What are the treatment options for bowel cancer?
The primary treatment options for bowel cancer (also known as colorectal cancer) include surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy. The type of treatment you receive will depend on a number of different considerations, such as if you have colon cancer or rectal cancer, the cancer’s stage, your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how bowel cancer treatment works.
Types of bowel cancer treatment
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Surgery
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Radiotherapy
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Chemotherapy
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Targeted therapies
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Immunotherapy
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Colonoscopy for bowel cancer
A colonoscopy is a procedure that involves inserting a colonoscope (a tube with a camera attached) into the anus, through to the rectum and colon.
Colonoscopies are used for many different purposes.
Diagnosis
Assess for abnormalities – Look at the lining of the bowel for tumours or areas of inflammation or bleeding
Biopsy – Collect a sample of tissue for analysis.
Treatment
Polypectomy – Remove small growths (called polyps) in the bowel’s lining
Stent insertion – Placement of a plastic tube to relieve an obstruction inside the bowel
Haemostasis – Used acutely to stop bleeding from a polyp, but most surgeons will just remove the polyp
Local Excision – To remove cancerous tissue.
Local excision
Local excisions are commonly used for early-stage rectal cancer. Methods include:
Transanal excision (TAE) – This procedure involves the removal of cancer from the lower rectal wall, including any surrounding rectal tissue. This is done through making minor incisions into the rectum
Transanal endoscopic microsurgery (TEMS) – Specialised equipment is inserted into the anus to remove cancers in the upper rectum which may not be accessible through a transanal excision
Transanal minimally invasive surgery (TAMIS) – Specialised equipment is inserted into the anus to remove the rectal cancer with minimal invasion.
Surgery for bowel cancer
Surgery for bowel cancer is performed to remove cancerous tissue and relieve symptoms when the cancer has advanced. Most people with bowel cancer will receive surgery as their primary form of treatment.
The two approaches for surgery, performed under general anaesthesia, include:
Open colectomy – where a long incision is made through the skin and abdominal wall to access your colon or rectum cancer. Typically half of the colon on the side of your tumour is removed e.g. left sided colon cancers have a left colectomy
Keyhole (laparoscopic) colectomy – a minimally invasive procedure that uses three to four small incisions to access the colon or rectum cancer. Keyhole procedures result in less postoperative pain and complications, shorter hospital stay, and faster recovery compared to open colectomy.
Even though they both fall under bowel cancer, colon cancer and rectal cancer are unique and are treated differently.
Colectomy
A colectomy (also known as a colorectal resection) is a major surgery that involves the removal of all or part of the colon and/or rectum, including nearby lymph nodes.
Colectomies used for colon cancer:
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Hemicolectomy
The right or left section of the colon is removed.
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Sigmoid colectomy
The sigmoid is removed.
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Subtotal or total colectomy
All of the colon is removed.
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Proctocolectomy
All of the colon and rectum is removed.
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High anterior resection
The upper rectum and part of the colon is removed, alongside nearby lymph nodes and fatty tissue.
Colectomies used for rectal cancer
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High anterior resection
The lower part of the colon and upper part of the rectum are removed, including nearby lymph nodes.
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Abdominoperineal resection or excision (APR or APE)
The sigmoid colon, rectum and the anus are removed. This requires a permanent stoma.
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Ultra-low anterior resection
The lower colon and all the rectum are removed. This includes nearby lymph nodes and tissue.
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Colonic J-pouch
An internal j-pouch is made from the bowel’s lining to work as the rectum.
Depending on the type of colectomy you receive, your surgeon may make a cut between both ends of your cancer and reconnect them back together (called an anastomosis). Sometimes, the ends of the bowel may not be able to be joined together. In these cases, a new opening will be made in your abdomen. An opening in the large bowel is known as a colostomy, whereas an opening in the small bowel is referred to as an ileostomy. The opening itself is called a stoma.
Stomas divert faecal waste out of the body. This waste is collected through a colostomy or ileostomy bag that is fixed around the stoma. A stoma can be temporary or permanent.
Radiotherapy for bowel cancer
Radiation is a common treatment option for rectal cancer but is not generally used for colon cancer. It is typically delivered over the pelvic area in combination with chemotherapy. Learn more about the types of radiotherapy commonly used for people with bowel cancer below.
Chemotherapy for bowel cancer
Chemotherapy uses a range of drugs to destroy and slow the growth of bowel cancer. These drugs may be delivered at any stage of your bowel cancer treatment.
Learn more about chemotherapy and how it is delivered.
Chemotherapy for bowel cancer is delivered in multiple sessions called cycles. This means you will have one to three weeks of rest between receiving an injection or infusion. Your care team will walk you through how many cycles you may need for your course of treatment, with most people completing chemotherapy in a period of four to six months.
Targeted therapies for bowel cancer
Targeted therapies use specialised drugs to destroy specific proteins or genes in bowel cancer cells.
Targeted therapies are only effective for certain colon and rectal cancers, and are generally used to treat advanced bowel cancers. Your care team will examine the make-up of your cancer cells to determine if targeted therapies are suitable for you.
Immunotherapy for bowel cancer
Immunotherapy trains the immune system to recognise and fight bowel cancer cells that are hiding behind your body’s natural defences. It is commonly used when your bowel cancer has come back after initial treatment or has spread to other areas in the body.
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Treatment by stage of bowel cancer
When you are diagnosed with bowel cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer and whether you have colon cancer or rectal cancer.
Colon cancer
Early (Stage I or II) colon cancer
Surgery is typically used as the first step in treatment for early-stage colon cancer. You may have a local excision, your polyps removed or a partial colectomy in advanced cases to remove a portion of your colon. If the cancer has grown into the wall of the colon, your doctor may also recommend chemotherapy.
Locally advanced (Stage III) colon cancer
Treatment for locally advanced colon cancer will usually involve surgery (colorectal resection) and chemotherapy. If you can’t have surgery or have an advanced cancer that can’t be completely removed through surgery, you may receive chemotherapy and radiotherapy treatment.
Advanced (Stage IV) colon cancer
Treatment for advanced colon cancer usually focuses on palliative care rather than curing the disease. Your care will be tailored to you and your preferences so that you can live as comfortably as possible. Some options include surgery, chemotherapy, targeted therapies, immunotherapy and radiotherapy. Clinical trials can also play an important role in treatment for advanced colon cancer.
Rectal cancer
Early (Stage I) rectal cancer
Like colon cancer, early-stage rectal cancer is usually treated with either a polypectomy, local excision or transanal endoscopic microsurgery (TEM). Alternatively, a more invasive treatment may be needed, such as a low anterior resection or abdominoperineal resection.
Locally advanced (Stage II or III) rectal cancer
Treatment for locally advanced rectal cancer will typically involve both chemotherapy and radiotherapy, followed by surgery. Depending on where your cancer is, the surgical procedure you have can vary. The most common surgeries are a low anterior resection, abdominoperineal resection or proctectomy with colo-anal anastomosis (where the colon is connected to the anus). After surgery, you may receive more chemotherapy depending on your needs.
Advanced (Stage IV) rectal cancer
Depending on the spread of cancer, treatment for advanced rectal cancer may include surgery and chemotherapy. Most commonly chemotherapy and targeted therapy are used as part of systemic treatment. In some cases, radiotherapy is used as a palliative treatment.
References
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