Bowel Cancer Treatments
Treatment for bowel cancer is determined by a number of factors including the stage of your cancer, the location of the tumour (whether it’s located in the colon or rectum) and your health in general.
Your MDT (multidisciplinary team), which may include a colorectal surgeon, consultant oncologists and specialist nurses will meet regularly to discuss your case and decide on the best course of treatment for you. Treatment may include surgery, chemotherapy and/or radiotherapy.
Below we talk about some of the common treatments available for bowel cancer. As with any condition, it is vital that you discuss your treatment in depth with your healthcare team. You should always speak to them if you have any questions or concerns, no matter how small they appear.
Surgery is the most common way of treating bowel cancer. The operation you have will depend on the location, size and stage of your tumour. Some operations may require you to have a stoma (an opening on your abdomen to allow waste to exit) either temporarily or permanently.
These operations may be performed laparoscopically (by keyhole) or open surgery. Your surgeon will explain the best option for you.
If you cancer has been caught very early and the tumour is still very small, a local resection may be performed which involves inserting a very small flexible tube (colonoscope) into the bowel to remove the tumour. This will then be examined and graded by a specialist to decide whether any further treatment is necessary.
Surgery For Colon Cancer
There are three main types of surgery for Colon Cancer…
This operation involves removing the right side of the colon and usually the appendix and rejoining with the small bowel.
This operation is also known as a sigmoid colectomy, this involves removing the left side of the bowel of sigmoid section and joining the two end of the colon back up.
A Total Colectomy involves removing the entire colon except for the rectum and joining up the small bowel to the rectum.
Surgery For Rectal Cancer
There are two main operations performed for rectal cancer…
If the tumour is located in the upper part of the rectum then your surgeon will remove the affected part of your rectum along with part of your colon and surrounding lymph nodes. A temporary stoma may be required to allow the join to heal.
Abdominoperineal Resection (APR, APeR)
If the tumour involves the lower part of your rectum then your surgeon may perform an abdominoperineal resection, this is also known as an APR or APeR. The surgeon will remove all your rectum, part of your colon and your anus which will be sewn shut. This operation will mean you will have a permanent stoma, in the form of a colostomy. The surgeon will only perform a permanent stoma as a last resort.
Chemotherapy may be offered prior to surgery alongside radiotherapy (neoadjuvant chemoradiation) to treat rectal cancer or may be offered after surgery (adjuvant chemotherapy) if there is a high risk of the cancer returning or instead of surgery for advanced cancers that cannot be operated on.
Below are the main types of chemotherapy used to treat bowel cancer. They may be used as a standalone treatment or a combination. Again, this will depend on your type and stage of cancer. How your chemotherapy is administered will be decided by your oncologist. It may range from several weeks to several months and may be taken as a tablet or administered via a drip.
This is the most common type of chemotherapy used to treat bowel cancer. It is usually given alongside Folinic Acid which increases the effectiveness of the treatment. It can be combined with one or more additional chemotherapy drug as part of your treatment.
This form of treatment is taken as a tablet and works the same as 5FU, it can be given alone before or after surgery or combined with other chemotherapy drugs.
Oxaliplatin is usually combined with 5FU and Folinic Acid which is known as FOLFOX or combined with capecitabine which is known as XELOX.
Irinotecan is usually combined with 5FU and Folinic Acid which is known as FOLFIRI, occasionally it can also be combined with Oxaliplatin which is known as FOLFOXIRI, this is usually to treat advanced bowel cancer.
Each chemotherapy drugs comes with its own side effects and these vary from person to person, you may experience all, some or none of these symptoms:
- Diarrhoea, nausea and vomiting
- Sore mouth and gums
- Neuropathy or nerve pain if you are on Oxaliplatin
- An increased risk of infection
You are unlikely to lose your hair from these chemotherapy treatments for bowel cancer although you may experience thinning hair.
Radiotherapy is used to treat rectal cancer either before (neoadjuvant) or after (adjuvant) surgery, this may be combined with chemotherapy which is known as chemoradiation.
This uses high dose x-rays to kill cancer cells. This can be given as a short course (usually over five days) or as a long course (up to 6 weeks). Your specialist will use a CT to plan and mark the areas to target. The treatment only lasts a few minutes but it will usually require you to have daily treatment for a number of days or weeks.
This is a form of internal radiotherapy which involves planting a source of radiation inside the rectum for a few minutes. This may be used as a standalone treatment or alongside external radiotherapy.
Pelvic radiotherapy can cause some short term and long term effects. These include:
- Sore skin
- Diarrhoea and nausea
- Fatigue/ extreme tiredness
- Bladder and bowel issues
- Sexual dysfunction
- Weaker pelvic bones
Your treatment for cancer is as individual as you and your team of specialists will be able to discuss your options so that you can make an informed decision and understand what to expect. For further information on bowel cancer you may like to look at the below sites.
- Bowel Cancer UK
- Beating Bowel Cancer
- Macmillan Cancer Support
- Cancer Research UK
- The Association of Coloproctology of Great Britain and Ireland
- Lyn’s Bowel Cancer Campaign
Living with bowel cancer can affect you emotionally and socially; sometimes it can help to speak to others who understand your situation. The Bladder & Bowel Community Forum is available 24 hours today and will allow you to connect with those who share your condition. Start your own topic today or just follow one that interests you.