid symptoms, such as soreness, discomfort, pain, itching or a lump hanging down outside the back passage
abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss
The symptoms of bowel cancer can be subtle and don’t necessarily make you feel ill.
The 3 main symptoms of bowel cancer are blood in the stools (faeces), a change in bowel habit, such as more frequent, looser stools, and abdominal (tummy) pain.
However, these symptoms are very common. Blood in the stools is usually caused by haemorrhoids (piles), and a change in bowel habit or abdominal pain is often the result of something you have eaten.
In the UK, an estimated 7 million people have blood in the stools each year. Even more people have temporary changes in their bowel habits and abdominal pain. Most people with these symptoms do not have bowel cancer.
As the vast majority of people with bowel cancer are over the age of 60, these symptoms are more important as people get older. These symptoms are also more significant when they persist in spite of simple treatments.
Most patients with bowel cancer present with one of the following symptom combinations:
a persistent change in bowel habit, causing them to go to the toilet more often and pass looser stools, usually together with blood on or in their stools
a persistent change in bowel habit without blood in their stools, but with abdominal pain
blood in the stools without other haemorrhoid symptoms, such as soreness, discomfort, pain, itching, or a lump hanging down outside the back passage
abdominal pain, discomfort or bloating always provoked by eating, sometimes resulting in a reduction in the amount of food eaten and weight loss
The symptoms of bowel cancer can be subtle and don’t necessarily make you feel ill.
Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.
Most cases of bowel cancer first develop inside clumps of cells on the inner lining of the bowel. These clumps are known as polyps. However, if you develop polyps, it does not necessarily mean you will get bowel cancer.
Exactly what causes cancer to develop inside the bowel is still unknown. However, research has shown several factors may make you more likely to develop it.
When you first see your GP, they will ask about your symptoms and whether you have a family history of bowel cancer.
They will then usually carry out a simple examination of your abdomen (tummy) and your bottom, known as a digital rectal examination (DRE).
This is a useful way of checking whether there are any lumps in your tummy or back passage. The tests can be uncomfortable, and most people find an examination of the back passage a little embarrassing, but they take less than a minute.
If your symptoms suggest you may have bowel cancer or the diagnosis is uncertain, you will be referred to your local hospital initially for a simple examination called a flexible sigmoidoscopy.
In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of bowel cancer and refer people for the right tests faster.
To find out if you should be referred for further tests for suspected bowel cancer, read the NICE 2015 guidelines on suspected cancer: recognition and referral.
Most people with bowel cancer can be diagnosed by flexible sigmoidoscopy. However, some cancers can only be diagnosed by a more extensive examination of the colon.
The two tests used for this are colonoscopy and computerised tomography (CT) colonography.
Colonoscopy
A colonoscopy is an examination of your entire large bowel using a device called a colonoscope, which is like a sigmoidoscope but a bit longer.
Your bowel needs to be empty when a colonoscopy is performed, so you will be advised to eat a special diet for a few days beforehand and take a laxative (medication to help empty your bowel) on the morning of the examination.
You will be given a sedative to help you relax during the test, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. This is not usually painful, but can feel uncomfortable.
The camera relays images to a monitor, which allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer. As with a sigmoidoscopy, a biopsy may also be performed during the test.
A colonoscopy usually takes about an hour to complete, and most people can go home once they have recovered from the effects of the sedative.
After the procedure, you will probably feel drowsy for a while, so you will need to arrange for someone to accompany you home. It is best for elderly people to have someone with them for 24 hours after the test. You will be advised not to drive for 24 hours.
In a small number of people, it may not be possible to pass the colonoscope completely around the bowel, and it is then necessary to have CT colonography.
Find out more about what a colonoscopy involves
CT colonography
CT colonography, also known as a ‘virtual colonoscopy’, involves using a computerised tomography (CT) scanner to produce three-dimensional images of the large bowel and rectum.
During the procedure, gas is used to inflate the bowel using a thin, flexible tube placed in your rectum. CT scans are then taken from a number of different angles.
As with a colonoscopy, you may need to have a special diet for a few days and take a laxative before the test to ensure your bowels are empty when the test is carried out.
This test can help identify potentially cancerous areas in people who are not suitable for a colonoscopy because of other medical reasons.
A CT colonography is a less invasive test than a colonoscopy, but you may still need to have colonoscopy or flexible sigmoidoscopy at a later stage so any abnormal areas can be removed or biopsied.
Read further information:
Bowel Cancer UK: Diagnosis
Cancer Research UK: Getting diagnosed
Macmillan Cancer Support: Symptoms of bowel cancer
If a diagnosis of bowel cancer is confirmed, further testing is usually carried out to check if the cancer has spread from the bowel to other parts of the body. These tests also help your doctors decide on the most effective treatment for you.
