(Continuation of Treatment of bowel cancer)

Stoma surgery

In some cases, the surgeon may decide that the colon needs to heal before it can be reattached, or that too much of the colon has been removed to make reattachment possible. It will therefore be necessary to find a way of removing wasting materials from your body without using all of your colon. This is done using stoma surgery.

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

• An ileostomy – 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 that is connected to the stoma to collect waste material.
• A colostomy – 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.

If most of your colon needs to removed in order to fully eliminate the cancer, it may be necessary to have a permanent ileostomy or colostomy.

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

Surgery – rectal cancer

There are three surgical procedures that can be used to treat rectal cancers:

• low anterior resection,
• colo anal anastomosis, and
• abdominoperineal resection.

These procedures are explained below.

Low anterior resection

Low anterior resection is a procedure that is 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. They will then attach your colon to the remainder of your rectum.

Colo anal anastomosis 

Colo anal anastomosis is used to treat cases where the cancer is in the middle section of your rectum. During the procedure, the surgeon will remove most of your rectum. They will then take a small section of your rectum and reconstruct it into a pouch which will act as an ‘artificial rectum’. The pouch is then connected to your anus. You will probably require a temporary colostomy to allow time for your bowel to heal.

Abdominoperineal resection

Abdominoperineal resection is used to treat cases where the cancer is in the lower section of your rectum. In this case, it will be necessary to remove a large section of your rectum. As there will not be enough rectum left to function properly, it will also be necessary to remove your anus and for you to have a permanent colostomy.

Chemotherapy

There are three ways that 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, and
• given to slow the spread of advanced bowel cancer and can help to control symptoms (palliative chemotherapy).

Chemotherapy for bowel cancer usually involves taking a combination of cancer cell killing medications. They can be given in tablet form (oral chemotherapy), or through a drip in your arm or chest (intravenous chemotherapy), or with 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, and
• a sensation of numbness, tingling and/or burning in your hands, feet, and neck.

These side effects should gradually pass once your treatment has finished. It usually takes between 3-6 months for your hair to grow back.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. You should inform your care team and/or your doctor as soon as possible if you experience the possible signs of an infection such as:

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

The medications that are used in chemotherapy can temporary damage sperm (in men) and eggs (in women). 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. It is therefore recommended that you use a reliable method of contraception while having chemotherapy treatment and for a further year after your treatment has finished.

Cetuximab

Cetuximab is a new type of medication known as monoclonal antibodies. Monoclonal antibodies are antibodies that have been genetically engineered in a laboratory.

Cetuximab targets special proteins that are 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, cetuximab can help prevent the cancer spreading. It is usually used in combination with chemotherapy and radiotherapy.

Cetuximab medication is very expensive. It is usually given in combination with chemotherapy. Cetuximab is given through a drip into your vein, which slowly administers the first dose over the course of a few hours. After this, further doses are given on a weekly basis and they should only take an hour.

The most common side effect of cetuximab is the development of an acne-like rash in the skin which occurs in about 80 per cent of cases.

Other side effects of cetuximab include:

• nausea,
• diarrhoea,
• breathlessness, and
• conjunctivitis (inflammation of the eyes)

Cetuximab has been known to trigger allergic reactions in some people, such as a swollen tongue or throat. Occasionally, these allergic reactions can be severe and life-threatening. This is known as an infusion reaction. Infusion reactions occur in about three per cent of people receiving cetuximab.

Most infusion reactions occur within the first 24 hours of someone beginning treatment. You will therefore be closely monitored when your treatment begins. If you start to experience symptoms of an infusion reaction, anti-allergy medicines, such as corticosteroids, can be used to relieve them.

Due to these precautionary measures, deaths from infusion reactions in people who are taking cetuximab are very rare, occurring in less than 0.1 per cent of cases.

Relate articles:

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

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