BOWEL CANC ER Colorectal cancer

The tissues and organs of the body are made up of cells. These age and become damaged, and need to repair and reproduce themselves continually.

Sometimes during this process, normal cells can become abnormal, and as a result of a long and complex series of changes, these abnormal cells can become cancerous. Bowel cancer is very common and affects men and women. There are nearly 42,000 cases* diagnosed each year in the United Kingdom (UK).

The cause of most bowel cancer is still unknown, but we do know that risk increases with age (95% of cases are found in people aged 50 or over*).

However, bowel cancer can affect anyone at any age. On average people with a family history have a slight increased risk of developing the disease.

*source: www.beatingbowelcancer.org 2017

A GRAPH IC R EPR ESENTATION SHOWI NG LOCATIONS OF WH ER E CANC ER CAN OCCU R

WHY DOES BOWEL (COLOR ECTAL) CANC ER OCCU R?

Transverse colon

Ascending colonDescending colon

Small bowel

Sigmoid colon

Anus

Caecum

Appendix

Rectum

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You may have had some of these tests/ investigations:

rigid sigmoidoscopy

flexible sigmoidoscopy

colonoscopy and biopsies

virtual colonoscopy

blood tests

scans

SIGMOI DOSCOPY

A small tube with a bright light at the end is inserted into the back passage so that the lower bowel (rectum) can be seen. The examination takes no more than two or three minutes to complete, during which time some air is inserted into the bowel. You may feel the need to pass wind but try not to worry, your consultant is aware that this may happen.

FLEXI BLE SIGMOI DOSCOPY

This simple procedure allows your consultant to examine more of the lower bowel (sigmoid and some of the descending colon). It involves passing a thin, flexible tube with a miniature camera on the end (an endoscope) through the anus to examine the rectum and the lower parts of the colon. It can be performed as an outpatient, and no sedation is usually required. A disposable enema will be given to you prior to the procedure.

Bowel cancer can be suggested by one or more of the following symptoms.

You may have experienced one, or a combination of the following:

change in bowel habit, usually as an increase in frequency or how loose the stool is

possibly increased bouts of constipation

blood and/or mucus in your stool

decreased appetite and weight loss for no known reason

lethargy or general ill health because you have been losing blood from your bowel causing anaemia

a feeling of not being able to completely empty your bowels (this is known as tenesmus)

vague discomfort in the abdomen, or even a colicky type pain, often related to bowel actions.

The diagnosis of colorectal cancer can be made from the results of tests and investigations.

When you visit your consultant, after you have been referred by your General Practitioner, they will take a full history from you by asking you questions about your health. They will also examine your back passage by inserting their finger gently into your back passage (anus), to feel for lumps or tender areas, and will gently examine your abdomen with the palm of their hand.

In some cases the exact stage and diagnosis cannot be confirmed until the suspected cancer has been removed and analysed by the pathologist (specialist consultant who examines tissue and cells under a microscope).

Having made a diagnosis of possible cancer, your consultant may ask for a number of tests to confirm this, and to look at whether the cancer has spread anywhere else. These are described on the next few pages.

SIGNS AN D SYMPTOMS CONSU LTATION AN D DIAGNOSTIC TESTS

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AVAI LABLE TESTS FOR DETECTI NG BOWEL CANC ER

AVAI LAB LE TESTS FOR DETECTI NG BOWEL CANC ER (continued)

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U LTRASOU N D

An ultrasound will take approximately 15 to 20 minutes and is completely painless. An ultrasound scan uses beams of high-pitched sound, which you cannot hear, directed via a small device like a microphone into the abdomen. Sound is reflected back onto a computer showing internal organs on a monitor for your consultant to view. Ultrasound is completely safe and is used for scanning babies in the womb.

COMPUTER ISED TOMOGRAPHY (CT SCAN)

For this scan you will be asked not to eat or drink anything for four hours before the scan, and the actual scan will take about 30 to 40 minutes. The scan is painless but you will be asked to lay still for this time.

