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Treatments for advanced bowel cancer

Advanced bowel (colorectal) cancer means the cancer has spread to other parts of the body from where it started in the bowel (colon) or back passage (rectum). Your cancer may be advanced when it is first diagnosed. Or the cancer may come back some time after you were first treated.

Once a bowel cancer has spread to another part of the body it is unlikely to be curable. But treatment can often keep the cancer under control for quite a long time. The choice of treatment depends on the cancer type, the number of secondary cancers and where they are, the treatment you have already had and your general health and fitness.

You may have chemotherapy or radiotherapy to shrink a cancer and control symptoms. In some situations, your specialist may suggest surgery to treat advanced bowel cancer. 

There are specialised surgical treatments that doctors sometimes use to destroy bowel cancer spread to the liver (liver secondaries). These treatments include hepatic artery chemoembolisation, radiofrequency ablation, cryotherapy, microwave ablation and laser therapy.

Newer types of biological therapy drugs, such as bevacizumab (Avastin) and cetuximab (Erbitux), are licensed for advanced bowel cancer.

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. It is important to understand what the treatment can do for you. You will also need to consider your quality of life while having the treatment. Your doctor will talk through the options with you. There may be a counsellor or specialist nurse you can talk to. You may also want to discuss things with a close relative or friend.

Some people feel they would like to get an opinion from a second doctor before they decide on their treatment. If you would like a second opinion, you can ask your specialist or your GP to refer you. 
 

CR PDF Icon You can view and print the quick guides for all the pages in the treating bowel cancer section.

 

 

What advanced bowel cancer is

Advanced bowel (colorectal) cancer means that the cancer has spread to other parts of the body from where it started in the bowel (colon) or back passage (rectum). Your cancer may be advanced when it is first diagnosed. Or the cancer may come back some time after you were first treated. When cancer comes back after treatment it is called recurrent cancer. The cancer can spread

 

Local spread

Local spread means the cancer has broken through the wall of the bowel and so cancer cells have spread into surrounding tissues in the abdomen or pelvis.

 

Secondary spread (metastasis)

Cancer that has spread to another part of the body is called secondary cancer or metastatic cancer. The bowel cancer cells have travelled through the lymphatic system or bloodstream to another part of the body. The cells have then settled and started to grow there.

Remember the most important thing is where the cancer started. Having bowel cancer cells in your liver doesn't mean that you have liver cancer. You have bowel cancer that has spread – it is also called secondary bowel cancer. This is important because your doctor needs to use treatments that work on bowel cancer cells – not treatment for liver cancer.

Diagram showing how the blood and lymph flow between the liver and the bowel

This diagram shows how blood flows from the bowel to the liver. It helps to explain why the liver is the most common place for bowel cancer to spread. The next most common site of spread is the lungs. We have information about cancer that has spread to the liver and cancer that has spread to the lungs.

 

Treatments for advanced bowel cancer

Once a 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. The choice of treatment 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
  • Your general health and fitness (performance status)

You are most likely to have chemotherapy. 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.

Biological therapies, such as monoclonal antibodies, can help some people with advanced bowel cancer.

 

Chemotherapy for advanced bowel cancer

Chemotherapy to shrink a cancer and control symptoms is called palliative chemotherapy. 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 are

You may have one or a combination of these drugs for advanced bowel cancer. There is more about this on our page about chemotherapy for advanced bowel cancer.

A research review found there was good evidence that chemotherapy helped people with advanced bowel cancer to live longer. But the researchers couldn’t say whether the treatment improved people's quality of life or not. You can read this review of chemotherapy in advanced bowel cancer in the Cochrane Library. It was written for researchers and specialists so is not in plain English.

 

Radiotherapy

Doctors sometimes use external beam radiotherapy to shrink a lump or tumour in the bowel that is causing pain. This is called palliative radiotherapy. They don't use radiotherapy much for colon cancers but may use it for rectal 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. There is information about research into internal radiotherapy on our bowel cancer research page.

 

Surgery for advanced bowel cancer

Your specialist may suggest surgery to treat advanced bowel cancer

  • To slow the cancer
  • When the bowel is blocked
  • To remove secondary cancer

There is detailed information about these operations on our page about surgery for advanced bowel cancer.

If the tumour in your bowel is causing symptoms it may be sensible 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

There is detailed information about these specialised surgical treatments on our page about surgery for advanced bowel cancer.

 

Biological therapies for advanced bowel cancer

Biological therapies are drugs that help the body to control the growth of cancer cells. A biological therapy called cetuximab (Erbitux) is licensed in the UK for people who have bowel cancer that has spread. We know from research that it 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 use it to treat people who have a normal k-ras gene in their cancer cells and where the cancer has spread only to the liver. Around 65 out of every 100 people with advanced bowel cancer (65%) have normal k-ras gene tumours.

Doctors usually give biological therapies for advanced bowel cancer along with the chemotherapy drugs fluorouracil, oxaliplatin, or irinotecan

Some biological therapies are very new and it will be some time before we know how well they work. Others, such as the monoclonal antibodies bevacizumab (Avastin) and panitumumab (Vectibix), and the anti angiogenic drug aflibercept (Zaltrap), are licensed for advanced bowel cancer. These drugs are generally not available within the NHS, but doctors in England may be able to fund bevacizumab and aflibercept through the cancer drugs fund. And in Scotland the Scottish Medicines Consortium (SMC) say that aflibercept should be available on the NHS when oxaliplatin is no longer working. You have it with FOLFIRI chemotherapy.

There is information about these treatments in the bowel cancer research section.

All new treatments have to go through the clinical trials process and this takes some years. To search for bowel cancer trials, visit our clinical trials database and select 'bowel' from the dropdown menu of cancer types.

 

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. If you would like to contact someone, look at our bowel cancer organisations page. To find out more about counselling, look in the counselling section.

If you want to find people to share experiences with people online, you could use CancerChat, our online forum.

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Updated: 11 September 2013