Bowel cancer treatments
Staging bowel cancerThe tests described in the Diagnosis article help determine whether you have bowel cancer. Some tests also show if the cancer has spread to other parts of the body. This is called staging. It helps your doctors work out the best treatment for you.
TreatmentThe main treatment for bowel cancer is surgery. You may also have chemotherapy or radiotherapy. You may only need one type of treatment, but sometimes you may have a combination.
SurgeryThere are different types of surgery for bowel cancer. Which one you have depends on where the cancer is in the bowel, the type and size of the cancer and whether it has begun to spread. The doctor will also consider your age and general health.
Minimally invasive surgeryThe term minimally invasive surgery, also called keyhole or laparoscopic surgery, means a surgical technique that involves several small cuts (incisions) instead of one large cut on the abdomen.
The surgeon passes a thin, flexible tube called a laparoscope through one of the cuts. The laparoscope is fitted with a light and camera so the surgeon can see into the abdomen and remove the cancer. This technique usually means less pain and scarring, a lower risk of infection and a faster recovery with less time spent in hospital.
Minimally invasive bowel surgery is often recommended for early stage cancers and if the surgeon is confident the tumour can be easily removed. This depends on the location of the cancer and its size.
Ask your surgeon if this type of surgery is suitable for you and if it is available at your hospital or treatment centre.
Surgery for colon cancerThe most common type of colon cancer surgery is called a colectomy. There are different types of colectomies depending on where in the bowel the tumour is located.
Before the surgery, the operation and what to expect afterwards will be explained to you. Some people have minimally invasive surgery instead of the procedure described here.
The surgeon will make a cut in the abdomen to remove the part of the colon containing the cancer. The lymph nodes near the colon are also removed. The surgeon joins the two ends of the colon back together.
Sometimes, to allow the area time to heal, the bowel isn’t joined but is brought out onto an opening on the outside of the body. This procedure is called a colostomy and the opening is called a stoma. Another operation to rejoin the bowel can be done a few months later. In some cases, the surgeon will be unable to rejoin the ends of the colon and will connect the large bowel to a permanent stoma. For information about temporary and permanent stomas,
After surgery you will have a scar, usually running from your navel to your pubic area.
Surgery for rectal and anal cancersIf you have rectal or anal cancer, you may have part of the bowel removed, known as a resection. There are different types of resections depending on where in the rectum the cancer is located.
Anterior resectionThe surgeon cuts out cancerous tissue in the rectum. You may have one large cut in your abdomen, or if your surgeon uses the minimally invasive technique, you will have small cuts. The type of surgery you have will depend on your situation.
During an anterior resection, the left part of the colon and the upper part of the rectum are removed, together with its blood supply and nearby lymph nodes. The ends of your bowel are rejoined.
Ultra-low anterior resectionIf you have an ultra-low anterior resection, the left part of the colon and the entire rectum will be removed. Your surgeon will then perform a coloanal anastomosis. This means that your colon is joined to your anus. In some cases the surgeon may also create an internal pouch (called a colonic J-pouch) using the lining of the large bowel. The J-pouch will be connected to the anus and will work as a rectum. You may have a temporary stoma, which will be reversed once your J-pouch is healed.
Abdominoperineal (AP) resectionAn AP resection is a less common type of rectal surgery. In this procedure, the entire rectum and anus are removed. After an AP resection, you will have two wounds: one on your abdomen and one where your anus was removed.
Your doctor will also create a permanent stoma, and waste will be removed through this opening.
Local excisionThis type of surgery is usually used for very early stage tumours. The surgeon removes the cancer without cutting into the abdomen. Instead, the surgeon inserts an endoscope, like the one used to take a biopsy, into the rectum and lower colon and cuts the cancer out.
There are several types of local excision. For example, if the surgeon cuts out a cancerous polyp, it is called a polypectomy. If a surgeon cuts out a tumour, it is called a transanal excision.
The type of surgery you have will depend on the location of the cancer. For example, if the cancer is in or near the anal sphincter muscles, a transanal resection is not suitable.
Surgery for advanced cancerA small number of people will have two separate cancers in their large bowel at the same time. Doctors may find the cancers using diagnostic tests or during surgery.
In this case, there are three options for surgery:
- 1. Remove the two small sections of the bowel.
- 2. Remove one larger section of the bowel, containing both areas with cancer.
- 3. Remove the entire colon and rectum (proctocolectomy) to prevent any chance of another cancer forming. The type of surgery you have depends on your doctors’ recommendations and what you want.
- Neoadjuvant therapy – Some people who have surgery have chemotherapy (and/or radiotherapy) beforehand to shrink the tumour and make it easier to remove during surgery.
- Adjuvant chemotherapy – Chemotherapy is often recommended for people if the bowel cancer has spread through the bowel wall or into the lymph nodes but no further.
- Reduce symptoms – If the cancer has spread to other organs, such as the liver or bones, chemotherapy may be used as palliative treatment.
In some cases, the cancerous part of the large bowel will be attached to another organ, such as the uterus or bladder. This may be caused by inflammation or by the cancer spreading. Your surgeon may remove the attached organ and the large bowel. If you need this type of operation, talk to your surgeon about what to expect. For example, the removal of a woman’s uterus (hysterectomy) causes infertility, so it is important to talk to a doctor or a fertility counsellor before treatment. This person can help you address your feelings and explore your options.
After surgery you will need regular checkups for the rest of your life as the chance of developing another primary cancer is higher than average. For more information about surgery for advanced bowel cancer, call the Cancer Council Helpline on 13 11 20.
ChemotherapyChemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells.
If the cancer is contained inside the bowel, surgery is the only treatment needed and chemotherapy is not used.
Chemotherapy may be used for the following reasons:
Chemotherapy drugs are usually injected into a vein (intravenously) or sometimes given in tablet form. Some people have a small medical appliance called a port-a-cath or catheter placed beneath their skin through which they can receive chemotherapy. You will probably have sessions of chemotherapy over several weeks or months. Your medical team will work out your treatment schedule.
Refer to Cancer Council’s free Understanding Chemotherapy book for more details.
Side effectsThe side effects of chemotherapy vary according to the drugs used. Your doctor will talk to you about these side effects and how to manage them.
Some of these side effects include tiredness, nausea, diarrhoea, mouth sores and ulcers, sore hands or feet, and a drop in levels of blood cells.
Most side effects are temporary and there are ways to prevent or reduce them. Tell your doctor or nurse about side effects you experience. They may prescribe medication to manage the side effects, arrange a break in your treatment, or change the kind of treatment you are having.
While having chemotherapy, you will be at a higher risk of getting an infection and bleeding in your bowel or other parts of your body. Tell your doctor if you are fatigued, or if you bruise or bleed easily. If you have a temperature over 38oC, contact your doctor or nurse immediately and go straight to the hospital emergency department.
RadiotherapyRadiotherapy uses high-energy x-rays or electron beams to kill or damage cancer cells. Radiotherapy may be given before or after surgery for some people with rectal cancer, instead of surgery, or as palliative treatment.
During treatment, you will lie under a machine that delivers x-ray beams to the treatment area. Each treatment only takes a few minutes once it has started, but setting up the machine and seeing the radiation oncologist during your first treatment session may take a few hours.
Radiotherapy is usually given once a day, Monday to Friday, for about 5–7 weeks. The number of radiotherapy treatments you have will depend on the site and extent of the cancer and your radiation oncologist’s recommendation.