Before the scan you may be asked to drink a special liquid which shows up on X-ray, and then again in the X-ray department. Just before the scan a similar liquid may be passed into your back passage through a small tube. This may be slightly unpleasant but it does ensure a clear picture is obtained.

MAGN ETIC R ESONANC E IMAGERY (MR I)

This is a very useful type of scan for cancer affecting the lower part of the anal canal (rectum). MRI scanning uses a magnetic field to produce a detailed image of the body. The scan can last for 30 to 60 minutes.

You may need to stop eating or drinking for four hours prior to the scan, depending on what part of the body is being scanned. If you have any metal implants you need to inform the department prior to your scan.

COLONOSCOPY

For this investigation you will be asked to take a laxative to completely clear out the bowel.

A sedative may be given to help relieve any fears and anxieties you may have, but you can choose not to have this if you wish. The examination involves a flexible telescope being inserted into the back passage so that the colon can be looked at. This procedure allows your consultant to see the entire colon, both lower and upper sections, and to remove any polyps at the same time.

VI RTUAL COLONOSCOPY

Virtual colonoscopy (VC) uses scanning technology to detect or stage bowel cancer. A small thin tube is inserted into the bottom and carbon dioxide is used to distend the bowel. You will then have a CT (Computerised Tomography) scan which picks up any abnormalities.

BLOOD TESTS

Blood tests are taken to check your general health. Sometimes this includes a carcinoembryonic antigen (CEA) blood test, which can also be used to monitor your recovery.

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Chemotherapy may be discussed following surgery once the full pathology report is back. This involves using drugs which attack cancer cells. It is usually given in the form of an injection into a vein, or in tablet form. The treatment is planned individually and is administered over a period of months. Before each treatment a blood test is done to ensure that there are enough healthy blood cells to protect you from infection, as chemotherapy has the potential to damage good cells as well as bad.

During your course of treatment you may also have further scans which will be ordered by your consultant.

Nowadays neither chemotherapy or radiotherapy cause too many unpleasant side effects. Many people lead a normal life, for example continuing to work.

All aspects of adjuvant therapy will be discussed in detail with you – as soon as we have confirmation that this type of treatment will be suitable for you.

If adjuvant therapy is advised you will be referred to see the Oncologists (cancer specialists). They will then discuss your diagnosis in detail and explain the options of treatment.

The London Clinic offers a confidential oncology counselling service; please ask your consultant or one of our nurses if you require this service.

We also offer complementary therapies for people with cancer. Based in our Duchess of Devonshire Wing, our therapists offer aromatherapy massage, Reflexology, Indian head massage, Reiki and spiritual healing.

We can also provide Macmillan cancer information to help with practical advice and emotional support during this time.

WHAT IS C H EMOTH ERAPY? FU RTH ER SU PPORT FOR YOU R JOU R N EY

WHAT TR EATMENTS AR E AVAI LABLE?

WHAT IS RADIOTH ERAPY?

Surgery is the main treatment for bowel cancer. However, some patients benefit from treatment following surgery – referred to as adjuvant therapy, or before surgery – referred to as neoadjuvant therapy. Neoadjuvant treatment prior to surgery can make the chance of cure better, and surgery more effective. This may be in the form of radiotherapy and/or chemotherapy.

These three treatments: surgery, radiotherapy and chemotherapy may be used alone, or alongside other therapies, depending on the extent of the disease.

However, until the part of the bowel containing the cancer has been removed surgically and examined by a pathologist, we may not be able to say if further treatment will be advised.

Radiotherapy uses high energy rays to destroy cancer cells. It is sometimes given to patients with rectal cancer before surgery.

The treatment is individually planned and monitored for each person, to ensure that normal cells suffer very little and there is no long term damage. Some patients may also benefit from radiotherapy after surgery.

