The types of treatment used for large bowel cancer

Overview

Surgery is the main treatment for cancer of the large bowel. It may be used either alone, or in combination with radiotherapy and chemotherapy. The aim of surgery is to completely remove the cancer if possible, and this may cure it.

Chemotherapy is often given after surgery to try to reduce the chances of the cancer coming back. It is also given when the cancer is advanced and has spread to other parts of the body.

Radiotherapy is usually only used to treat cancer of the rectum and can be given before or after surgery.

In some people, radiotherapy and chemotherapy are combined and given together. This is called chemoradiotherapy.

Sometimes a further type of drug therapy known as a monoclonal antibody may be used to treat advanced or metastatic bowel cancer.

Cancers affecting the colon and those affecting the rectum are usually treated in slightly different ways.

How is treatment planned?

In most hospitals a team of specialists will decide the treatment that is best for you. This multidisciplinary team (MDT) will include a surgeon who specialises in bowel cancers, a medical oncologist (chemotherapy specialist), a clinical oncologist (radiotherapy specialist) and may include a number of other healthcare professionals such as a:

• nurse specialist
• dietitian
• physiotherapist
• occupational therapist
• psychologist or counsellor.

Together, the doctors will be able to advise you on the best course of action and plan of treatment, taking into account a number of factors. These include your age, general health, the type and size of the tumour, and whether it has begun to spread.

If two treatments are equally effective for your type and stage of cancer, your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision. If you are asked to make a choice, it is important to make sure that you have enough information about the different treatment options, what is involved and the side effects you might have. You can then decide what is the right treatment for you.

Remember to ask questions about any aspects of the treatment that you do not understand or feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your cancer specialist and also with the nurses at CancerBACUP.

If you have any questions about your own treatment, don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions and to take a close friend or relative with you.

Second opinion

Even though a number of cancer specialists work together as a team to decide on the most suitable treatment, you may want to have another medical opinion.

Most doctors will be pleased to refer you to another specialist for a second opinion, if you feel that this will be helpful. The second opinion may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will provide useful information.

If you do go for a second opinion, again it may be a good idea to take a friend or relative with you, and to have a list of questions ready, so that you can make sure your concerns are covered during the discussion.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment.

No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any possible alternative treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need their treatment to be explained more than once.

It is often a good idea to have a friend or relative with you to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.

People often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision when it is first explained to you. You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it.

The benefits and disadvantages of treatment

Many people are frightened at the thought of having cancer treatments, particularly because of the side effects that may occur. Some people ask what would happen if they do not have any treatment.

Although the treatments can cause side effects, these can often be well controlled with medicines.

Treatment can be given for different reasons and the potential benefits will vary depending upon your particular situation.

Early-stage bowel cancer

In people with early-stage bowel cancer, surgery is often done with the aim of curing the cancer. Occasionally additional treatments are given to help reduce the risks of it coming back.

Advanced-stage bowel cancer

If the cancer is at a more advanced stage, treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. However, for some people in this situation, the treatment will have no effect upon the cancer and they will have  the side effects without any of the benefit.

Treatment decisions

If you have been offered treatment that is intended to cure your cancer, the decision whether to accept the treatment may not be a difficult one. However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, which often involves medicines to control any symptoms.