In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer. Your outlook depends on the stage of the cancer when it was diagnosed. This means how big it is and whether it has spread.
The type of cancer and grade of the cancer cells can also affect your survival. Grade means how abnormal the cells look under the microscope. Your general health and fitness also affect survival, the fitter you are, the better you may be able to cope with your cancer and treatment. Some bowel cancers make a protein called carcinoembryonic antigen CEA. People wth high CEA levels before treatment may have a worse outlook. Bowel cancer can sometimes cause a blockage in the bowel bowel obstruction.
If this happens, you have a small risk of developing a hole in the wall of the bowel. This is called perforation. People with bowel cancer who have an obstruction or perforation of the bowel have a worse outlook. The terms 1 year survival and 5 year survival don't mean that you will only live for 1 or 5 years.
They watch what happens to people with cancer in the years after their diagnosis. But some people live much longer than this. If the rectal cancer is more advanced and close to the anus, surgery will be done to take out the cancer and make an opening on your belly to get rid of body waste poop. This is called a colostomy. You will need it for the rest of your life. If the rectal cancer has spread into nearby organs, more surgery is needed. The doctor may take out the rectum and nearby organs, like the bladder, prostate, or uterus, if the cancer has spread to those organs.
You will need a colostomy after that surgery. If the bladder is removed, an opening to collect urine or pee called a urostomy is needed, too. If you have a colostomy or a urostomy, you will need to learn how to take care of it. Nurses with special training will see you before and after surgery to teach you what to do.
Ask your doctor what type of surgery you will need. Ask what your body will look like and how it will work after surgery.
Any type of surgery can have risks and side effects. Ask the doctor what you can expect. If you have problems, let your doctors know.
Doctors who treat people with colon and rectal cancer should be able to help you with any problems that may come up.
Radiation uses high-energy rays like x-rays to kill cancer cells. After surgery, radiation can kill small spots of cancer that may not be seen during surgery. If the size or place of the cancer makes surgery hard to do, radiation may be used before the surgery to shrink the tumor so it's easier to take it out. In both cases, radiation helps keep the cancer from coming back in the place where it started. Radiation can also be used to lessen some problems caused by the cancer, like pain.
If your doctor suggests radiation treatment, ask about what side effects you might have. The most common side effects of radiation are:. Many side effects can be treated ,and most get better after treatment ends. Some might last longer than others. Talk to your cancer care team about what you can expect during and after treatment. Chemo is the short word for chemotherapy -- the use of drugs to fight cancer. The drugs may be given through a needle into a vein or taken as pills.
The drugs go into the blood and are carried through the body. Chemo is given in cycles or rounds. Each round of treatment is followed by a break. This break lets the body recover from side effects before the next treatment is due. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months. Chemo after surgery can help some people live longer. It can also help ease problems caused by the cancer.
Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends. There are ways to treat most chemo side effects. If you have side effects, talk to your cancer care team so they can help. Targeted therapy drugs may be used for certain types of colon or rectum cancer. These drugs affect mainly cancer cells and not normal cells in the body.
These drugs have different side effects than chemo. Side effects of targeted therapy depend on which drug is used. Most people with bowel cancer can be diagnosed by flexible sigmoidoscopy. However, some cancers can only be diagnosed by a more extensive examination of the colon. The two tests used for this are colonoscopy and computerised tomography CT colonography. These tests are described in more detail below.
A colonoscopy is an examination of your entire large bowel using a device called a colonoscope, which is like a sigmoidoscope but a bit longer. Your bowel needs to be empty when a colonoscopy is performed, so you will be advised to eat a special diet for a few days beforehand and take a laxative medication to help empty your bowel on the morning of the examination.
You will be given a sedative to help you relax during the test, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. This is not usually painful, but can feel uncomfortable. The camera relays images to a monitor, which allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer. As with a sigmoidoscopy, a biopsy may also be performed during the test. A colonoscopy usually takes about an hour to complete, and most people can go home once they have recovered from the effects of the sedative.
After the procedure, you will probably feel drowsy for a while, so you will need to arrange for someone to accompany you home. It is best for elderly people to have someone with them for 24 hours after the test.