Radiotherapy or chemotherapy may be used before surgery to shrink the size of the cancer, especially if it is located in the rectum. It can also be used after surgery with the aim of killing any cancer cells circulating in the body, or any which have spread to other sites.

Your surgeon will refer you, if appropriate, to an Oncologist (cancer specialist) who will advise you on the most appropriate treatment for your needs.

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Surgery involves removing the area of diseased bowel, plus a section of normal bowel on either side of the tumour and the surrounding lymph nodes. Following resection of the diseased bowel either;

normal continuity of the bowel is re-established by joining the two healthy ends of bowel together (anastomosis). A temporary covering stoma may be necessary to protect the join and divert faeces away from it (either a colostomy or an ileostomy). This can usually be closed two to three months later by another (less major) operation.

abdominoperineal resection, which involves excision of the rectum and anal sphincter requiring a permanent colostomy.

A stoma is Greek for ‘a mouth’ and is a piece of bowel brought to the surface of the abdomen through which stools pass. If it is formed from the colon it is a colostomy, if it is from the last part of the small bowel (ileum) it is called an ileostomy.

If you have a stoma, The London Clinic stoma nurse will advise you before and after your surgery.

The type of operation depends on your individual circumstances. Your operation details will be discussed with you by your surgeon and specialist nurse. A written explanation about your surgery and operation will be given to you.

Your care is led by your surgical consultant and discussed at multidisciplinary colorectal meetings. This team of multidisciplinary professionals specialises in colorectal cancer, and discusses the benefits of treatment available for each patient individually.

COLOR ECTAL SU RGERYTH E DIGESTIVE SYSTEM DU KES’ STAGI NG

U N DERSTAN DI NG DIGESTION

To understand your operation it helps to have some knowledge of how your body works.

When food is eaten it passes from the mouth down the oesophagus (gullet) into the stomach, here it is broken down and becomes semi-liquid. It then continues through the small bowel, (a coiled tube 10 to 15 feet long), where digestion of nutrients takes place and where most of these are absorbed into the body.

Following this, waste (faeces) passes through the large bowel (colon) into the rectum (back passage) and to the anus (back passage opening) for passing out of the body when we go to the toilet.

Cancer is confined to the bowel wall

STAGE

A

B

C

D

EXTENT OF CANC ER

Cancer has spread through the bowel wall

Cancer has spread to lymph nodes. Not all will have spread through the bowel wall

Cancer has spread to other sites, often the liver

The growth of the cancer is often described according to Dukes’ staging. Dr Dukes was a famous pathologist from St Mark’s Hospital, who was the first to describe a staging system for any cancer.

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R IGHT H EMICOLECTOMY

Operative details: The caecum, ascending colon and right side of transverse colon are removed, together with a few centimetres of small bowel. Continuity is restored by joining the two ends together.

ABDOMI NOPER I N EAL R ESECTION

Operative details: Excision of the rectum requiring a permanent colostomy.

OPERATIONS

Transverse colon

Ascending colon

Caecum

Rectum

Transverse colon

Descending colon

Sigmoid colon

Sphincter

Rectum

OPERATIONS

Transverse colon

Descending colon

Sigmoid colon

Rectum

Transverse colon

Descending colon

Sigmoid colon

Rectum

Transverse colon

Descending colon

Sigmoid colon

Rectum

ANTER IOR R ESECTION

Operative details: The low part of the sigmoid colon and the high part of the rectum are removed. Continuity is restored by joining the two ends together.

LEFT H EMICOLECTOMY

Operative details: The distal part of the transverse colon or descending colon is removed. Continuity is restored by joining the two ends of the bowel together.

Shaded area – the part of the bowel that will be removed.

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SIGMOI D COLECTOMY

Operative details: The sigmoid colon is removed and continuity is restored by joining the two ends back together.