These tests can include a:
CT scan of your abdomen and chest – this will check if the rest of your bowel is healthy and whether the cancer has spread to the liver or lungs
magnetic resonance imaging (MRI) scan – this can provide a detailed image of the surrounding organs in people with cancer in the rectum
Read about the symptoms of bowel cancer, and when you should see your GP to discuss whether any tests are necessary.
Your doctor will probably carry out a simple examination of your tummy and bottom to make sure you have no lumps.
They may also arrange for a simple blood test to check for iron deficiency anaemia. This can indicate whether there is any bleeding from your bowel that you haven’t been aware of.
In some cases, your doctor may decide it is best for you to have a simple test in hospital to make sure there is no serious cause for your symptoms.
Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age.
Read more about diagnosing bowel cancer
Bowel cancer can be treated using a combination of different treatments, depending on where the cancer is in your bowel and how far it has spread.
The main treatments are:
surgery – the cancerous section of bowel is removed; it is the most effective way of curing bowel cancer, and is all that many people need
chemotherapy – where medication is used to kill cancer cells
radiotherapy – where radiation is used to kill cancer cells
biological treatments – a newer type of medication that increases the effectiveness of chemotherapy and prevents the cancer spreading
As with most types of cancer, the chances of a complete cure depends on how far it has advanced by the time it is diagnosed.
Read more about how bowel cancer is treated and living with bowel cancer
Read about the symptoms of bowel cancer, and when you should see your GP to discuss whether any tests are necessary.
Your doctor will probably perform a simple examination of your tummy and bottom to make sure you have no lumps, as well as a simple blood test to check for iron deficiency anaemia. This can indicate whether there is any bleeding from your bowel you haven’t been aware of.
In some cases, your doctor may decide it is best to have a simple test in hospital to make sure there is no serious cause for your symptoms.
Make sure you return to your doctor if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age.
Read more about diagnosing bowel cancer
If colon cancer is at a very early stage, it may be possible to remove just a small piece of the lining of the colon wall. This is known as local excision.
If the cancer spreads into muscles surrounding the colon, it will usually be necessary to remove an entire section of your colon. This is known as a colectomy.
There are 2 ways a colectomy can be performed:
an open colectomy – where the surgeon makes a large cut (incision) in your abdomen and removes a section of your colon
a laparoscopic (keyhole) colectomy – where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of colon
During surgery, nearby lymph nodes are also removed. It is usual to join the ends of the bowel together after bowel cancer surgery, but very occasionally this is not possible and a stoma is needed.
Both open and laparoscopic colectomies are thought to be equally effective at removing cancer and have similar risks of complications.
However, laparoscopic colectomies have the advantage of a faster recovery time and less postoperative pain. It is becoming the routine way of doing most of these operations.
Laparoscopic colectomies should be available in all hospitals that carry out bowel cancer surgery, although not all surgeons perform this type of surgery. Discuss your options with your surgeon to see if this method can be used.
Biological treatments, including cetuximab, bevacizumab and panitumumab, are a newer type of medication also known as monoclonal antibodies.
Monoclonal antibodies are antibodies that have been genetically engineered in a laboratory. They target special proteins found on the surface of cancer cells, known as epidermal growth factor receptors (EGFR).
As EGFRs help the cancer grow, targeting these proteins can help shrink tumours, and improve the effect and outcome of chemotherapy.
Biological treatments are therefore usually used in combination with chemotherapy when the cancer has spread beyond the bowel (metastatic bowel cancer).
These treatments are not available to everyone with bowel cancer. The National Institute for Health and Care Excellence (NICE) has specific criteria that need to be met before these can be prescribed.
Cetuximab is only available on the NHS when:
surgery to remove the cancer in the colon or rectum has been carried out or is possible
bowel cancer has spread to the liver and cannot be removed surgically
a person is fit enough to undergo surgery to remove the cancer from the liver if this becomes possible after treatment with cetuximab
Cetuximab, bevacizumab and panitumumab are available on the NHS through a government scheme called the Cancer Drugs Fund. All these medications are also available privately, but are very expensive.
Further information is available from:
Macmillan Cancer Support: Targeted therapies and immunotherapies for bowel cancer
Bowel Cancer UK: Surgery
Cancer Research UK: Treatment
Bowel Cancer UK: Radiotherapy
Macmillan Cancer Support: Radiotherapy
There are some things that increase your risk of bowel cancer that you can’t change, such as your family history or your age.
However, there are several ways you can lower your chances of developing the condition.
Bowel incontinence is a symptom of an underlying problem or medical condition.
