If you have bowel cancer, you may see several, or all, of these healthcare professionals as part of your treatment. Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.

Your treatment plan

Your recommended treatment plan will depend on the stage and location of your bowel cancer. If the bowel cancer is confined to your rectum, radiotherapy will be used to shrink the tumour, and then surgery may be used to remove the tumour. Sometimes, radiotherapy is combined with chemotherapy, which is known as chemoradiation.

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

If you have Dukes B, or C, bowel cancer, surgery may be used to remove the cancer and, in some cases, near by lymph nodes. Surgery is usually followed by a course of chemotherapy in order to prevent the bowel cancer returning.

It is not usually possible to cure Dukes D cancer. However, the symptoms can be controlled and the spread of the bowel cancer can be slowed using a combination of chemotherapy, radiotherapy, surgery, and a new type of medication called cetuximab (Erbitux).

Radiotherapy

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, and used to control symptoms and slow the spread of cancer, in cases of advanced bowel cancer (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 in order to kill cancerous cells, and
• internal radiotherapy (also known as brachytherapy) – where a radioactive tube is inserted into your anus and placed next to the tumour in order to shrink it.

Research suggests that people who are treated with internal radiotherapy are less likely to need to have their entire rectum and anus removed and will not need to have a permanent colostomy (where a section of the colon is diverted and attached to an opening in the abdominal wall called a stoma).

However, as internal radiotherapy is a relatively new treatment, there is no information about how successful it is in the long-term in prolonging life and preventing bowel cancer returning.

You should discuss the advantages of both types of radiotherapy treatment with your care team.

External radiotherapy is usually given on a daily basis, five days a week, with a break at the weekend. Depending on the size of your tumour, you may need 1-5 weeks of treatment. Each session of radiotherapy is short and will only last for between 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:

• 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, and
• a burning sensation when passing urine.

These side effects should pass once the course of radiotherapy has finished. You should 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, and, in men,
• impotence.

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

Medications such as sildenafil (Vigra) can be used to treat some cases of impotence.

Surgery – colon cancer

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 has begun to spread into the 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, and
• sigmoid colectomy – where the lower section of your colon is removed.

There are two ways that 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, or
• laparoscopic colectomy  – 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 to be equally effective in removing cancer and have similar risks of complications. Laparoscopic colectomies have the advantage of having a faster recovery time and causing less post-operative pain. Laparoscopic colectomies are a new technique so they may only be available at specialist cancer clinics, and there may be a longer waiting time for this type of surgery.

During surgery, near-by lymph nodes may also be removed. In some cases, it will be possible to reconnect the remaining sections of the colon.

Continue in part 2

Relate articles:

1. Treat­ing breast can­cer — part 2
2. Bowel Can­cer
3. Dia­gnos­ing bowel can­cer
4. Pro­state can­cer is the most com­mon can­cer in men
5. Under­stand­ing the symp­toms of a pro­state can­cer
6. Intro­duc­tion 1: Improve your know­ledge of can­cer 
7. Biopsy
8. Bone Can­cer (Sar­coma)
9. Bowel Can­cer
10. Breast Can­cer in Women
11. Can­cer of the blad­der
12. Veget­ables and tea reduce colon and rectal can­cer risk!

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1. Treating breast cancer — part 1
2. Introduction part 3: Treating cancer (1)
3. Treating Breast Cancer Part 2
4. Treating Breast Cancer Part 3
5. Introduction part 3: Treating Cancer (2)
6. Diagnosing Bowel Cancer
7. Treatment For Bone Cancer
8. Introduction part 4: Preventing cancer