YOU R OPERATION

BEFOR E YOU R OPERATION

While you are waiting to come in for your operation, it is important you try to prepare yourself physically. Try to eat a well-balanced diet; meat, fruit and vegetables. Take gentle exercise such as walking and get plenty of fresh air. If you smoke, stop before you come into hospital.

You will be contacted before your operation by the colorectal clinical nurse specialist to organise your admission.

WH EN YOU COME I NTO HOSPITAL

You will be visited by a member of the medical team and the specialist colorectal/stoma nurse before your operation. You will also be seen by a physiotherapist who will assist you with breathing and leg exercises, which need to be done daily post-surgery.

A phlebotomist will also visit to take bloods from your arm. This gives the anaesthetist and surgeon a base line from which to work.

AFTER YOU R OPERATION

When you return to the ward or our intensive care unit (ICU) after your operation, you will be attached to several tubes which are put in while you are anaesthetised. Many surgeons are happy to allow you to eat and drink very quickly after you wake up as there is evidence to say that this helps with postoperative recovery. Others may be more cautious and only allow fluids initially, depending on the surgery. Your Consultant will let you know what to do.

You will have a drip in your arm or neck to give you the fluids you require while you cannot drink normally. You may have a tube in your nose (a nasogastric tube) which goes down the back of your throat into your stomach to prevent nausea and vomiting.

There is likely to be a catheter into your bladder to drain urine away. This is so we can monitor the amount of urine you pass, and so you do not have to get out of bed to go to the toilet.

You may have a drain tube in your abdomen to drain blood and fluid produced from the operation. This is normal, it will be removed after a few days. When it is removed it is not painful. The tubes will be removed over a period of days after the operation.

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PAI N R ELI EF IMMEDIATE POTENTIAL COMPLICATIONS WH I LST I N HOSPITAL

You will be sore, but everything will be done to relieve any pain. You will be given analgesia (pain killers) either in the form of a PCA (patient controlled analgesia) hand held pump which you control yourself or a continuous infusion of pain killers. You may also be given an epidural anaesthetic via a fine tube in your back. The pain nurse specialist will visit you during your stay. They will help change your pain relief from the intravenous route to oral once you are eating and drinking.

The anaesthetist will see you prior to your operation and discuss this with you. You may be in hospital for approximately seven to ten days following your operation. When you go home will depend on how you as an individual progress after the operation.

haemorrhage

sepsis

intra-abdominal abscess formation

anastomotic leakage

bowel blockages

wound infection

others such as deep vein thrombosis

pulmonary embolism

chest infection

All of the above will be explained to you fully by your consultant, serious complications are not common.

TH E POST-OPERATIVE PER IOD

Each day your consultant will assess your abdomen to see if your bowel is now working again. When it does you can have sips of water to drink and then progress onto a cup of tea, soup and then a low fibre diet as tolerated.

While you are not eating and drinking, fluid will be administered to you through a drip in your arm, hand or neck.

The most important sign of recovery of bowel function is the passing of wind, followed usually by a bowel action. There is considerable variation as to when this occurs, and it can take as long as a week before the bowel starts working. Each day your consultant will inform you of what you are allowed to eat and drink.

Your wound will have stitches or staples (metal clips) to keep it together while it heals. Occasionally the wound is glued. These will be removed between ten to fourteen days after the operation. The procedure is painless. Some people go home and return to the hospital to have them removed, others visit their GP or practice nurse.

If you have any questions at any time ask the ward nurses, doctors, or your colorectal/stoma nurse. They will be only too pleased to explain anything that concerns you or your family. A good tip is to write your thoughts and questions down so that you do not forget.

If necessary you will be visited by the dietitian. The physiotherapist will continue to visit you, and the phlebotomist will also take blood to monitor your recovery.

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TIP: Write any thoughts or questions you have down so that you don't forget to ask.

GETTI NG BAC K TO NORMAL

For most people whatever their age, it will take three months or longer to recover from this type of surgery. During the first three to four weeks at home you will be tired and weak. The length of time between your return to work following this type of surgery will depend upon the type of work you do.

