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Bowel cancer treatment

After a bowel cancer diagnosis, the next step is to determine the best course of treatment. You have several options to consider. Your doctor will advise you on the best approach to take. Treatments may include the following, alone, or in combination:

As with many cancers, a team approach to treating colorectal cancer is often used. In addition to receiving care by nurses, counsellors and dieticians, you may also be treated by one or more of the following specialists.

  • Surgeon
  • Gastroenterologist, a doctor who specialises in treating diseases of the digestive system
  • Medical oncologist, a doctor who specialises in treating cancer with drugs, namely chemotherapy.
  • Radiotherapy oncologist, a doctor who specialises in treating cancer using radiation.

Each of the above specialists brings special skills to the treatment of cancer.

Bowel cancer treatment

The primary treatment of colon cancer is to surgically remove part or all of your colon. Suspicious polyps, if few in number, may be removed during colonoscopy.

Chemotherapy after surgery can prolong survival for people whose cancer has spread to nearby lymph nodes.

Radiotherapy treatment after surgery does not help people with colon cancer, but it does prolong survival for people with rectal cancer.

  • Given before surgery, radiotherapy may reduce tumour size. This can improve the chances that the tumour will be removed successfully.
  • Radiotherapy before surgery also appears to reduce the risk of the cancer coming back after treatment.


Treatment options

  • Surgery is the most effective treatment for local bowel tumours. Very small tumours can be removed through a colonoscope, but even with small tumours, removing the portion of the colon containing the tumour, the surrounding fat and nearby lymph nodes is often the best treatment. Surgery may be performed either laparoscopically or by the open method, which uses larger incisions.
  • Usually, the surgeon can reconnect the healthy sections of the colon and rectum. When this is not possible, the surgeon forms an opening - known as a stoma - in the abdomen and re-routes the divided colon to it. Waste is collected in a bag worn over the stoma outside the body. This procedure, known as a colostomy, is often only temporary. Once the bowel has had time to heal, a second operation reconnects the colon and rectum. The need for permanent colostomy is more common with rectal cancer, since retaining the rectum may be difficult.
  • In the immediate postoperative period, the patient can expect to receive painkillers and other medication to ease temporary diarrhoea or constipation. After surgery, patients are encouraged to eat nutritious foods, rich in calories and proteins, in order to gain strength and heal properly.
  • Radiotherapy is treatment with high-energy rays that destroy the cancer cells. For rectal cancer, radiotherapy is usually administered after surgery, along with chemotherapy (known as adjuvant therapy), in order to destroy any cancer cells left behind. Alternatively, it can be used along with chemotherapy before surgery (known as neo-adjuvant therapy) in order to shrink a large tumour, making the surgery easier. In advanced rectal cancer, radiotherapy can be used to shrink tumours that cause symptoms of bowel obstruction, bleeding or pain.
  • Radiotherapy can be used in people with colon cancer when the tumour has attached to another organ in the abdomen, or if a tumour is found at the surgical margin of resection.
  • Chemotherapy medications are used to treat various stages of bowel cancer. Different medications are commonly used in combination with one another. Chemotherapy can also be administered directly into the liver if the colon cancer has metastasised there.
  • Occasionally other medications called monoclonal antibodies or biologic therapy that work in an entirely different way are used. The medications work by using the body's own immune system to fight cancer. They can be used to treat advanced bowel cancer that has spread (metastasised) to other parts of the body.
  • Once cancer of either the colon or rectum is in remission, follow-up examinations to check for recurrence are essential. Hundreds of thousands of people are living comfortable, normal lives even after bowel surgery and a colostomy. Although adjusting to life after a colostomy requires time, support and understanding, people with a stoma have discovered for the most part they can eat, play and work as well as they did before their surgery.
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