Treatment

Colorectal cancer can be treated in a number of ways, or with a combination of:

• surgery
• chemotherapy
• radiotherapy

Each person is different and your treatment will be tailored to suit your needs. Your specialist team will tell you about the benefits, risks and side-effects of the treatment being offered to you. Your treatment will be discussed fully with you before proceeding.

Surgery

The majority of patients with a colorectal cancer will need surgery. Surgery is provided at Antrim Area Hospital and Causeway Hospital.

Usually the surgery performed for colorectal cancer is a bowel resection. This involves removing the affected part of the bowel and then rejoining the bowel together again. For some patients it may not be possible to re-join the bowel and they may require a stoma. A stoma is an opening on the outside of your abdomen for waste materials (faeces) to leave the body; into a pouch or stoma bag.  A stoma care nurse looks after patients who have had a stoma formed. The stoma care nurse will provide information, education and support to patients and their families. If you require a stoma, you will meet a stoma nurse prior to your surgery who will review you whilst you are in hospital.

In many cases colorectal cancer can be cured with surgery and there may be no need for further treatment. However, in some cases, patients may require chemotherapy and/or radiotherapy before or after surgery.

Chemotherapy

Chemotherapy for colorectal cancer is given as an outpatient at Laurel House in Antrim Area Hospital. There are three ways chemotherapy can be used to treat colorectal cancer:

• before surgery – this is used in combination with radiotherapy to shrink the bowel tumour
• after surgery – to reduce the risk of the cancer recurring
• palliative chemotherapy – this is given to slow the spread of advanced bowel cancer and to help control any symptoms

There are many different types of chemotherapy. Some chemotherapies can be given as tablet form (oral chemotherapy), or through a drip in your arm (intravenous chemotherapy), or as a combination of both. Treatments are typically in cycles which are 2 to 3 weeks long, and can go on for up to 6 months. This will depend on the stage of cancer.

Side effects of colorectal chemotherapy may include:

• fatigue / tiredness
• feeling sick or vomiting
• diarrhea or constipation
• mouth ulcers
• a sensation of numbness, tingling or burning in your hands or feet
• redness of the palms of hands and feet
• weakened immune system – making you more vulnerable to infection

These side effects should gradually pass once your treatment has finished.

If you are on chemotherapy and experience a possible sign of an infection, including a high temperature (fever), or you suddenly feel generally unwell, you must contact the helpline number immediately.

Radiotherapy

Radiotherapy for colorectal cancer is given as an outpatient at the Northern Ireland Cancer Centre (Belfast City Hospital) or the North West Cancer Centre (Altnagelvin Hosptial), depending on where you live. There are several ways radiotherapy can be used to treat cancer:

• before surgery – to shrink rectal cancers. This aims to increase the chance of complete removal, and reduce the risk of cancer recurring.
• instead of surgery – to cure or stop the spread of early stage rectal cancer, if you can’t have surgery.
• palliative radiotherapy – to control symptoms and slow the spread of cancer when the cancer is advanced.

Radiotherapy given before surgery for rectal cancer can be performed in 2 ways. This will depend on the size and position of the tumour, and will be decided by your specialist team:

• short course – radiotherapy which is given daily for 5 consecutive days. Surgery follows this type of treatment, usually the week after radiotherapy finishes.
• long course (chemo-radiotherapy) – radiotherapy which is given daily, 5 days a week for 5 weeks, with a break at the weekend. You will also receive oral chemotherapy to take in alongside your treatment, on the days you are receiving radiotherapy.

Radiotherapy uses high-energy waves to treat cancer. It destroys the cancer cells in the area where it is given. Some normal cells in the area which is treated can also be damaged by radiotherapy. This can cause side effects. The normal cells are usually able to repair themselves, but cancer cells cannot. As the normal cells recover over time, the side effects usually get better.

Short-term side effects of radiotherapy may include:

• feeling sick
• fatigue/tiredness
• diarrhoea
• burning/irritated skin around the rectum and pelvis – this may look and feel like sunburn
• need to urinate more frequently
• a burning sensation when passing urine

These side effects should pass once the course of radiotherapy has finished, or shortly afterwards.

If you are on radiotherapy (and/or chemotherapy) and experience a possible sign of an infection, including a high temperature (fever), or you suddenly feel generally unwell, you must contact the helpline number immediately:

Long-term side effects of radiotherapy may include:

• the frequent need to pass urine or stool
• blood in your urine and/or stool
• infertility
• erectile dysfunction
• vaginal dryness and/or tightness

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. Your doctor will discuss this with you before you begin any form of treatment.