For the first six weeks you are advised not to lift anything heavy such as shopping and wet washing. Do not lift anything heavier than a full kettle, and do not do anything strenuous like digging the garden or mowing the lawn.

Your consultant will review your progress within a few weeks following your surgery. At that point you can seek their advice regarding returning to any heavy exercise.

You should not drive until you can do an emergency stop without hesitation for fear that your wound will hurt. Drivers wishing to drive after surgery should establish with their own doctors when it is safe to drive. It is advisable to check your car insurance policy as there may be a written clause about driving

after operations, often this is six weeks from the date of surgery.

You may resume sexual intercourse when you feel comfortable. This will depend on the surgery performed. If you are unsure, please speak to one of the colorectal team.

If you live alone and have no friends or family to help you, please let us know and we will try and organise some help or convalescence for you.

COMMON ISSU ES

We hope that after having one of the operations described in this booklet you will not have any issues. If you do, please do not hesitate to contact your colorectal nurse who can give advice and support over the telephone, or while at The London Clinic.

The common functional issues are constipation, diarrhoea or alternating bouts from one to the other.

With constipation it is important to eat a high fibre diet, mobilize gently, and to drink at least two litres of fluid each day. This can be made up of soup, tea, coffee, juice, or squash, although it is advisable to avoid too much tea and coffee because they contain caffeine and can cause dehydration. Sometimes kiwi fruit or prune juice will help you empty your bowels.

If you experience diarrhoea it is important to keep drinking to keep your body hydrated. One to two re-hydration sachets (such as Dioralyte) or one to two bottles of a sports drink (such as Gatorade) will help hydrate you. At least one glass of water should be consumed each hour.

Try to avoid food and dairy products for 24 hours, and when the diarrhoea subsides eat dry bland food, toast, crackers, etc., and slowly introduce foods such as white rice, peanut butter, marshmallows, jelly babies, arrowroot biscuits, mashed potato, cereal, toast, bananas, and pasta.

A diet sheet will be available for you if you have a stoma.

If these symptoms persist it is important to contact your GP or consultant who may prescribe the appropriate medication.

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OTH ER USEFU L ADDR ESSES

BEATI NG BOWEL CANC ER

Harlequin House 7 High Street Teddington TW11 8EET: 020 8973 0000www.beatingbowelcancer.org

BOWEL CANC ER U K

Willcox House 140-148 Borough High Street London SE1 1LBT: 020 7940 1760www.bowelcanceruk.org.uk

MACMI LLAN CANC ER SU PPORT

89 Albert Embankment London SE1 7UQT: 0808 808 0000www.macmillan.org.uk

COLOSTOMY ASSOC IATION

Enterprise House 95 London Street Reading Berkshire RG1 4QAT: 0800 328 4257www.colostomyassociation.org.uk

IA ( I LEOSTOMY AN D I NTER NAL

POUC H SU PPORT GROU P)

Danehurst Court 35-37 West Street Rochford Essex SS4 1BET: 0800 018 4724www.iasupport.org

ABSC ESS

A localised collection of pus in a cavity formed by the decay of diseased tissues

ACUTE

Sudden onset of symptoms

ADJ UVANT TH ERAPY

Chemotherapy and radiotherapy following surgery

AETIOLOGY

Cause

ANAEMIA

A reduction in the number of red cells containing haemoglobin (iron) in the body

ANALGESIA

Pain relievers such as paracetamol and morphine

ANASTOMOSIS

�e joining together of two ends of healthy bowel after diseased bowel has been removed (resected) by the surgeon

AN US

�e back passage

BAR I UM EN EMA

A diagnostic X-ray of the large bowel (colon). Barium and air are inserted into the rectum via the anus (back passage) and rolled around the bowel

BEN IGN

Non cancerous

BIOPSY

Removal of small pieces of tissue from parts of the body (eg colon – colonic biopsy) for examination under the microscope for diagnosis

