Once bowel cancer has spread to another part of the body it is unlikely to be curable. But treatment can often keep it under control for quite a long time, and help people live longer. For some people with bowel cancer that has spread to the liver or lungs, it may be possible to cure it with chemotherapy and surgery. The choice of treatment for advanced bowel cancer depends on:
• The type of cancer you have;
• The size and number of secondary cancers and where they are in the body;
• The treatment you have already had; and
• Your general health and fitness.
Chemotherapy for advanced bowel cancer
You are most likely to have chemotherapy. Chemotherapy drugs slow the process of cancer cells growing or multiplying. You may receive chemotherapy as a tablet that you swallow, or by injection.
The chemotherapy drugs doctors commonly use to treat bowel cancer include:
• Fluorouracil (also called 5FU) – often given with a vitamin called folinic acid;
• Capecitabine (Xeloda);
• Oxaliplatin (Eloxatin); and
• Irinotecan (Campto).
In some circumstances you may have surgery. If you have areas of cancer in the liver, your doctor may recommend one of the specialised surgical techniques. You may have chemotherapy before surgery for cancer of the back passage (rectal cancer). The chemotherapy aims to shrink the cancer and make it easier to remove during surgery.
Chemotherapy before surgery is called neo-adjuvant chemotherapy (pronounced nee-oh- ad-joo-vant). You are likely to have this alongside radiotherapy (chemo-radiation).
Biological therapies, such as monoclonal antibodies, can help some people with advanced bowel cancer.
Palliative chemotherapy when you have advanced bowel cancer
Chemotherapy to shrink a cancer and control symptoms is called ‘palliative chemotherapy’. To be told that treatment will be palliative can be very distressing and sometimes patients can fear that this means that they are at the very final stages of life. However, ideally palliative care is in
place early in a patient’s treatment plan as it has been shown to help patients live comfortably for longer and with greater dignity. If you have any concerns or fears, talk to your nursing and medical team.
To treat advanced bowel cancer, you have chemotherapy either into a vein or as a tablet. If the first type of chemotherapy you have (called 1st-line treatment) does not control your cancer, you can usually have a different type of chemotherapy (2nd-line or 3rd-line treatment). The
chemotherapy drugs you may have have been listed under the chemotherapy section. You may have one or a combination of these drugs for advanced bowel cancer.
Daily life with chemotherapy
Some people find that they can lead an almost normal life during chemotherapy, but others find everyday life more difficult. You may feel unwell during and shortly after each treatment, but recover quickly between treatments. You may be able to take your chemotherapy tablets at home.
Some treatments are harder going than others, and everyone is different. So it is best to do whatever you feel is right for you.
As well as feeling unwell physically, it is not unusual for people to have ups and downs emotionally. It can be difficult coping with a diagnosis of cancer and having treatment. So you may find you have good and bad days. Remember that there isn’t a right and a wrong way to be.
Side effects of chemotherapy can include:
• Nausea and vomiting;
• Hair loss;
• Being vulnerable to infection;
• Bruising and bleeding;
• Pain and inflammation on the inside of your mouth;
• Loss of appetite;
• Skin becomes dry and sore;
• Short-term memory loss;
• Reduced libido;
• Loss of fertility, temporary or permanent;
• Diarrhoea and constipation;
• Hand and foot syndrome;
• Peripheral neuropathy
Doctors sometimes use external beam radiotherapy to shrink a lump or tumour in the bowel that is causing pain. This is called palliative radiotherapy. You are more likely to have radiotherapy for rectal cancers than colon cancers.
Your specialist may suggest a type of internal radiotherapy called selective internal radiation therapy (SIRT) for secondary cancer in the liver. This has been approved by the National Institute for Health and Care Excellence (NICE) as a treatment for people who cannot have their liver secondaries surgically removed.
Radiotherapy can also be used before surgery to shrink a tumour so it is easier to remove. In some cases, it is used after surgery to destroy any small amounts of cancer cells that may be left.
Surgery for advanced bowel cancer
Your specialist may suggest surgery to treat advanced bowel cancer:
• To slow the cancer;
• When the bowel is blocked; or
• To remove secondary cancer.
If the tumour in your bowel is causing symptoms your doctor may want to operate, to remove as much of it as possible. This type of operation is called ‘debulking’.
Specialised surgical treatments for liver secondaries
Specialised surgical treatments may be able to destroy bowel cancer that has spread to the liver
(liver secondaries). These treatments include:
• Hepatic artery chemoembolisation – blocking liver blood vessels to give a high chemotherapy dose to the cancer;
• Radiofrequency ablation – using radio waves to destroy the cancer cells
• Cryotherapy – freezing the cancer cells;
• Microwave ablation – using micro waves to destroy the cancer;
• Laser therapy – using a laser to destroy the cancer cells;
• Alcohol injection – injecting alcohol into the cancer to destroy the cells;
Biological therapies for advanced bowel cancer
Biological therapies are drugs that help the body to control the growth of cancer cells. Research shows that some biological therapies can help some people with advanced bowel cancer to live longer when added to standard chemotherapy treatment. It can also improve quality of life. Doctors usually give biological therapies such as Bevacizumab (Avastin), cetuximab (Erbitux) and panitumumab (Vectibix) for advanced bowel cancer along with the chemotherapy drugs:
• Fluorouracil (FU or 5FU);
• Oxaliplatin (Eloxatin); or
• Irinotecan (Campto).
Deciding about treatment
It can be difficult to decide which treatment to try, or whether to have treatment at all, when you have an advanced cancer. You will need to consider your quality of life while you are having the treatment. The side effects of treatment, as well as stresses such as travelling back and forth to
the hospital, can have a big effect on your quality of life.
Your doctor will explain what they hope to achieve with the different treatments they offer you. Some people feel they would like to get an opinion from a second doctor before deciding on their treatment. If you would like a second opinion, you can ask your specialist or GP to refer you. Your doctor will talk to you about all the options. There may also be a counsellor or specialist nurse at the hospital you can talk to. You may also want to discuss things with a close relative or friend. It can be helpful to talk over difficult decisions with someone outside your circle of family and friends.
Ask your nurse
If you have questions about your illness or treatment, your Clinical Nurse Specialist can help. He or she will be supporting you through your diagnosis and treatment plan so ask them about any questions or speak to them about any concerns you have.
Coping with advanced bowel cancer
Download a copy of the Marie Keating Foundation’s booklet, Coping with Advanced Bowel Cancer.