Showing posts with label Bowel cancer. Show all posts
Showing posts with label Bowel cancer. Show all posts

Bowel cancer - Living With

Living with-Bowel cancer




Bowel cancer can affect your daily life in different ways, depending on what stage it's at and the treatment you're having.
How people cope with their diagnosis and treatment varies from person to person. There are several forms of support available if you need it.
Not all of these will work for everyone, but one or more should help:
  • talk to your friends and family – they can be a powerful support system
  • communicate with other people in the same situation – for example, through bowel cancer support groups
  • find out as much as possible about your condition
  • don't try to do too much or overexert yourself
  • make time for yourself

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Talk to others

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.
Bowel Cancer UK offers support to people with bowel cancer.
They have an ask the nurse service where specialist nurses give information and signpost you to further support. Email nurse@bowelcanceruk.org.uk.
Bowel Cancer UK also has an online forum for anyone affected by bowel cancer.

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Your emotions

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's hard to predict how knowing you have cancer will affect you.
However, you and your loved ones may find it helpful to know about the feelings that people diagnosed with cancer have reported.

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Recovering from surgery

Surgeons and anaesthetists have found using an enhanced recovery programme after bowel cancer surgery helps patients recover more quickly.
Most hospitals now use this programme. It involves giving you more information about what to expect before the operation, avoiding giving you strong laxatives to clean the bowel before surgery, and in some cases giving you a sugary drink two hours before the operation to give you energy. 
During and after the operation, the anaesthetist controls the amount of IV fluid you need very carefully. After the operation, you'll be given painkillers that allow you to get up and out of bed by the next day.
Most people will be able to eat a light diet the day after their operation.
To reduce the risk of blood clots in the legs (deep vein thrombosis), you may be given special compression stockings that help prevent blood clots, or a regular injection with a blood-thinning medication called heparin until you're fully mobile.
A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home within a few days.
With the enhanced recovery programme, most people are well enough to go home within a week of their operation.
The timing depends on when you and the doctors and nurses looking after you agree you're well enough to go home.
You'll be asked to return to hospital a few weeks after your treatment has finished so tests can be carried out to check for any remaining signs of cancer.
You may also need routine check-ups for the next few years to look out for signs of the cancer recurring. It's becoming increasingly possible to cure cancers that recur after surgery.

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Bowel cancer - Lester's story
Lester talks about how he discovered he had bowel cancer. He and his wife Carolyn offer advice to others about coping with the diagnosis.
Media last reviewed: 19 October 2016
Media review due: 19 October 2019

Diet after bowel surgery

If you've had part of your colon removed, it's likely you'll experience some diarrhoea or frequent bowel motions. 
One of the functions of the colon is to absorb water from stools and empty when going to the toilet.
After surgery, the bowel initially doesn't empty as well, particularly if part of the rectum has been removed.
Inform your care team if this becomes a problem, as medication is available to help control these problems.
You may find some foods upset your bowels, particularly during the first few months after your operation.
Different foods can upset different people, but food and drink known to cause problems include fruit and vegetables that are high in fibre, such as beans, cabbages, apples and bananas, and fizzy drinks, such as cola and beer.
You may find it useful to keep a food diary to record the effects of different foods on your bowel.
Contact your care team if you find you're having continual problems with your bowels as a result of your diet, or you're finding it difficult to maintain a healthy diet. You may need to be referred to a dietitian for further advice.

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Living with a stoma

If you need a temporary or permanent stoma with an external bag or pouch, you may feel worried about how you look and how others will react to you.
Information and advice about living with a stoma – including stoma care, stoma products and stoma-friendly diets – is available on the ileostomy and colostomy topics.
For those who want further information about living with a stoma, there are patient support groups that provide support for people who may have had, or are due to have, a stoma.
You can get more details from your stoma care nurse, or visit support groups online for further information:

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Sex and bowel cancer

Having cancer and receiving treatment may affect how you feel about relationships and sex.
Although most people are able to enjoy a normal sex life after bowel cancer treatment, you may feel self-conscious or uncomfortable if you have stoma.
Talking about how you feel with your partner may help you both support each other. Or you may feel you'd like to talk to someone else about your feelings. Your doctor or nurse will be able to help.