CAECUM

�e �rst part of the large intestine forming a dilated pouch into which the ileum, the colon and the appendix opens

C H EMOTH ERAPY

Drug therapy used to attack cancer

C H RON IC

Symptoms occurring over a long period of time

COLITIS

In�ammation of the colon

COLON

�e large intestine extending from the caecum to rectum

COLONOSCOPY

Inspection of the colon by an illuminated telescope called a colonoscope

MEDICAL WOR DS AN D TERMS

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TH E LON DON C LI N IC DIGESTIVE

DISEASES U N IT (DDU)

20 Devonshire Place London W1G 6BWT: 020 7935 4444 (Switchboard)

Lead Colorectal Stoma Nurse (extension 3090) Colorectal Stoma Clinical Nurse Specialist (extension 3044)

colorectalnurses@thelondonclinic.co.uk www.thelondonclinic.co.uk

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MEDICAL WOR DS AN D TERMS (continued)

COLOSTOMY

Surgical creation of an opening between the colon and the surface of the body. Part of the colon is brought out of the abdomen creating a stoma. A bag is placed over this to collect waste material

CONSTI PATION

Infrequent or difficulty in the passage of bowel motions

CONTI N ENC E

The ability of the anal sphincter muscle to control faeces in the rectum

CT SCAN (COMPUTER ISED

TOMOGRAPHY)

A type of X-ray. A number of pictures are taken of the abdomen and fed into a computer to form a detailed picture of the inside of the body

DEFAECATION

The act of passing faeces

DIAGNOSIS

Determination of the nature of the disease

DIAR R HOEA

An increase in frequency, liquidity and weight of bowel motions

DISTAL

Further down the bowel towards the anus

DIVERTICU LA

Small pouch-like projections through the muscular wall of the intestine which may become infected, causing diverticulitis

DYSPLASIA

Alteration in size, shape and organisation of mature cells that indicate tumour formation and thus the possible development of cancer

ELECTROLYTES

Salts in the blood (eg sodium, potassium, calcium and magnesium)

EN DOSCOPY

A collective name for all visual inspections of body cavities with an illuminated telescope. Examples: gastroscopy – colonoscopy – sigmoidoscopy

EN EMA

A liquid introduced into the rectum to encourage the passing of motions

EXAC ER BATION

An aggravation of symptoms

FAEC ES

The waste matter eliminated from the anus (other names – stools, motions)

FISTU LA

An abnormal connection, usually between two organs, or leading from an internal organ to the body surface (eg between the anus and skin surface – anal fistula)

HAEMOR R HOI DS

Swollen arteries and veins in the area of the anus which bleed easily and may prolapse (protrude from the anus)

H ER EDITY

Genetic transmission of characteristics from patient to child

H ISTOLOGY

The examination of tissues under the microscope to assist diagnosis

I LEOSTOMY

The open end of healthy ileum (small bowel) is diverted to the surface of the abdomen and secured there to form a new exit for waste matter

I LEUS

The temporary paralysis of the bowel. It will resolve with time

I N FLAMMATION

A natural response of the body to disease, producing rushes to the site of damage or infection leading to reddening, swelling and pain. If external the area is usually hot to touch

LAXATIVE

Medicine or tablet that acts to assist emptying of the bowel. This may be by purging (irritating the lining) or increasing the volume of stool (bulking)

LESION

A term used to describe any structural abnormality in the body

MALIGNANT

Cancer

MUCUS

A white, slimy lubricant produced by the mucus membranes

MUCOUS MEMBRAN E

The lining of internal body surfaces: the inside skin

N EUTROPEN IA

Reduction in the number of white cells which fight infection

OEDEMA

Accumulation (build up) of excessive amounts of water in the tissues resulting in swelling

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MEDICAL WOR DS AN D TERMS (continued)

