Role of the colorectal multidisciplinary team

Information for patients, relatives and carers

This information sheet has been provided to help answer some of the questions you, your family and friends may have about what to expect after your colorectal surgery.

The multidisciplinary team (MDT)

If you are a patient who is suspected to have a diagnosis of colorectal (bowel) cancer or anal cancer, your individual case will be discussed by a highly qualified team of clinicians with specialist knowledge. This team is called a multidisciplinary team (MDT). The team meets weekly to discuss all patients who have been diagnosed with cancer. Regardless of which specialist you were referred to or how your care was transferred to us, your case will be discussed at this meeting if you have, or are suspected to have, colorectal (bowel) cancer or anal cancer.

At the MDT meeting, your medical records and investigation (test) results are made available to all the experts so that they can make joint decisions about your care based on all the facts of your case. The MDT room is equipped with technology that enables all clinicians to look at your scans, X-rays or histology on a large screen.

The team will agree your plan of care with treatment options. The notes from the meeting are typed up immediately afterwards and recorded on an MDT summary sheet. One of the consultants and the specialist nurse will discuss these treatment options with you, usually in a clinic appointment soon after the MDT meeting. You will have an opportunity to ask questions to make sure that:

  • You are clear about the treatment option that is being offered to you
  • This is the best possible treatment option for you

Therefore, it may be a good idea to bring someone along with you to this appointment. A letter outlining the discussion will be sent to you and your GP.

Please tell us during your consultation if you do not want these letters sent to your home address.

At this time you will also meet your ‘keyworker’ who is usually a specialist nurse. Your keyworker will:

  • Act as a direct link between you, your family and health professionals throughout your pathway of care
  • Answer any questions or concerns you may have, or direct you to the relevant people or organisations
  • Ensure that you have the appropriate information and literature you need to understand your illness
  • Discuss with you what support services are available
  • Ensure that all requested tests are booked within a certain time frame
  • Liaise between you, your GP and the hospital clinicians 

The following section will tell you about some of the members of the multidisciplinary team you may meet at the hospital.

Gastroenterologists

You may have been referred by your GP to a gastroenterologist (a doctor who specialises in diseases of the bowel). The gastroenterologist may have initiated your investigations (tests) and perhaps performed your colonoscopy (an examination of the bowel with a video telescope), which diagnosed your cancer.

Surgeons

Your GP may have referred you directly to a surgeon, who may carry out a colonoscopy (see above) or refer you to a gastroenterologist. Surgery (operation) is the most common form of treatment for cancer of the bowel. Your doctor will discuss any proposed treatment with you. Please remember that no operation or procedure will be done without your consent.

Radiologists

During your time at hospital you will have had several X-rays and special scans that have determined the stage of your cancer. The results of these scans are interpreted by radiologists (X-ray specialists) and future treatment can then be planned.

Oncologists and radiotherapists

These doctors are cancer specialists. You will see an oncologist if you need further treatment such as chemotherapy (drug treatment), or a radiotherapist if you need radiotherapy (X-ray treatment).

Sometimes it is necessary to have one of these treatments before you have surgery to ‘shrink’ the cancer and so make it easier to remove. Your doctor will discuss this with you. These doctors work closely with your surgeon and gastroenterologist.

There are Macmillan Cancer Support leaflets available containing written information on chemotherapy and radiotherapy. If you are interested, please ask your specialist nurse for a copy.

Other nurse specialists

The role of these nurses is to support patients and their relatives with cancer from the time of diagnosis and throughout their illness. They include:

  • Colorectal nurse specialist/nurse practitioner/nurse consultant (usually your keyworker): This nurse will be available to you from the time your cancer is diagnosed until you are discharged from hospital. He/she will organise the MDT meetings, document the outcomes and action any points from the meeting. If you feel you need someone to talk to while you are waiting to come into hospital for your operation, please contact your specialist nurse who can arrange to meet up with you and your family.
  • Stoma nurse specialist: If it is necessary for you to have a stoma/colostomy or ileostomy, then the stoma nurse can answer any questions you may have about this. She can also offer you support and follow-up care both in hospital and when you are discharged home. She/he will also teach you how to look after your stoma.
  • Palliative care nurse: Palliative care nurses offer patients with advanced cancer pain and symptom control with counselling and support.
  • Research nurses/coordinators: Chelsea and Westminister NHS Foundation Trust  undertakes a number of research studies (also known as ‘clinical trials’) and so you may be asked to participate in research while you are in hospital. All research studies have to be approved by an ethics committee (which includes doctors, nurses and members of the public) before patients can be approached to participate. You will be given written information about the research before you are asked for your consent. It will not affect your treatment if you do not wish to take part in the research programme. Even if you do agree to take part, you will be free to leave the study at any time.

Histopathologist

This doctor specialises in analysing tissue samples (biopsies or surgical specimens).

Genetics Team

You may be eligible for genetic testing and additional screening for you or your relatives, you may enquire from any member of the team if you are interested in knowing more.

MDT coordinator

MDT coordinator will help with preparation of the MDT meetings together with the specialist nurses. This includes obtaining notes and results of investigations (tests), and ensuring that the MDT summary sheets with the outcomes are filed in the medical notes.

The extended MDT team includes clinicians that do not need to be present in every MDT meeting:

  • A Liver specialist will help to decide whether liver surgery may be appropriate if the cancer has spread there from the bowel, and will perform the liver surgery.
  • A dietitian will advise you, your family and carers as well as staff about your dietary needs if necessary.

There are many other members of the team (doctors, nurses, other specialists, researchers and managers) who are not all listed here. They each have special skills in dealing with a different part of cancer care and they will be involved in your care from time to time.

We regularly look at how we work as a team of different experts to provide you with the best possible patient-centred care throughout your journey. We always look for ways to improve this care, and from time to time we may ask you to help us by filling in surveys about the Trust or services we offer. We would be grateful for any constructive feedback or suggestions from you or your relatives or carers about how we might try to improve the care we give you at present.

Where will I have my treatment?

This will depend on the type of treatment you need. Treatment usually takes place in the form of surgery, chemotherapy or radiotherapy. Sometimes you may just need one treatment or sometimes a combination of treatment is required. Your treatment will take place in one or two of the following hospitals ;

  • West Middlesex Hospital
  • Chelsea and Westminster Hospital
  • Charing Cross Hospital
  • Hammersmith Hospital
  • The Royal Marsden Hospital

Frequently asked questions (FAQs)

What does the future hold?

First we need to prove that you have cancer and the stage of the disease.. This will be done by looking at the results of various tests. Your doctor will tell you what investigations you will need. 

Cancer is a frightening word surrounded by fears and myths. In fact, nowadays many cancers are curable if they are caught at an early stage. When a cancer is not completely curable, modern treatments often mean that the disease can be controlled for years and many patients can live an almost normal life.

The answer to this question depends on many factors, for example:

  • Your general health
  • The stage of your cancer
  • How well the cancer responds to treatment

All these factors make this question very difficult to answer. Even your doctors may not have all these answers.

What happens now?

You will undergo one or more investigations to give the doctors the information they need to decide the best treatment for you. The type of treatment you receive will depend on many factors, such as whereabouts in the bowel or anus the cancer is and the stage of your cancer (how far the cancer has spread).

How will this affect my relationship with my family?

Those people close to you will also be affected by your diagnosis of cancer. They may want to be supportive and helpful, but don’t know what to do or say.

Relationships can change. You may find some people try to avoid you and this may upset you. If this happens, try to understand that some people may not know what to say to you but it will help both of you and those around you if you are able to tell them what you need. 

Some questions you may want to ask your doctor/nurse

  • What are the aims of the treatment?
  • What are the side-effects of the treatment?
  • How long will the treatment take?
  • How will it affect my everyday life?
  • What might happen if I don’t have treatment?

Local support groups/organisations

Mulberry Centre

A drop-in centre, built within the grounds of West Middlesex University Hospital, covering the boroughs of Ealing, Hammersmith and Fulham, Hounslow, Kingston upon Thames and Richmond upon Thames. No referrals needed—call or email Mon–Fri.