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Financial concerns

A diagnosis of cancer can cause money problems because you're unable to work, or someone you're close to has to stop working to look after you.
There's financial support available for carers and yourself if you have to stay off work for a while or stop work because of your illness.

Free prescriptions

People being treated for cancer are entitled to apply for an exemption certificate giving free prescriptions for all medication, including medication to treat unrelated conditions.
The certificate is valid for five years. You can apply for one by speaking to your GP or cancer specialist.

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Dealing with dying

If you're told there's nothing more that can be done to treat your bowel cancer, your GP will still provide you with support and pain relief. This is called palliative care.
Support is also available for your family and friends.

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Bowel cancer - Treatment

Treatment-Bowel cancer




Treatment for bowel cancer will depend on which part of your bowel is affected and how far the cancer has spread.
Surgery is usually the main treatment for bowel cancer, and may be combined with chemotherapy, radiotherapyor biological treatments, depending on your particular case.
If it's detected early enough, treatment can cure bowel cancer and stop it coming back.
Unfortunately, a complete cure isn't always possible and there's sometimes a risk that the cancer could recur at a later stage.
A cure is highly unlikely in more advanced cases that can't be removed completely by surgery.
But symptoms can be controlled and the spread of the cancer can be slowed using a combination of treatments.

Your treatment team

If you're diagnosed with bowel cancer, you'll be cared for by a multidisciplinary team, including:
  • a specialist cancer surgeon
  • a radiotherapy and chemotherapy specialist (an oncologist)
  • a radiologist
  • a specialist nurse
When deciding what treatment is best for you, your care team will consider the type and size of the cancer, your general health, whether the cancer has spread to other parts of your body, and how aggressive the cancer is.

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Surgery for colon cancer

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, known as local excision.
If the cancer spreads into muscles surrounding the colon, it's usually necessary to remove an entire section of your colon, known as a colectomy.
There are 3 ways a colectomy can be performed:
  • an open colectomy – where the surgeon makes a large cut (incision) in your abdomen and removes a section of your colon
  • a laparoscopic (keyhole) colectomy – where the surgeon makes a number of small incisions in your abdomen and uses special instruments guided by a camera to remove a section of colon
  • robotic surgery – a type of keyhole surgery where the surgeon's instruments guide the robot, which removes the cancer
During robotic surgery, there's no direct connection between the surgeon and the patient, which means it would be possible for the surgeon to not be in the same hospital as the patient.
Robotic surgery isn't available in many centres in the UK at the moment.
During surgery, nearby lymph nodes are also removed. It's usual to join the ends of the bowel together after bowel cancer surgery, but very occasionally this isn't 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.
But laparoscopic or robotic colectomies have the advantage of a faster recovery time and less postoperative pain.
Laparoscopic surgery is now 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.

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Surgery for rectal cancer

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.
Some operations are entirely through the bottom, with no need for abdominal incisions.
Some of the main techniques used are described below.

Local resection

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, through the bottom resection).
The surgeon puts an endoscope in through your back passage and removes the cancer from the wall of the rectum.

Total mesenteric excision

In most cases, a local resection isn't possible at the moment. 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 types of TME operations may be carried out.
These are outlined below.

Anterior resection

Low anterior resection is a procedure used to treat cases where the cancer is away from the sphincters that control bowel action.
The surgeon will make an incision in your abdomen and remove part of your rectum, as well as some surrounding tissue to make sure any lymph glands containing cancer cells are also removed.
They 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.
You'll probably require a temporary stoma to give the joined section of bowel time to heal.
This will be closed at a second, less major, operation.

Abdominoperineal resection

Abdominoperineal resection is used to treat cases where the cancer is in the lowest section of your rectum.
In this case, it's usually 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's 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.