ONCOLOGIST

A doctor who specialises in cancer care using drugs and radiotherapy

PALLIATIVE CAR E

Improving the quality of life by providing support and control of unpleasant symptoms

PATHOLOGIST

Special doctor who studies specimens removed from the body

PATHOLOGY

The study of the cause of disease

PER FORATION

An abnormal opening (hole) in the bowel wall which causes the contents to spill into the normally sterile abdominal cavity causing peritonitis

PER ITON EUM

The membrane lining the abdominal cavity and covering the outside of the intestines

PER ITON ITIS

Inflammation of the peritoneum, often due to a perforation

POLYP

An abnormal elevation from the mucous membrane (lining of the bowel) eg colonic polyp – in the colon

PROPHYAXIS

Treatment to prevent a disease occurring before it has started

PROXIMAL

Further up the bowel towards the mouth

RADIOLOGIST

The doctor who interprets X-ray pictures to make a diagnosis

RADIOTH ERAPY

The use of high energy X-rays which attack cancer cells

R ECTUM

The lowermost part of the large intestine, above the anus (back passage) and below the colon approximately 15cm long

R ELAPSE

Return of disease activity

R EMISSION

A lessening of symptoms of the disease and return to good health

SIGMOI D

The portion of the colon shaped like a letter ‘S’ between the descending colon and the rectum

SIGMOI DOSCOPY

Inspection of the sigmoid colon with an illuminated telescope called a sigmoidoscope (rigid or flexible)

SPH I NCTER

The circular muscle around the anus which keeps it shut and maintains continence

STOMA

A piece of bowel brought to the surface of the abdomen

STR ICTU R E

The narrowing of a portion of the bowel

TEN ESMUS

Persistent urge to empty the bowel

TERMI NAL I LEUM

The last part of the ileum (small bowel) joining the caecum via the ileo-caecal valve

U LC ERATIVE

Colitis ulceration and inflammation of the large bowel

U LTRASOU N D

Use of high-pitched sound waves to produce pictures of organs on a screen for diagnostic purposes, by passing a transducer with conducting jelly over a specific body cavity, (eg the abdomen – abdominal ultrasound)

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A MAIN HOSPITAL

B THE DUCHESS OFDEVONSHIRE WING

C OUTPATIENT DEPARTMENTAND CONSULTING ROOMS

D CONSULTING ROOMS

E PATHOLOGY SERVICESAND CONSULTING ROOMS

F CONSULTING ROOMS

G EYE CENTRE ANDCONSULTING ROOMS

H ADMINISTRATION BUILDING

The London Clinic’s eight sites are conveniently located at the top ofHarley Street and Devonshire Place.

A THE LONDON CLINIC MAIN HOSPITAL

20 Devonshire Place London W1G 6BW

B THE LONDON CLINIC THE DUCHESS OF DEVONSHIRE WING

22 Devonshire Place London W1G 6JA

THE LONDON CLINIC OUTPATIENT DEPARTMENT AND CONSULTING ROOMS

5 Devonshire Place London W1G 6HL

C

THE LONDON CLINICPATHOLOGY SERVICES AND CONSULTING ROOMS

120 Harley Street London W1G 7JW

THE LONDON CLINICCONSULTING ROOMS

Harley Street 145 London W1G 6BJ

D

E

THE LONDON CLINIC ADMINISTRATION BUILDING

1 Park Square West London NW1 4LJ

H

THE LONDON CLINIC EYE CENTRE AND CONSULTING ROOMS

119 Harley Street London W1G 6AU

G

THE LONDON CLINIC CONSULTING ROOMS

116 Harley Street London W1G 7JL

F

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The London Clinic Digestive Diseases Unit

20 Devonshire Place London W1G 6BW

T: 020 7935 4444 F: 020 7486 3782

colorectalnurses@ thelondonclinic.co.uk

www.thelondonclinic.co.ukThe London Clinic is the trademark of Trustees of the London Clinic Limited. Registered company number 307579. Registered charity number 211136.