Bowel cancer - Treatment 

Treating bowel cancer 

Surgery is usually the main treatment for bowel cancer, and may be combined with chemotherapy, radiotherapy or biological treatments, depending on your particular case.

The treatments recommended for you will depend on which part of your bowel is affected and how far the cancer has spread, but surgery is usually the main treatment.

If it's detected early enough, treatment can cure bowel cancer and stop it coming back. Unfortunately, however, a complete cure is not always possible and there is sometimes a risk that the cancer could recur at a later stage.

In more advanced cases that cannot be removed completely by surgery, a cure is highly unlikely. However, symptoms can be controlled and the spread of the cancer can be slowed using a combination of surgery, chemotherapy, radiotherapy and biological treatments where appropriate.

Your treatment team

If you are diagnosed with bowel cancer, you will be cared for by a multidisciplinary team – including a specialist cancer surgeon, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist and a specialist nurse.  

When deciding what treatment is best for you, your care team will consider the type and size of the cancer, your general health, whether the cancer has spread to other parts of your body and how aggressive the cancer is.

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Surgery for colon cancer hide

If colon 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 spreads 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.

There are two ways a colectomy can be performed:

  • an open colectomy – where the surgeon makes a large incision in your abdomen and removes a section of your colon
  • a laparoscopic (‘keyhole') colectomy – 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

During surgery, nearby lymph nodes are also 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 (see below) is needed.

Both open and laparoscopic colectomies are thought to be equally effective in removing cancer and have similar risks of complications. Laparoscopic colectomies, however, have the advantage of a faster recovery time and less post-operative pain and this is becoming the routine way of doing most of these operations.

Laparoscopic colectomies should be available in all hospitals carrying out bowel cancer surgery, although not all surgeons perform this type of surgery. Discuss your options with your surgeon to see if the laparoscopic method can be done.

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Surgery for rectal cancer show

There are a number of different types of operation that can be carried out to treat rectal cancer, depending on how far the cancer has spread.

Some of the main techniques used are described below.

Local resection

If you have a very small, early stage rectal cancer, your surgeon may be able to remove it in an operation called a local resection (trans anal resection).

The surgeon puts an endoscope (a flexible tube with a light) in through your back passage and removes the cancer from the wall of the rectum.

Total mesenteric excision

In many cases, however, a local resection is not possible. Instead, a larger area of the rectum will need to be removed, along with a border of rectal tissue around it that is free of cancer cells and fatty tissue from around the bowel (known as the mesentery). This type of operation is known as total mesenteric excision (TME).

Removing the mesentery can help ensure all the cancerous cells are removed, which can lower the risk of the cancer recurring at a later stage.

Depending on exactly where in your rectum the cancer is located, one of two main TME operations may be carried out. These are outlined below.

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 (see below) to give the joined section of bowel 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 re-growing in the same area.

This involves removing and closing the anus and removing 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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Stoma surgery show

Where a section of the bowel is removed and the remaining bowel joined, the surgeon may sometimes decide to divert your stool away from the join to allow it to heal. The stool is temporarily diverted by bringing a loop of bowel out through the abdominal wall and attaching to the skin – this is called a stoma. A bag is worn over the stoma to collect the stool.

Where the stoma is made from small bowel (ileum) it is called an ileostomy and where it is made from large bowel (colon) it is called a colostomy

A specialist nurse, known as a stoma care nurse, is usually available to advise you, prior to surgery, on the best site for a stoma. The nurse will take into account factors such as your body shape and lifestyle, although this may not be possible where surgery is performed in an emergency. During the first few days post surgery the stoma care nurse will advise on the care necessary to look after the stoma and the type of bag suitable.

Once the join in the bowel has safely healed, which can take several weeks, the stoma can be closed during further surgery. In some people, for various reasons, re-joining the bowel may not be possible or may lead to problems controlling bowel function and therefore the stoma may become permanent.

Before having surgery, the care team will advise whether it may be necessary to form an ileostomy or colostomy and the likelihood of this being temporary or permanent.

For anyone wishing to obtain further information about living with a stoma, there are patient support groups which provide support for patients who may have just had or are due to have, a stoma. You can obtain details through your stoma care nurse or visit them online for further information.

These include:

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Side effects of surgery show

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

The operations all carry a number of risks specific to the procedure.

One risk is that the joined up section of 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 people 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 rectal cancer surgery most people need to go to the toilet to open their bowels more often than before, although it usually settles down within a few 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 to shrink rectal cancers and increase the chances of complete removal, or used to control symptoms and slow the spread of cancer in advanced cases (called palliative radiotherapy).

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

  • external radiotherapywhere 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 cancer 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 two to three days to 10 days.

Short-term side effects of radiotherapy can include:

  • feeling sick
  • 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 can include:

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 to shrink a tumour, after surgery to reduce the risk of the cancer recurring, or 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 (intravenous chemotherapy), or as a combination of both. Treatment is given in courses (cycles) each two to three weeks long, depending on the stage or grade of your cancer.

A single session of intravenous chemotherapy can last from several hours to several days.

Most people having oral chemotherapy take tablets over the course of 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. In some cases it can be given in smaller doses over longer periods of time (maintenance chemotherapy).

Side effects of chemotherapy can include:

  • fatigue
  • feeling sick
  • vomiting
  • diarrhoea
  • mouth ulcers
  • hair loss with certain treatment regimens, but this is generally uncommon in the treatment of bowel cancer       
  • 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 a few months for your hair to grow back if you experience hair loss.

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) or 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 period 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 also 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, targeting these proteins can help shrink tumours and improve the effect and outcome of chemotherapy.

Biological treatments are therefore usually used in combination with chemotherapy when the cancer has spread beyond the bowel (metastatic bowel cancer).

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

Cetuximab is only available on the NHS when:

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

Cetuximab, bevacizumab and panitumumab are available on the NHS through a government scheme called Cancer Drugs Fund. All these medications are also available privately but are very expensive.

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Page last reviewed: 02/09/2014

Next review due: 02/09/2016

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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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