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Wednesday, May 7, 2008

Treatment for large bowel cancer

Treatment depends on the stage of the cancer and where it is in the bowel. It is important that you discuss your treatment with your doctor and that you understand why a particular type of treatment has been recommended for you. Cancers affecting the colon and those affecting the rectum are usually treated in slightly different ways.

Early-stage bowel cancer

In people with early-stage bowel cancer, surgery is an important treatment. Often, the cancer can be completely removed, and for some people it will never come back. People who have Dukes A cancer do not usually need to have any further treatment after their surgery.

However, for people with Dukes B cancer, there is a risk that the cancer may come back in the future, especially if cancer cells are found in the blood vessels or lymph vessels around the tumour. So, treatment with chemotherapy is sometimes given after surgery to help reduce the risks of the cancer coming back.

In people with Dukes C cancer, there is a greater risk that the cancer will come back and chemotherapy is often recommended after surgery.

Research trials are trying to find out whether giving monoclonal antibodies, as well as chemotherapy, after surgery can further reduce the chance of the cancer coming back.

Other types of treatment that are in the very early stages of research are discussed on the clinical trials section.

Rectal cancer

In people with rectal cancer, radiotherapy may be given before or after the surgery. Radiotherapy and chemotherapy may be given together to shrink a rectal cancer and make it easier to remove with surgery. This is known as chemoradiotherapy.

Advanced-stage bowel cancer

Advanced-stage bowel cancer means that the cancer has spread from where it started in the bowel. It can spread into the area around the bowel, such as the abdomen and this is known as local spread. If the cancer has spread to other parts of the body such as the liver or lungs, this is known as secondary cancer or metastatic cancer.

It is not usually possible to cure advanced-stage bowel cancer, but treatment may be able to control it for quite a long time. Treatment may also be used to reduce symptoms and give a good quality of life. However, for some people in this situation, treatment will have little effect upon the cancer and they will have the side effects without many of the benefits.

The treatment that is most appropriate for you will depend on:

  • whether you have colon or rectal cancer
  • which part of your body the cancer has spread to
  • the treatment that you have already had.

Chemotherapy is the most commonly used treatment for advanced-stage bowel cancer. Chemotherapy may be given into a vein by injection or drip, or may be taken as tablets or capsules.

Surgery may be used to take away some of the cancer cells, remove a tumour that is blocking the bowel, or sometimes to remove secondary bowel cancers from the liver or lungs.

Radiotherapy may be used to shrink a tumour that is causing pain. This is used most often for rectal cancers and is known as palliative radiotherapy.

Monoclonal antibodies such as bevacizumab (Avastin®) and cetuximab (Erbitux®) may sometimes be used to control advanced bowel cancer for a time.

How treatment is planned

In most hospitals, a team of specialists will discuss 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 and chemotherapy specialist)
  • a radiologist (who analyses x-rays)
  • a pathologist (who advises on the type and grade of the cancer, and how far it has spread).

The team may also include a:

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

Together, the MDT 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 general health, age, the type and size of the tumour, and whether it has begun to spread.

If you have any questions about your treatment, don’t be afraid to ask your doctor or nurse, or the nurses at Cancerbackup. It often helps to make a list of questions and to take a close friend or relative with you. It may also be helpful for you to record the discussion, or to write down your questions and the answers you are given.

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 mean that the start of your treatment is delayed, so you and your doctor need to be confident that it will be useful.

If you do go for a second opinion, it may be a good idea to have a list of questions ready, so that you can make sure all 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. They will usually ask you 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 other types of treatments that may be appropriate
  • 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 can be very complex, so it is not unusual for people to need repeated explanations.

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

Patients 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. 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. The staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Benefits and disadvantages of treatment

Many people are frightened at the thought of having cancer treatments, because of the side effects that may occur. Some people ask what will 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.

Treatment decisions

If you have early-stage cancer and have been offered treatment that is intended to cure it, it may be easy to decide whether to accept the treatment. Your doctor will talk through your treatment and any other options with you.

However, if a cure is not possible and the treatment would be 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. 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.

Via: http://www.cancerbackup.org.uk

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