You will be advised not to drive for 24 hours. In a small number of people, it may not be possible to pass the colonoscope completely around the bowel, and it is then necessary to have CT colonography. Find out more about what a colonoscopy involves. CT colonography, also known as a "virtual colonoscopy", involves using a computerised tomography CT scanner to produce three-dimensional images of the large bowel and rectum.
During the procedure, gas is used to inflate the bowel using a thin, flexible tube placed in your rectum. CT scans are then taken from a number of different angles. As with a colonoscopy, you may need to have a special diet for a few days and take a laxative before the test to ensure your bowels are empty when the test is carried out. This test can help identify potentially cancerous areas in people who are not suitable for a colonoscopy because of other medical reasons.
A CT colonography is a less invasive test than a colonoscopy, but you may still need to have colonoscopy or flexible sigmoidoscopy at a later stage so any abnormal areas can be removed or biopsied. If a diagnosis of bowel cancer is confirmed, further testing is usually carried out to check if the cancer has spread from the bowel to other parts of the body. These tests also help your doctors decide on the most effective treatment for you. Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer.
Staging refers to how far your cancer has advanced. Grading relates to how aggressive your cancer is and how likely it is to spread. This is important, as it helps your treatment team choose the best way of curing or controlling the cancer. A number of different staging systems are used by doctors.
A simplified version of one of the common systems used is outlined below. If colon cancer is at a very early stage, it may be possible to remove just a small piece of the lining of the colon wall. This is known as local excision. If the cancer spreads into muscles surrounding the colon, it will usually be necessary to remove an entire section of your colon. This is known as a colectomy. During surgery, nearby lymph nodes are also removed. It is usual to join the ends of the bowel together after bowel cancer surgery, but very occasionally this is not possible and a stoma is needed.
Both open and laparoscopic colectomies are thought to be equally effective at removing cancer and have similar risks of complications. However, laparoscopic colectomies have the advantage of a faster recovery time and less postoperative pain. It is becoming the routine way of doing most of these operations. Laparoscopic colectomies should be available in all hospitals that carry out bowel cancer surgery, although not all surgeons perform this type of surgery.
Discuss your options with your surgeon to see if this method can be used. There are a number of different types of operation that can be carried out to treat rectal cancer, depending on how far the cancer has spread. If you have a very small, early-stage rectal cancer, your surgeon may be able to remove it in an operation called a local resection transanal resection. The surgeon puts an endoscope in through your back passage and removes the cancer from the wall of the rectum.
In many cases, however, a local resection is not possible. Instead, a larger area of the rectum will need to be removed. This area will include a border of rectal tissue free of cancer cells, as well as fatty tissue from around the bowel the mesentery. This type of operation is known as total mesenteric excision TME. Removing the mesentery can help ensure all the cancerous cells are removed, which can lower the risk of the cancer recurring at a later stage.
Depending on where in your rectum the cancer is located, one of two main TME operations may be carried out. These are outlined below. Low anterior resection is a procedure 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 to make sure any lymph glands containing cancer cells are also removed.
They will then attach your colon to the lowest part of your rectum or upper part of the anal canal. Sometimes they turn the end of the colon into an internal pouch to replace the rectum. Abdominoperineal resection is used to treat cases where the cancer is in the lowest section of your rectum.
In this case, it will be necessary to remove the whole of your rectum and surrounding muscles to reduce the risk of the cancer regrowing in the same area. This involves removing and closing the anus and removing its sphincter muscles, so there is no option except to have a permanent stoma after the operation. Bowel cancer surgeons always do their best to avoid giving people permanent stomas wherever possible.
Where a section of the bowel is removed and the remaining bowel joined, the surgeon may sometimes decide to divert your stool away from the join to allow it to heal. The stool is temporarily diverted by bringing a loop of bowel out through the abdominal wall and attaching it to the skin — this is called a stoma.
A bag is worn over the stoma to collect the stool. When the stoma is made from the small bowel ileum it is called an ileostomy , and when it is made from the large bowel colon it is called a colostomy.
A specialist nurse, known as a stoma care nurse, can advise you on the best site for a stoma prior to surgery. The nurse will take into account factors such as your body shape and lifestyle, although this may not be possible where surgery is performed in an emergency. In the first few days after surgery, the stoma care nurse will advise on the care necessary to look after the stoma and the type of bag suitable.