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Stoma surgery

Where a section of the bowel is removed and the remaining bowel joined, the surgeon may sometimes decide to divert your faeces away from the join to allow it to heal.
The faeces are 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 faeces.
When the stoma is made from the small bowel (ileum) it's called an ileostomy, and when it's made from the large bowel (colon) it's 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.
For various reasons, in some people 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.
These include:

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Side effects of surgery

Bowel cancer operations carry many of the same risks as other major operations, including:
  • bleeding
  • infection
  • developing blood clots
  • 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 a 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.
Occasionally, some people – particularly men – have other distressing symptoms, such as pain in the pelvic area and constipation alternating with frequent bowel motions.
Frequent bowel motions can lead to severe soreness around the anal canal.
Support and advice should be offered on how to cope with these symptoms until the bowel adapts to the loss of part of the back passage.

Radiotherapy

There are several ways radiotherapy can be used to treat bowel cancer:
  • before surgery – to shrink rectal cancers and increase the chances of complete removal
  • instead of surgery – to cure or stop the spread of early-stage rectal cancer, if you can't have surgery
  • as palliative radiotherapy – to control symptoms and slow the spread of cancer in advanced cases
Radiotherapy given before surgery for rectal cancer can be performed in 2 ways:
  • external radiotherapy – where a machine is used to beam high-energy waves at your rectum to kill cancerous cells
  • internal radiotherapy (brachytherapy) – where a tube that releases a small amount of radiation is inserted into your anus and placed next to the cancer to shrink it and kill the cancer cells
External radiotherapy is usually given daily, 5 days a week, with a break at the weekend.
Depending on the size of your tumour, you may need 1 to 5 weeks of treatment. Each session of radiotherapy is short and will only last for 10 to 15 minutes.
Internal radiotherapy may also involve several treatment sessions. If you're also having surgery, this will usually be carried out a few weeks after your radiotherapy course finishes.
Palliative radiotherapy is usually given in short daily sessions, with a course ranging from 2 to 3 days, up to 10 days.
Short-term side effects of radiotherapy can include:
  • feeling sick
  • fatigue
  • diarrhoea
  • burning and irritation of the skin around the rectum and pelvis – this looks and feels like sunburn
  • a frequent need to urinate
  • a burning sensation when passing urine
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.
Long-term side effects of radiotherapy can include:
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.

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Chemotherapy

There are 3 ways chemotherapy can be used to treat bowel cancer:
  • before surgery – used in combination with radiotherapy to shrink the tumour
  • after surgery – to reduce the risk of the cancer recurring
  • palliative chemotherapy – to slow the spread of advanced bowel cancer and help control symptoms
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 2 to 3 weeks long each, depending on the stage or grade of your cancer.
A single session of intravenous chemotherapy can last from several hours to several days.
Most people having oral chemotherapy take tablets over the course of 2 weeks before having a break from treatment for another week.
A course of chemotherapy can last up to 6 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).
Side effects of chemotherapy can include:
  • fatigue
  • feeling sick
  • vomiting
  • diarrhoea
  • mouth ulcers
  • hair loss with certain treatment regimens, but this is generally uncommon in the treatment of bowel cancer       
  • a sensation of numbness, tingling or burning in your hands, feet and neck
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.
Chemotherapy can also weaken your immune system, making you more vulnerable to infection.
Inform your care team or GP as soon as possible if you experience possible signs of an infection, including a 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 there's a risk to the unborn baby's health for women who become pregnant or men who father a child. 
It's recommended that you use a reliable method of contraception while having chemotherapy treatment and for a period after your treatment has finished.

Biological treatments

Biological treatments, including cetuximab and panitumumab, are newer medicines also known as monoclonal antibodies.
They target special proteins, called epidermal growth factor receptors (EGFRs), found on the surface of some cancer cells.
As EGFRs help the cancer grow, targeting these proteins can help shrink tumours and improve the effect of chemotherapy.
Biological treatments are sometimes used in combination with chemotherapy when the cancer has spread beyond the bowel (metastatic bowel cancer).

