Bowel cancer - Treatment 

Treating bowel cancer 

People with bowel cancer should be cared for by a multidisciplinary team (MDT). This is a team of specialists who work together to provide the best treatment and care.

The team often consists of a specialist cancer surgeon, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, pathologist, radiographer and a specialist nurse. Other members may include a physiotherapist, dietitian and occupational therapist, and you may have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

  • the type and size of the cancer
  • your general health
  • whether the cancer has spread to other parts of your body
  • what grade it is

There are several treatments for bowel cancer, including:

Surgery is usually the main treatment for bowel cancer, but in about one in five cases, the cancer is too advanced to be removed by surgery. If you have surgery, you may also need chemotherapy, radiotherapy or biological therapy, depending on your particular case.

Your treatment plan

Your recommended treatment plan will depend on the stage and location of your bowel cancer.

If the cancer is confined to your rectum, radiotherapy will usually be used to shrink the tumour, then surgery may be used to remove the tumour. Sometimes, radiotherapy is combined with chemotherapy, which is known as chemoradiation.

If you have stage 1 bowel cancer, it should be possible to surgically remove the cancer and no further treatment will be required.

If you have stage 2 or 3 bowel cancer, surgery may be used to remove the cancer and, in some cases, nearby lymph nodes. Surgery is usually followed by a course of chemotherapy to stop the cancer returning.

It is not usually possible to cure stage 4 (advanced) cancer. However, symptoms can be controlled and the spread of the cancer can be slowed using a combination of surgery, chemotherapy, radiotherapy and biological therapy where appropriate.

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Surgery - colon cancer hide

If the cancer is at a very early stage, it may be possible to remove just a small piece of the lining of the colon wall. This is known as local excision.

If the cancer spread into muscles surrounding the colon, it will usually be necessary to remove an entire section of your colon. Removing some of the colon is known as a colectomy.

Depending on the location of the cancer, possible surgical procedures include:

  • left-hemi colectomy  where the left half of your colon is removed
  • transverse colectomy  where the middle section of your colon is removed
  • right-hemi colectomy  where the right half of your colon is removed
  • sigmoid colectomy  where the lower section of your colon is removed

There are two ways a colectomy can be performed:

  • In an open colectomy, the surgeon makes a large incision in your abdomen and removes a section of your colon.
  • A laparoscopic colectomy is a type of ‘keyhole surgery’, where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of colon.

Both techniques are thought equally effective in removing cancer and have similar risks of complications. Laparoscopic colectomies have the advantage of a faster recovery time and less post-operative pain.

Laparoscopic colectomies should now be available in all hospitals carrying out bowel cancer surgery, although not all surgeons perform this type of surgery. If you are considering having your bowel cancer surgery done using keyhole surgery, discuss this with your surgeon.

During surgery, nearby lymph nodes may also be removed. It is usual to join the ends of the bowel together after bowel cancer surgery, but very occasionally this is not possible and a stoma is needed. 

Enhanced recovery programmes

Enhanced recovery surgical programmes should be used for most bowel cancer patients. These programmes differ from traditional surgery by:

  • ensuring patients are in the best possible physical condition before surgery
  • minimising the trauma patients go through during surgery - for example, minimally invasive surgery when possible and better pain control
  • ensuring patients experience the best possible rehabilitation after surgery

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Stoma surgery show

In some cases, the surgeon may decide the colon needs to heal before it can be reattached, or that too much of the colon has been removed to make reattachment possible.

In this case, it will be necessary to find a way of removing waste materials from your body without stools passing through your anus. This is done using stoma surgery.

Stoma surgery involves the surgeon making a small hole in your abdomen, which is known as a stoma. There are two ways that stoma surgery can be carried out.

  • An ileostomy is where a stoma is made in the right-hand side of your abdomen. Your small intestine is separated from your colon and connected to the stoma, and the rest of the colon is sealed. You will need to wear a pouch connected to the stoma to collect waste material.
  • A colostomy is where a stoma is made in your lower abdomen and a section of the colon is removed and connected to the stoma. As with an ileostomy, you will need to wear a pouch to collect waste material.

In most cases, the stoma will be temporary and can be removed once your colon has recovered from the effects of the surgery. This will usually take at least nine weeks. Specialist stoma nurses are available to advise on the best site for a stoma, and about the best sort of pouch to cover the stoma and collect the waste material.

Before you have a colectomy, your care team will tell you whether they think stoma surgery will be necessary and the likelihood that you will need to have a temporary or permanent ileostomy or colostomy.

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Surgery - rectal cancer show

Two common surgical procedures can be used to treat rectal cancers:

  • low anterior resection
  • abdominoperineal resection

Low anterior resection

Low anterior resection is a procedure used to treat cases where the cancer is in the upper section of your rectum. The surgeon will make an incision in your abdomen and remove the upper section of your rectum, as well as some surrounding tissue to make sure any lymph glands containing cancer cells are also removed. They will then attach your colon to the lowest part of your rectum or upper part of the anal canal. Sometimes, they turn the end of the colon into an internal pouch to replace the rectum. You will probably require a temporary stoma to give the join-up time to heal.

Abdominoperineal resection

Abdominoperineal resection is used to treat cases where the cancer is in the lowest section of your rectum. In this case, it will be necessary to remove the whole of your rectum and surrounding muscles to reduce the risk of the cancer regrowing in the same area. This involves removing the anus and its sphincter muscles too, so there is no option except to have a permanent stoma after the operation. Bowel cancer surgeons always do their best to avoid giving people permanent stomas wherever possible.

