Treatment of colon cancer This information is an extract from the booklet, Understanding colon cancer. You may find the full booklet helpful. We can send you a copy free see page 5. Contents How treatment is planned Second opinion Giving your consent The advantages and disadvantages of treatment Treatment depends on the stage of the cancer and where it is in the colon. Your doctors will have carried out various tests and investigations to help them plan your treatment. Although they will have a good idea about which treatments you need, they may not be able to tell you exactly until after an operation. It s important that you discuss with your doctor the treatments they are recommending and that you understand why a particular type of treatment has been suggested for you. Early colon cancers Most stage 1 colon cancers are treated with just surgery. Often, the cancer can be completely removed, and for most people it will never come back. People who have stage 1 colon cancer don t usually need to have any further treatment after their surgery. Macmillan and Cancerbackup have merged. Together we provide free, high quality information for all. Page 1 of 5
People with stage 2 colon cancer are also usually treated with surgery. There may be a risk that the cancer could come back in the future, especially if cancer cells are found in the blood vessels or lymph vessels around the cancer. So, treatment with chemotherapy is sometimes given after surgery to help reduce the risks of the cancer coming back. In people with stage 3 colon cancer, there is a greater risk that the cancer will come back after surgery, so chemotherapy is usually recommended. Research trials are trying to find out whether giving drugs known as monoclonal antibodies, as well as chemotherapy, after surgery can further reduce the chance of the cancer coming back. Advanced colon cancer Stage 4 colon cancer means that the cancer has spread from where it started in the bowel. It can spread into the area around the bowel, such as the abdomen, and this is known as local spread. If the cancer has spread to other parts of the body such as the liver or lungs, this is known as secondary or metastatic cancer. It s not usually possible to cure stage 4 colon cancer, but treatment may be able to control it for some time. Treatment may also be used to reduce symptoms and give a good quality of life. However, for some people in this situation, treatment will have little effect upon the cancer and they will have the side effects with little benefit. The treatment that is most appropriate for you will depend on: which part of your body the cancer has spread to the treatment that you have already had. Chemotherapy is the most commonly used treatment for stage 4 colon cancer. It may be given into a vein by injection or drip, or may be taken as tablets or capsules. Surgery may sometimes be used to remove a cancer that is blocking the bowel, for example, or sometimes to remove secondary bowel cancers from the liver or lungs. Radiotherapy may be used to shrink a cancer that is causing pain. This is known as palliative radiotherapy. Monoclonal antibodies such as bevacizumab (Avastin ), Page 2 of 5
cetuximab (Erbitux ) and panitumumab (Vectibix ) may be used to control advanced colon cancer for a time. How treatment is planned In most hospitals, a team of specialists will discuss the treatment that is best for you. This multidisciplinary team (MDT) will include: a surgeon who specialises in bowel cancers a medical oncologist (chemotherapy specialist) a clinical oncologist (radiotherapy and chemotherapy specialist) a radiologist (who analyses x-rays) a pathologist (who advises on the type and grade of the cancer, and how far it has spread). The team may also include: a nurse specialist a specialist in symptom control (palliative care) a dietitian a physiotherapist a occupational therapist a psychologist or counsellor. Second opinion Together, the MDT will be able to advise you on the best course of action and plan of treatment, taking into account a number of factors. These include your general health, age, the size of the cancer and whether it has spread. Even though a number of cancer specialists work together as a team to decide on the most suitable treatment, you may want to have another medical opinion. Most doctors will be happy to refer you to another specialist for a second opinion, if you feel that this will be helpful. Having a second opinion may mean that the start of your treatment is delayed, so you and your doctor need to be confident that it will be useful. If you do go for a second opinion, it may be a good idea to have a list of questions ready, so that you can make sure all your concerns are covered during the discussion. Page 3 of 5
Giving your consent Before you have any treatment, your doctor will explain its aims to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about: the type and extent of the treatment you are advised to have the advantages and disadvantages of the treatment any other types of treatments that may be appropriate any significant risks or side effects of the treatment. If you don t understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments can be very complex, so it s not unusual for people to need repeated explanations. It s often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment. Patients often feel that the hospital staff are too busy to answer their questions, but it s important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions. You can always ask for more time to decide about the treatment if you feel that you can t make a decision when it is first explained to you. You are also free to choose not to have the treatment. The staff can explain what may happen if you don t have it. It s essential to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You don t have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice. Page 4 of 5
The benefits and disadvantages of treatment Treatment of colon cancer Many people are frightened at the thought of having cancer treatments, because of the side effects that may occur. Some people ask what will happen if they don t have any treatment. Although the treatments can cause side effects, these can often be well controlled with medicines. Treatment can be given for different reasons and the potential benefits will vary depending upon your particular situation. Treatment decisions If you have early-stage colon cancer and have been offered treatment that is intended to cure it, it may be easy to decide whether to accept the treatment. Your doctor will talk through your treatment and any other options with you. However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead. Making decisions about treatment in these circumstances is always difficult. You may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, which often involves medicines to control any symptoms. More information and support If you have any questions about cancer, ask Macmillan. If you need support, ask Macmillan. Or if you just want someone to talk to, ask Macmillan. Our cancer support specialists are here for everyone living with cancer, whatever you need. Call free on 0808 808 00 00, Monday Friday, 9am 8pm www.macmillan.org.uk We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. Macmillan Cancer Support 2010. Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ Page 5 of 5