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Bowel cancer - Diagnosis

Diagnosis-Bowel cancer




When you first see your GP, they'll ask about your symptoms and whether you have a family history of bowel cancer.
They'll usually carry out a simple examination of your bottom, known as a digital rectal examination (DRE), and examine your tummy (abdomen).
This is a useful way of checking whether there are any lumps in your tummy or back passage.
The tests can be uncomfortable, and most people find an examination of the back passage a little embarrassing, but they take less than a minute.
Your GP will also check your blood to see if you have iron deficiency anaemia.
Although most people with bowel cancer do not have symptoms of anaemia, they may have a lack of iron as a result of bleeding from the cancer. 
In most people with bowel cancer, iron deficiency anaemia is found incidentally.

Hospital tests

If your symptoms suggest you may have bowel cancer or the diagnosis is uncertain, you'll be referred to your local hospital for a simple examination called a flexible sigmoidoscopy.
A small number of cancers can only be diagnosed by a more extensive examination of the colon.
The 2 tests used for this are colonoscopy or CT colonography.
Emergency referrals, such as people with bowel obstruction, will be diagnosed by a CT scan.
Those with severe iron deficiency anaemia and few or no bowel symptoms are usually diagnosed by colonoscopy.

Flexible sigmoidoscopy

A flexible sigmoidoscopy is an examination of your back passage (rectum) and some of your large bowel using a device called a sigmoidoscope.
A sigmoidoscope is a long, thin, flexible tube attached to a very small camera and light. It's inserted into your rectum and up into your bowel.
The camera relays images to a monitor and can also be used to take biopsies, where a small tissue sample is removed for further analysis.
It's better for your lower bowel to be as empty as possible when sigmoidoscopy is performed, so you may be asked to carry out an enema (a simple procedure to flush your bowels) at home beforehand.
This should be used at least 2 hours before you leave home for your appointment.
A sigmoidoscopy can feel uncomfortable, but it only takes a few minutes and most people go home straight after the examination.

Colonoscopy

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'll be advised to eat a special diet for a few days beforehand and take a medication to help empty your bowel (laxative) on the morning of the examination.
You'll be given a sedative to help you relax during the test. The doctor will then 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.
You'll probably feel drowsy for a while after the procedure, so you'll need to arrange for someone to accompany you home.
It's best for elderly people to have someone with them for 24 hours after the test. You'll 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's then necessary to have CT colonography.

CT colonography

CT colonography, also known as a "virtual colonoscopy", involves using a CT scanner to produce 3-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 it's carried out.
You may also be asked to take a liquid called gastrograffin before the test.
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.

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Further tests

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.
These tests can include:
  • a CT scan of your abdomen and chest – to check if the rest of your bowel is healthy and whether the cancer has spread to the liver or lungs
  • an MRI scan – this can provide a detailed image of the surrounding organs in people with cancer in the rectum

Stages of bowel cancer

After all tests have been completed, it's usually possible to determine the stage of your cancer.
There are 2 ways that bowel cancer can be staged.
The first is known as the TNM staging system:
  • T – indicates the size of the tumour
  • N – indicates whether the cancer has spread to nearby lymph nodes
  • M – indicates whether the cancer has spread to other parts of the body (metastasis)
Bowel cancer is also staged numerically. The 4 main stages are:
  • stage 1 – the cancer is still contained within the lining of the bowel or rectum
  • stage 2 – the cancer has spread beyond the layer of muscle surrounding the bowel and may have penetrated the surface covering the bowel or nearby organs
  • stage 3 – the cancer has spread into nearby lymph nodes
  • stage 4 – the cancer has spread beyond the bowel into another part of the body, such as the liver
Cancer Research UK has more information about bowel cancer stages.

Bowel cancer screening

In England, everyone aged 60 to 74 who's registered with a GP is eligible for NHS bowel cancer screening.
This involves using a home testing kit to send off some samples of your stool to be tested for the presence of blood.
This can help detect bowel cancer before symptoms appear, making it easier to treat and improving the chances of survival.
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