West Middlesex Hospital
Twickenham Road
Isleworth
Middlesex
TW7 6AF

T: 020 8321 6300
E:
W: www.themulberrycentre.co.uk

Services:

  • Information and support for cancer patients, their families, carers and friends, irrespective of where they live
  • An information library with access to the internet, advocacy, yoga, tai chi and support groups
  • Aromatherapy, massage and reflexology
  • Counselling is free but limited to four or six sessions, depending on the therapy

Cancer Resource Centre

Provides information, support and complementary therapies for people with cancer, their families, friends and health professionals in the London area.

20–22 York Road
Battersea
London
SW11 3QA

T: 020 7924 3924
W: www.paulscancercentresupport.org.uk

Services:

  • Telephone support
  • Information service
  • A selection of complementary therapies that may be used alongside medical treatment, including counselling and massage, healing, yoga, relaxation, visualisation and art therapy
  • Support groups
  • Regular workshops and various publications available
  • A home visiting service for Wandsworth and surrounding areas, with trained volunteers offering a choice of befriending, counselling, massage or healing
  • Morning introductions to the Centre for health professionals every two or three months

Maggie’s Centre

Hospital-based support group for anyone with or who has had cancer, their families, friends and health professionals.

Maggies Centre
Charing Cross Hospital
Fulham Palace Road
London
W6 8RF

T: 020 7386 1750
E:
W: www.maggiescentres.org

Services:

  • Emotional support and practical help
  • Meetings held regularly at the Maggie’s Centre at Charing Cross Hospital
  • Guest speakers talking about medical and general topics
  • People are welcome to attend, regardless of where they have been receiving treatment

Macmillan Cancer Information and Support Centre

A walk-in information centre that provides information, practical advice and support to anyone affected by cancer.

Maggies Centre
Charing Cross Hospital
Fulham Palace Road
London
W6 8RF

T: 020 3313 0171
E:
W: www.macmillan.org.uk

Macmillan Information and Support Centre
Lower Ground Floor Outpatient Atrium
Chelsea and Westminster Hospital
369 Fulham Road
London
SW10 9NH

T: 020 3315 2386
E:
W: www.macmillan.org.uk

Services:

  • The centre is staffed by a cancer information specialist nurse
  • Information available about all cancers and their treatments, including booklets and factsheets
  • All services are independent and confidential

National support groups/organisations

Macmillan Cancer Information and Support

A national cancer charity supporting people with cancer and their families with specialist information, treatment and care.

89 Albert Embankment
London
SE1 7UQ

T: 0808 808 00 00 (freephone helpline, Mon–Fri 9am–8pm)
W: www.macmillan.org.uk

Services:

  • A national information telephone helpline
  • Specialist advice on treatment, symptom management and psychological support, from diagnosis onwards, by Macmillan doctors and Macmillan nurses
  • Grants for people with cancer who are in financial need

Colostomy Association

Represents the interests of people with a colostomy. Offers expert advice about living with colostomy to all colostomates via personal contact with their volunteers. If you have any worries, please contact our 24-hour helpline. A colostomate will talk to you and listen to your concerns. The Colostomy Association receives no government funding and relies entirely on public generosity to fund its services – without you we simply cannot function. Registered charity n°1113471.

95 London Street
Enterprise House
Reading
RG1 4QA

T: 0118 939 1537 (Mon–Fri 9am–5pm)
T: 0800 328 4257 (24/7 helpline)
W: www.colostomyuk.org

Ileostomy and Internal Pouch Support Group

Helps people who have had their colon removed (ileostomy). It was started in 1956 by a group of people who had ileostomies themselves, together with some members of the medical profession. Registered Charity n°1172338.

IA National Office
Danehurst Court
35–37 West Street
Rochford
Essex
SS4 1BE

T: 0800 018 4724
W: www.iasupport.org

We look forward to meeting you again on your next visit to hospital. In the meantime, if you need any further information, please do not hesitate to contact your cancer Nurse Practitioner 0208 321 5892.

Contact information

Colorectal Nurse Specialists

Chelsea and Westminster Hospital
T: 020 3315 8354

West Middlesex University Hospital
T: 020 8321 5892

Contributors
thomastn George Vasilopoulos