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Side effects of surgery show

Bowel cancer operations carry the same risks as other major operations, including the risks of bleeding, infection, developing blood clots or heart or breathing problems. 

One risk is that the join-up in the bowel may not heal properly and may leak inside your abdomen. This is usually only a risk in the first few days after the operation. 

Another risk is for patients having rectal cancer surgery. The nerves controlling passing urine and sexual function are very close to the rectum, and sometimes an operation to remove a rectal cancer can damage these nerves. 

After bowel cancer surgery, the bowel is shorter than it used to be. This results in some patients needing to go to the toilet to open their bowels more often than before. This usually settles down within three to six months of the operation.

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Radiotherapy show

There are two main ways that radiotherapy can be used to treat bowel cancer. It can be:

  • given before surgery, in cases of rectal cancer
  • used to control symptoms and slow the spread of cancer, in cases of advanced bowel cancer (called palliative radiotherapy)

Radiotherapy given before surgery for rectal cancer can be performed in two ways:

  • external radiotherapy, where a machine is used to beam high-energy waves at your rectum to kill cancerous cells
  • internal radiotherapy (also known as brachytherapy), where a radioactive tube is inserted into your anus and placed next to the tumour to shrink it

External radiotherapy is usually given daily, five days a week, with a break at the weekend. Depending on the size of your tumour, you may need one to five weeks of treatment. Each session of radiotherapy is short and will only last for 10-15 minutes.

Internal radiotherapy can usually be performed in one session before surgery is carried out a few weeks later.

Palliative radiotherapy is usually given in short, daily sessions, with a course ranging from 2-3 days to 10 days.

Short-term side effects of radiotherapy include:

  • nausea
  • fatigue
  • diarrhoea
  • burning and irritation of the skin around the rectum and pelvis (this looks and feels like sunburn)
  • a frequent need to urinate
  • a burning sensation when passing urine

These side effects should pass once the course of radiotherapy has finished. Tell your care team if the side effects of treatment become particularly troublesome. Additional treatments are often available to help you cope better with the side effects.

Long-term side effects of radiotherapy include:

  • a more frequent need to pass urine or stools
  • blood in your urine and stools
  • infertility
  • impotence in men

If you want to have children, it may be possible to store a sample of your sperm or eggs before treatment begins so they can be used in fertility treatments in the future.

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Chemotherapy show

There are three ways chemotherapy can be used to treat bowel cancer. It can be:

  • given before surgery for rectal cancer in combination with radiotherapy
  • given after surgery to prevent the return of cancer
  • given to slow the spread of advanced bowel cancer and help control symptoms (palliative chemotherapy)

Chemotherapy for bowel cancer usually involves taking a combination of medications that kill cancer cells. They can be given as a tablet (oral chemotherapy), through a drip in your arm or chest (intravenous chemotherapy), or as a combination of both.

Depending on the stage and grade of your cancer, a single session of intravenous chemotherapy can last from several hours to several days.

Most people have regular daily sessions of chemotherapy over the course of one or two weeks before having a break from treatment for another week.

A course of chemotherapy can last up to six months depending on how well you respond to the treatment.

Side effects of chemotherapy include:

  • fatigue
  • nausea
  • vomiting
  • diarrhoea
  • mouth ulcers
  • hair loss
  • redness and soreness on the palms of your hands and the soles of your feet
  • a sensation of numbness, tingling or burning in your hands, feet and neck

These side effects should gradually pass once your treatment has finished. It usually takes three to six months for your hair to grow back.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. Inform your care team or GP as soon as possible if you experience possible signs of an infection, including:

  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • a sudden feeling of being generally unwell

Medications used in chemotherapy can cause temporary damage to men's sperm and women's eggs. This means that for women who become pregnant or for men who father a child, there is a risk to the unborn baby’s health. Therefore, it is recommended you use a reliable method of contraception while having chemotherapy treatment and for a further year after your treatment has finished.

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Biological treatments  show

Biological treatments, including cetuximab, bevacizumab and panitumumab, are a newer type of medication known as monoclonal antibodies. Monoclonal antibodies are antibodies that have been genetically engineered in a laboratory. They target special proteins found on the surface of cancer cells, known as epidermal growth factor receptors (EGFR). As EGFRs help the cancer to grow, by targeting these proteins, biological treatments can help prevent the cancer spreading.

Biological treatments are usually used in combination with chemotherapy and radiotherapy.

These treatments are not available to everyone with bowel cancer. The National Institute for Health and Clinical Excellence (NICE) has determined specific criteria which need to be met before they can be prescribed.

Cetuximab is only available on the NHS when:

  • bowel cancer has spread to the liver and cannot be removed using surgery
  • surgery to remove the cancer in the colon or rectum has been carried out or is possible
  • a person is fit enough to undergo surgery to remove the cancer from the liver if this becomes possible after treatment with cetuximab

Bevacizumab and panitumumab are not available on the NHS. All these medications are available privately but are very expensive. The medication is usually given in combination with chemotherapy.

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Page last reviewed: 29/08/2012

Next review due: 29/08/2014

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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

tollers said on 02 September 2013

On the 21st of august I was admitted to sheffields northern general teaching hospital for surgery on my colon for cancer , an extended right hemicolectomy,e I was put on the enhanced recovery procedure and I really thought I would be in hospital recovering for up to a week . The operation took three and half hours and I was back on a ward at five thirty pm , everyone I came into contact with including the surgeon who I saw three times over the next two days were wonderful ,so positive and confident it made me feel the same , two days later I was leaving hospital and it is now eleven days and I feel well on the way to full recovery , I am 58 years old so no spring chicken , and cant thank everyone involved enough

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