Treatment decisions for advanced bowel cancer

Advanced bowel cancer is cancer that started in either the back passage (rectum) or large bowel (colon) and has spread to another part of the body.

Deciding about treatment can be difficult when you have advanced cancer. Treatments such as chemotherapy, targeted drugs, immunotherapy and radiotherapy can help to reduce symptoms and might make you feel better. But they also have side effects that can make you feel unwell for a while.

You need to understand:

• the aim of the treatment
• how it might affect your quality of life
• possible side effects

Your doctor or specialist nurse can talk to you about the benefits and possible side effects. You can ask them questions.

You might also find it helps to talk things over with a close relative, a friend or a counsellor at the hospital.

Types of treatment

Treatment depends on:

• the size of the cancer and where it is in the body

• how far it has spread

• the treatment you have already had

• your general health

To shrink your cancer, slow its growth and relieve your symptoms your doctor might recommend:

Surgery

You might have surgery to treat a blocked bowel. And sometimes you can have surgery to remove small areas of cancer that has spread to the liver or lungs.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.

Chemotherapy for advanced bowel cancer can relieve the symptoms. It can also control the cancer and improve your quality of life for a time.

Radiotherapy

Radiotherapy uses high energy rays to destroy cancer cells. You might have radiotherapy to shrink your cancer and help relieve symptoms.

Targeted and immunotherapy drugs

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system attack cancer. They are called immunotherapies.

Some drugs work in more than one way. So they are targeted as well as working with the immune system. They can shrink or slow the growth of advanced bowel cancer

Controlling symptoms

Bowel cancer that has spread to other parts of the body might cause symptoms such as pain. The symptoms you have depend upon where the cancer has spread to.

Treatment  to control symptoms might include:

• a tube (stent) to relieve symptoms from a bowel blockage

• a tube to drain fluid from a swollen tummy (abdomen)

• medicines to help control symptoms such as pain or feeling sick

Chemotherapy, surgery, radiotherapy and targeted and immunotherapy drugs can all help to control symptoms as well.

Your choices

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments
• if you need more tests
• the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.