In many cases patients with suspected early stage bowel cancer face the prospect of major surgery, intensive care and considerable changes to their lifestyle.
But now, thanks to advances in clinical endoscopic practice, Sheffield Teaching Hospitals NHS foundation trust's early cancer reception service offers diagnosis and treatment on a day list.
This extraordinary turnaround is down to the introduction of cutting edge technology that creates images almost identical to those produced in the laboratory. It does this alongside a safe and efficacious method for the removal of growths in the bowel lining.
Dr Paul Hurlstone, a recently appointed consultant endoscopist at the trust's Royal Hallamshire hospital, performs the investigations and interventions. This combination of factors has led to considerable improvements in early detection, and five-year survival rates for gastrointestinal cancer.
Although the techniques are still relatively new to the UK and Europe, they have been used elsewhere for several years.
Paul says: 'Magnification endoscopy and other advanced practices have been used for some time in Japan to detect early lesions. The west, however, wasn't prepared to accept their significance or the link to morbidity and mortality among their own cohorts.'
Paul got specialist endomicroscopy training at Japan's national cancer centre as part of his MD research project. His hospital was able to buy the microscopic probes through the practice list, and he raised further charitable money to purchase endoscopic ultrasound equipment. A more or less cost-neutral clinic started running in Sheffield in 2002.
Further research in this setting - for which Paul and his team won this years BUPA Foundation research award of£10,000 - showed that the lesions the Japanese had been finding were prevalent to the same extent in Western patients. Moreover they were equally likely to be those that went on to develop into larger and more widely disseminated cancers in people who had already had conventional examinations.
Papers published by Paul and his colleagues have since examined the best means of grading the level of spread of lesions, and the cure rate two years after microendoscopic surgery. Three years after the publication of this paper the cure rate among the 58 patient cohort remains constant, giving an equivalent five-year rate of 96 per cent.
Another study looks at how many times the centre has done a resection without the need for a later procedure to remove cancerous spread. Within these parameters, the new technique is attaining a cure rate of 71 per cent.
'Not everybody is a suitable candidate for this diagnostic and intervention procedure,' says Paul. 'But for those who are it offers a safe and cost effective alternative to surgery. I dedicate two lists to it a week and while it is time consuming and there is some displacement of work - I do two interventional procedures rather than four or five diagnostic colonoscopies - the net gain for the trust is very good.
'It saves surgeon's and theatre time, cuts down on ITU bed occupancy and removes the risks of post-operative complications.'
By their own calculations, and using British Society of Gastroenterology guidelines, the early intervention team believe that over a five-year period they can save the trust more than£1 million and the equivalent of 118,000 hours of path lab time.
Other cost and resource implications are minimal. The restrictions imposed by the need for a high level of technical expertise mean Paul must run the clinic single-handedly. Training for existing endoscopy suite nursing staff is provided at no charge by equipment manufacturers Olympus and Pentax.
Clearly the clinic is at the forefront of endoscopy practice in the UK. However, in Paul's view that is not where the true innovation lies.
He says: 'The key to moving the service forward, and something the trust realised very early on, is the creation of a new breed of gastroenterologist - the consultant endoscopist. This ensures a central figure provides a speciality while at the same time coordinating education, promoting research and supporting clinical governance.'
'This dedicated post guarantees me the time I need to see enough cases to stay technically on my feet and get good results,' continues Dr Hurlstone.
'With no general GI component I am free to run eight or nine weekly endoscopy lists and find time to supervise without the worry of ward rounds.'
Early intervention reduces colorectal cancers, saves lives and spares people from a great deal of discomfort. Out-of-area referrals to Sheffield are on the increase but ultimately, as Paul advocates, the way forward lies in regional centres of excellence.
He adds: 'Standard practice here wouldn't be considered in many other services. Interventional endoscopy remains relatively unknown. The great challenge is to use training and education to move the agenda on.'
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