| Bowel cancer | Faecal Occult Blood Tests | Diagnosing bowel cancer |
| Treatment for bowel cancer | Having a stoma |
This information has been reviewed by:
Dr Michael Jefford MBBS, MPH, MHlthsevMt, PhD, MRACMA, FRACP
Consultant Medical Oncologist, Peter MacCallum Cancer Centre
Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer. Your doctor will advise you on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread, your general health, and what you want.
The main treatment for bowel cancer is surgery. Chemotherapy and radiotherapy may also be used.
An operation for bowel cancer aims to remove the cancer and nearby tissue that could be affected by cancer. This is major surgery and you will need time to recover from it.
More people are having keyhole surgery to remove the part of the colon where the cancer is. It is less invasive than the operations described below. (This means it is done using smaller incisions or cuts.) Speak to your doctor to see if this is possible for you.
A colectomy is an operation for cancer in the colon. It removes the part of the colon containing the cancer and then joins the two ends of the colon together. After the operation you will have a scar on your lower abdomen, a catheter (tube) to collect urine until your wound begins to heal, and a shorter colon.
Depending on how much of the colon is removed, you may have to open your bowels more often or you may have diarrhoea. You may also need a colostomy for a time (see ‘Having a stoma').
There are two types of surgery for cancer in the rectum. In an anterior resection (see illustration), the surgeon removes the part of the bowel where the cancer is, then joins the two ends of the bowel together. Anterior resection leaves one scar. A permanent stoma is not needed, although you may need a stoma for a time while your bowel heals. In the other type of surgery, an abdominoperineal (AP) resection, you will have two wounds-one on your abdomen and one where your anus was removed. You will need to have a permanent stoma because you no longer have a rectum or anus.
In a small number of people who have bowel cancer, the cancer is attached to another organ, such as the uterus or bladder. If this happens in your case, the doctor may remove part of the attached organ with the bowel.
Very rarely, a woman's uterus needs to be removed. This means she can no longer have children. Your doctor should discuss this possibility with you before the surgery, so that you can talk with a fertility counsellor or another specialist if you wish.
You will discuss your care after the operation with your surgeon. You will need to have pain relief. This is usually by epidural anaesthetic, which dulls feeling below the waist. Some people will have morphine by a slow injection into a vein (infusion). Morphine is safe for short-term use. Other people will have patient-controlled analgesia (PCA), which means you control the dose you take.
You will need to rest for a couple of days and then start eating and drinking in a normal way again. Most people are able to move around again within 4 to 5 days and can go home about 7 to 10 days after surgery. It takes 2 to 3 months to recover from the surgery.
Chemotherapy is often used to treat bowel cancer. Chemotherapy is the use of anti-cancer drugs. It can be used to increase the chance of cure or to shrink the size of the cancer when cure is not possible. When cancer can't be cured, chemotherapy can improve survival, reduce symptoms and improve quality of life.
The aim is to destroy all cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing.
Chemotherapy can be given before or after surgery and is usually given by injecting the drugs into a vein (intravenous treatment). There are other ways of having chemotherapy, including tablets.
Some drugs used in chemotherapy can cause side effects. They may include feeling sick (nausea), vomiting, feeling unwell and tired, and some thinning or loss of hair from your body and head. Generally, these side effects are temporary and can be prevented or reduced.
The medical oncologist will discuss these and other side effects and risks with you.
Radiotherapy treats cancer by using radiation to destroy cancer cells. Radiation can be targeted to cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissue.
Radiotherapy is often part of the treatment for rectal cancer. It can be given before or after surgery. It reduces the chance of cancer coming back.
The treatment is given over a number of weeks, with a small dose of radiation each day from Monday to Friday. Each treatment only takes a few minutes. Chemotherapy may be used in addition to radiotherapy.
Side effects of radiotherapy may include general tiredness, skin redness and tanning, nausea, vomiting, diarrhoea and frequent urination. Side effects usually get better within a few weeks of ending treatment.
Longer-term effects of radiotherapy may occur months or years after treatment. Radiotherapy can sometimes cause persistent diarrhoea, narrowing of the bowel, bleeding, and not being able to absorb food properly. In women, it can cause infertility (no longer being able to conceive children naturally) and the end of menstruation (some women may experience symptoms of menopause). For men, radiotherapy to the abdomen or around the rectum may cause infertility and erection problems.
The radiation oncologist will discuss these and other side effects and risks with you and how to manage them.
Bowel cancer spreads (metastasises) outside the bowel if it is not treated. It spreads fairly slowly and can stay in the bowel for months or years before moving outside it, generally first to the lymph nodes, then to other organs. This gives doctors a chance to treat and cure the cancer. Bowel cancer treatment is most effective if it happens before the cancer spreads.
If you would like information about your own prognosis, you need to speak to your doctor, who is familiar with your full medical history.
People who have been treated for bowel cancer need regular check-ups. This allows your doctors to keep an eye on your health. It may also help you to feel more confident about your health after treatment.
If your surgeon couldn't examine your whole bowel before or at the time of the operation, you should have a colonoscopy within six months. If you had a colonoscopy before or soon after your surgery, you should have one every three to five years.
After the treatment, give yourself time. Finding out you have cancer, and having treatment are all tiring. You need to give yourself time to get your strength back. If you look after the house, you will need some help for a while. If you work outside the home, you will need to ease back into it slowly, rather than rushing back the week after leaving hospital.
This means you might have to remind your family and friends that for a while you won't be fit enough to do all your usual activities.
Research into all aspects of bowel cancer is occurring in Australia and around the world. The information from these research studies is made available to doctors through medical journals and meetings of medical societies. New treatments become available when it is clear they are more effective than existing treatments. Ask your doctor about any new research results that might be relevant to your illness.
You will probably have to make some changes to your eating habits after treatment for bowel cancer. Your doctor or the hospital dietitian will advise you about the sort of diet that you need to follow.
At first you may notice that certain foods upset the normal action of your bowel or your colostomy if you have one. Foods such as fruit and vegetables may give you loose stools and make your colostomy act more often than normal. This is often temporary and after a while you may find that the same foods do not have any effect. There are no set rules about the types of food to avoid and each person needs to experiment. Some foods that disagree with one person may be fine for another. If you continue to have problems, it may help to talk to a dietitian at the hospital.
Depending on the type and extent of the surgery you have had, you may have diarrhoea. Tell your doctor or nurse if this happens as they can give you medicine to help control it. It is important to drink plenty of fluids if you do have diarrhoea.
It is very important that you try to eat as well as you can, to maintain your weight and strength. This is also true if you have chemotherapy or radiotherapy, although food may seem very unappealing at times.
In the longer term, plan to stick to a healthy diet and include regular exercise in your week. There is growing evidence that a good diet, staying a healthy weight and exercising regularly may reduce the chance of cancer coming back.