Once the join in the bowel has safely healed, which can take several weeks, the stoma can be closed during further surgery. In some people, for various reasons, rejoining the bowel may not be possible or may lead to problems controlling bowel function, and the stoma may become permanent. Before having surgery, the care team will advise you about whether it may be necessary to form an ileostomy or colostomy, and the likelihood of this being temporary or permanent.
There are patient support groups available that provide support for patients who have just had or are about to have a stoma. You can get more details from your stoma care nurse, or visit the groups online for further information.
Learn more about coping with a stoma after bowel cancer. Bowel cancer operations carry many of the same risks as other major operations, including bleeding, infection, developing blood clots, or heart or breathing problems. The operations all carry a number of risks specific to the procedure. One risk is that the joined-up section of bowel may not heal properly and leak inside your abdomen. This is usually only a risk in the first few days after the operation.
Another risk is for people having rectal cancer surgery. The nerves that control urination and sexual function are very close to the rectum, and sometimes surgery to remove rectal cancer can damage these nerves.
After rectal cancer surgery, most people need to go to the toilet to open their bowels more often than before, although this usually settles down within a few months of the operation. There are two main ways radiotherapy can be used to treat bowel cancer. It can be given before surgery to shrink rectal cancers and increase the chances of complete removal, or be used to control symptoms and slow the spread of cancer in advanced cases palliative radiotherapy. External radiotherapy is usually given daily, five days a week, with a break at the weekend.
Depending on the size of your tumour, you may need one to five weeks of treatment. Each session of radiotherapy is short and will only last for 10 to 15 minutes. Internal radiotherapy can usually be performed in one session before surgery is carried out a few weeks later. Palliative radiotherapy is usually given in short daily sessions, with a course ranging from 2 to 3 days, up to 10 days.
These side effects should pass once the course of radiotherapy has finished. Tell your care team if the side effects of treatment become particularly troublesome. Additional treatments are often available to help you cope with the side effects better. If you want to have children, it may be possible to store a sample of your sperm or eggs before treatment begins so they can be used in fertility treatments in the future.
There are three ways chemotherapy can be used to treat bowel cancer:. Chemotherapy for bowel cancer usually involves taking a combination of medications that kill cancer cells. They can be given as a tablet oral chemotherapy , through a drip in your arm intravenous chemotherapy , or as a combination of both.
Treatment is given in courses cycles that are two to three weeks long each, depending on the stage or grade of your cancer. Most people having oral chemotherapy take tablets over the course of 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. In some cases, it can be given in smaller doses over longer periods of time maintenance chemotherapy.
These side effects should gradually pass once your treatment has finished. It usually takes a few months for your hair to grow back if you experience hair loss. Inform your care team or GP as soon as possible if you experience possible signs of an infection, including high temperature fever or a sudden feeling of being generally unwell.
Medications used in chemotherapy can cause temporary damage to men's sperm and women's eggs. 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 you use a reliable method of contraception while having chemotherapy treatment and for a period after your treatment has finished.
Find out more about chemotherapy. Biological treatments, including cetuximab, bevacizumab and panitumumab, are a newer type of medication also known as monoclonal antibodies.
Monoclonal antibodies are antibodies that have been genetically engineered in a laboratory. They target special proteins found on the surface of cancer cells, known as epidermal growth factor receptors EGFR. As EGFRs help the cancer grow, targeting these proteins can help shrink tumours, and improve the effect and outcome of chemotherapy.
Biological treatments are therefore usually used in combination with chemotherapy when the cancer has spread beyond the bowel metastatic bowel cancer. These treatments are not available to everyone with bowel cancer. Cetuximab, bevacizumab and panitumumab are available on the NHS through a government scheme called the Cancer Drugs Fund. All these medications are also available privately, but are very expensive.
Your GP or nurse may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP surgery will have information on these.
Some people find it helpful to talk to others with bowel cancer at a local support group or through an internet chat room. Beating Bowel Cancer offers support services to people with bowel cancer. They run a nurse advisory line on or available 9am to 5. You can also email a nurse at nurse beatingbowelcancer.
The organisation also runs a national patient-to-patient network called Bowel Cancer Voices for people affected by bowel cancer and their relatives. Find more support from Bowel Cancer UK and cancer support groups. Having cancer can cause a range of emotions. These may include shock, anxiety, relief, sadness and depression.
Different people deal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you.
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