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Which treatment for early bowel cancer

Men and women discussing bowel cancer

This page tells you about treatments for early bowel cancer. You can find the following information

 

A quick guide to what's on this page

Treatments for early bowel cancer

Your doctor will be part of a team of health professionals who work together to decide on the best treatment and care for you. This team is called the multi disciplinary team or MDT. They will look at a number of factors when they are planning your treatment, including the type and size of the cancer and your general health and fitness. Most people with early bowel cancer have surgery. Some people also have chemotherapy or radiotherapy.

Surgery

For many people with early bowel cancer, the surgeon can cut away all of the cancer. Some people who have this treatment will be cured. This means that their cancer never comes back. Unfortunately, not everyone who has surgery will be cured. If the cancer has spread into the lymph nodes close to the bowel, some cells may have travelled on to other parts of the body. These cells may grow into secondary cancers (metastases) in the future. To try to prevent this your doctor may suggest further treatment after your surgery.

Radiotherapy

Doctors don't often use radiotherapy to treat cancer of the large bowel. But they may suggest it before or after surgery for cancer in the back passage (rectum). You may have radiotherapy and chemotherapy together for rectal cancer. If you have a large tumour these treatments can shrink it before surgery.

Chemotherapy

Your specialist may suggest chemotherapy to try to kill any cancer cells left behind after your operation for colon or rectal cancer. This is called adjuvant chemotherapy.
 

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

 

 

How doctors plan treatment

Your specialist will be part of a team of health professionals who work together to decide on the best treatment and care for you. This team is called the multi disciplinary team or MDT. The MDT includes

  • Surgeons who specialise in bowel cancers
  • Doctors who specialise in using drugs to treat cancer, such as chemotherapy (medical oncologist)
  • Doctors who specialise in radiotherapy and chemotherapy treatment (clinical oncologist)
  • Doctors specialising in diagnosis from tissue specimens (histopathologist)
  • Clinical nurse specialist
  • Stoma care nurse
  • Dietician
  • Physiotherapist
  • Occupational therapist
  • Psychologist or counsellor

The MDT look at a number of factors when they are planning your treatment, including the type and size of the cancer and your general health and fitness. You can ask your doctor or nurse any questions you have about your treatment plan.

Most people with early bowel cancer have surgery. Some people will also have chemotherapy or radiotherapy.

Discover your options for early bowel cancer treatment.

Early bowel Cancer Flowchart

 

Surgery

In many people with early bowel cancer the surgeon can take out all of the cancer during an operation. Some people who have this treatment will be cured. This means that their cancer never comes back.

Unfortunately, not everyone who has surgery will be cured. The cancer may come back in the bowel some time later. If the cancer had spread into the lymph nodes close to the bowel, it is possible that some cells had already travelled to other parts of the body before you had your surgery. These cells may begin to grow into secondary cancers (metastases) in the future. To try to prevent this, your specialist may suggest further treatment after your surgery.

 

Radiotherapy

Doctors don't often use radiotherapy to treat cancer of the large bowel (colon). But you may have it either before or after surgery if you have cancer of the back passage (rectal cancer).

Sometimes doctors give radiotherapy and chemotherapy together for rectal cancer. If you have a large tumour, chemotherapy and radiotherapy before surgery may shrink the cancer and make it possible to completely remove it. Or it may mean that you do not need such a big operation. Radiotherapy after surgery can lower the chance of the cancer coming back for some people.

 

Chemotherapy

Your specialist may suggest chemotherapy to try to kill any cancer cells left behind after your operation. This is called adjuvant chemotherapy. The surgeon removes all the cancer they can see. But sometimes cells are left behind because they have spread into the surrounding tissue or to nearby lymph nodes. You can have chemotherapy after surgery for tumours anywhere in the bowel or rectum. Several clinical trials in the UK are comparing different types of chemotherapy before and after surgery to see which works best. 

People with very early stage bowel cancer (stage 1) do not need chemotherapy after surgery.

If you have a stage 2 cancer, your specialist may suggest chemotherapy after surgery, possibly as part of a clinical trial. Doctors are still not sure whether chemotherapy after surgery lowers the risk of the cancer coming back in bowel cancers of this stage. Some people with stage 2 bowel cancer may be at a higher risk of their cancer coming back, for example if cancer cells are found in blood or lymph vessels around the tumour, or if the cancer has grown into organs or structures next to the bowel. In this case your doctor may discuss the option of chemotherapy with you.

Most people with stage 3 bowel cancer will have chemotherapy after surgery. Fluorouracil is commonly used. You may have this through a drip into a vein or as a tablet (capecitabine). You may have another cancer drug with fluoruracil, such as oxaliplatin. Your doctor may suggest a clinical trial to you. Researchers are testing several different drugs, drug combinations and length of treatment to try to find out which is best at stopping bowel cancer from coming back.

 

New approaches to treatment

Doctors are researching other ways of trying to shrink a cancer before surgery and of trying to stop cancer from coming back. For example, one trial is looking at giving chemotherapy before surgery for large bowel cancers. Other trials are using biological therapies called monoclonal antibodies before or after surgery. You can find more information about this on the bowel cancer research page.

Our clinical trials database has information about bowel cancer trials in the UK. To get there, follow the link and choose 'bowel' from the dropdown menu of cancer types.

 

Follow up

After your treatment has finished, you may have regular check ups for several years. At first they will be every few months. But if all is well the appointments will gradually become less and less frequent. You can read more about this and the tests you may have on the follow up for bowel cancer page.

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Updated: 14 August 2013