Many cases are caused by diarrhoea, constipation, or weakening of the muscle that controls the opening of the anus.
It can also be caused by long-term conditions such as diabetes, multiple sclerosis and dementia.
Read more about the causes of bowel incontinence.
Bowel incontinence is usually caused by a physical problem with the parts of the body that control the bowel.
The most common problems are:
problems with the rectum – the rectum is unable to retain poo properly until it’s time to go to the toilet
problems with the sphincter muscles – the muscles at the bottom of the rectum don’t work properly
nerve damage – the nerve signals sent from the rectum don’t reach the brain
These problems are explained in more detail below.
It’s important to discuss any bowel problems with your GP as there’s a small chance they could be a sign of a more serious condition, such as bowel cancer.
Your GP will begin by asking you about the pattern of your symptoms and other related issues, such as your diet.
You may find this embarrassing, but it’s important to answer as honestly and fully as you can to make sure you receive the most suitable treatment. Let your doctor know about:
any changes in your bowel habits lasting for more than a few weeks
rectal bleeding
stomach pains
any changes to your diet
any medication you’re taking
Your GP will usually carry out a physical examination. They’ll look at your anus and the surrounding area to check for damage and carry out a rectal examination, inserting a gloved finger into your bottom.
A rectal examination will show whether constipation is the cause, and check for any tumours in your rectum. Your GP may ask you to squeeze your rectum around their finger to assess how well the muscles in your anus are working.
Depending on the results, your GP may refer you for further tests.
Endoscopy (sigmoidoscopy)
During an endoscopy, the inside of your rectum (and in some cases your lower bowel) is examined using a long, thin flexible tube with a light and video camera at the end (endoscope). Images can also be taken of the inside of your body.
The endoscope checks whether there’s any obstruction, damage or inflammation in your rectum.
An endoscopy isn’t painful, but it can feel uncomfortable, so you may be given a sedative to relax you.
Anal manometry
Anal manometry helps to assess how well the muscles and nerves in and around your rectum are working.
The test uses a device that looks like a small thermometer with a balloon attached to the end. It’s inserted into your rectum and the balloon is inflated. It may feel unusual, but it’s not uncomfortable or painful.
The device is attached to a machine, which measures pressure readings taken from the balloon.
You’ll be asked to squeeze, relax and push your rectum muscles at certain times. You may also be asked to push the balloon out of your rectum in the same way you push out a stool. The pressure-measuring machine gives an idea of how well your muscles are working.
If the balloon is inflated to a relatively large size but you don’t feel any sensation of fullness, it may mean there are problems with the nerves in your rectum.
Ultrasound
An ultrasound scan can be used to create a detailed picture of the inside of your anus. Ultrasound scans are particularly useful in detecting underlying damage to the sphincter muscles.
Defecography
Defecography is a test used to study how you pass stools. It can also be useful in detecting signs of obstruction or prolapse that haven’t been discovered during a rectal examination.
During this test, a liquid called barium is placed into your rectum. The barium helps make it easier to highlight problems using an X-ray. Once the barium is in place, you’ll be asked to pass stools in the usual way while scans are taken.
This test is occasionally carried out using a magnetic resonance imaging (MRI) scanner instead of an X-ray.
Bowel incontinence can be upsetting and hard to cope with, but treatment is effective and a cure is often possible, so make sure you see your GP.
It’s important to remember that:
bowel incontinence isn’t something to be ashamed of – it’s simply a medical problem that’s no different from diabetes or asthma
it can be treated – there’s a wide range of successful treatments
bowel incontinence isn’t a normal part of ageing
it won’t usually go away on its own – most people need treatment for the condition
If you don’t want to see your GP, you can usually make an appointment at your local NHS continence service without a referral. These clinics are staffed by specialist nurses who can offer useful advice about incontinence.
Read more about diagnosing bowel incontinence.
In many cases, with the right treatment, a person can maintain normal bowel function throughout their life.
Treatment will often depend on the cause and how severe it is, but possible options include:
lifestyle and dietary changes to relieve constipation or diarrhoea
exercise programmes to strengthen the muscles that control the bowel
medication to control diarrhoea and constipation
surgery, of which there are a number of different options
Incontinence products, such as anal plugs and disposable pads, can be used until your symptoms are better controlled.
Even if it isn’t possible to cure your bowel incontinence, symptoms should improve significantly.
Read more about treating bowel incontinence.
Treatment for bowel incontinence depends on underlying cause and the pattern of your symptoms.
Trying the least intrusive treatments first, such as dietary changes and exercise programmes, is often recommended.
Medication and surgery are usually only considered if other treatments haven’t worked.