Overview-Bowel cancer
Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon or rectal cancer.
Bowel cancer is one of the most common types of cancer diagnosed in the UK. Most people diagnosed with it are over the age of 60.
Symptoms of bowel cancer
The 3 main symptoms of bowel cancer are:
- persistent blood in your poo – that happens for no obvious reason or is associated with a change in bowel habit
- a persistent change in your bowel habit – which is usually having to poo more and your poo may also become more runny
- persistent lower abdominal (tummy) pain, bloating or discomfort – that's always caused by eating and may be associated with loss of appetite or significant unintentional weight loss
Most people with these symptoms do not have bowel cancer. Other health problems can cause similar symptoms. For example:
- blood in the poo when associated with pain or soreness is more often caused by piles (haemorrhoids)
- a change in bowel habit or abdominal pain is usually caused by something you've eaten
- a change in bowel habit to going less often, with harder poo, is not usually caused by any serious condition – it may be worth trying laxatives before seeing your GP
These symptoms should be taken more seriously as you get older and when they persist despite simple treatments.
When to get medical advice
See your GP If you have 1 or more of the symptoms of bowel cancer and they have persisted for more than 4 weeks.
Your GP may decide to:
- examine your tummy and bottom to make sure you have no lumps
- arrange for a simple blood test to check for iron deficiency anaemia – this can show whether there's any bleeding from your bowel that you have not been aware of
- arrange for you to have a simple test in hospital to make sure there's no serious cause of your symptoms
Make sure you see your GP if your symptoms persist or keep coming back after stopping treatment, regardless of their severity or your age. You'll probably be referred to hospital.
Causes of bowel cancer
The exact cause of bowel cancer is not known, but there are a number of things that can increase your risk, including:
- age – almost 9 in 10 people with bowel cancer are aged 60 or over
- diet – a diet high in red or processed meats and low in fibre can increase your risk
- weight – bowel cancer is more common in overweight or obese people
- exercise – being inactive increases your risk of getting bowel cancer
- alcohol – drinking alcohol might increase your risk of getting bowel cancer
- smoking– smoking may increase your chances of getting bowel cancer
- family history – having a close relative (mother or father, brother or sister) who developed bowel cancer under the age of 50 puts you at a greater lifetime risk of developing the condition; screening is offered to people in this situation, and you should discuss this with your GP
Some people also have an increased risk of bowel cancer because they've had another condition, such as extensive ulcerative colitis or Crohn's disease in the colon for more than 10 years.
Although there are some risks you cannot change, such as your age or family history, there are several ways you can lower your chances of developing the condition.
Bowel cancer screening
To detect cases of bowel cancer sooner, the NHS offers 2 types of bowel cancer screening to adults registered with a GP in England:
- All men and women aged 60 to 74 are invited to carry out a FIT or FOB test. Every 2 years, they're sent a home test kit, which is used to collect a poo sample. If you're 75 or over, you can ask for this test by calling the freephone helpline on 0800 707 60 60.
- An additional one-off test called bowel scope screening is gradually being introduced in England. This is offered to men and women at the age of 55. It involves a doctor or nurse looking inside the lower part of the bowel using a camera on the end of a thin, flexible tube.
Taking part in bowel cancer screening reduces your chances of dying from bowel cancer. Removing any polyps – small growths that can develop on the inner lining of your bottom (rectum) – found in bowel scope screening can prevent cancer.
However, all screening involves a balance of potential harms, as well as benefits. It's up to you to decide if you want to have it.
Treatment for bowel cancer
Bowel cancer can be treated using a combination of different treatments, depending on where the cancer is in your bowel and how far it has spread.
The main treatments are:
- surgery – the cancerous section of bowel is removed; it's the most effective way of curing bowel cancer and in many cases is all you need
- chemotherapy – where medicine is used to kill cancer cells
- radiotherapy – where radiation is used to kill cancer cells
- targeted therapies – a newer group of medicines that increases the effectiveness of chemotherapy and prevents the cancer spreading
As with most types of cancer, the chance of a complete cure depends on how far it's spread by the time it's diagnosed. If the cancer is confined to the bowel, surgery is usually able to completely remove it.
Keyhole or robotic surgery is being used more often, which allows surgery to be performed with less pain and a quicker recovery.
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:
- 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
- do not try to do too much or overexert yourself
- make time for yourself
You may also want advice on recovering from surgery, including diet and living with a stoma, and any financial concerns you have.
If you're told there's nothing more that can be done to treat your bowel cancer, there's still support available. This is known as end of life care.
Symptoms-Bowel cancer
The symptoms of bowel cancer can be subtle and do not necessarily make you feel ill. However, it's worth trying simple treatments for a short time to see if they get better.
More than 90% of people with bowel cancer have 1 of the following combinations of symptoms:
- a persistent change in bowel habit – pooing more often, with looser, runnier poos and sometimes tummy (abdominal) pain
- blood in the poo without other symptoms of piles (haemorrhoids) – this makes it unlikely the cause is haemorrhoids
- abdominal pain, discomfort or bloating always brought on by eating – sometimes resulting in a reduction in the amount of food eaten and weight loss
Constipation, where you pass harder stools less often, is rarely caused by serious bowel conditions.
Most people with these symptoms do not have bowel cancer.
When to get medical advice
See your GP if you have 1 or more of the symptoms of bowel cancer, and they persist for more than 4 weeks.
Bowel obstruction
In some cases, bowel cancer can stop digestive waste passing through the bowel. This is known as a bowel obstruction.
Symptoms of a bowel obstruction can include:
- intermittent, and occasionally severe, abdominal pain – this is always bought on by eating
- unintentional weight loss – with persistent abdominal pain
- constant swelling of the tummy – with abdominal pain
- being sick – with constant abdominal swelling
A bowel obstruction is a medical emergency. If you suspect your bowel is obstructed go to the accident and emergency (A&E) department of your nearest hospital.
Causes-Bowel cancer
The exact cause of bowel cancer is unknown. However, research has shown several factors may make you more likely to develop it.
Cancer develops when the cells in a certain area of your body divide and multiply too quickly. This produces a lump of tissue called a tumour.
Bowel cancer usually first develops inside clumps of cells called polyps on the inner lining of the bowel.
However, it does not necessarily mean you'll get bowel cancer if you develop polyps.
Some polyps go away by themselves, and some do not change. Only a few grow and eventually develop into bowel cancer over a period of several years.
Age
More than 9 out of 10 cases of bowel cancer develop in older adults over the age of 50, and nearly 6 out of 10 cases develop in people aged 70 or older.
Family history
Having a family history of bowel cancer in a first-degree relative – a mother, father, brother or sister – under the age of 50 can increase your lifetime risk of developing the condition yourself.
If you're particularly concerned that your family's medical history may mean you're at an increased risk of developing bowel cancer, it may help to speak to your GP.
If necessary, your GP can refer you to a genetics specialist, who can give you more advice about your level of risk and recommend any necessary tests to periodically check for the condition.
Diet
A large body of evidence suggests a diet high in red and processed meat can increase your risk of developing bowel cancer.
For this reason, the Department of Health and Social Care recommends that people who eat more than 90g (cooked weight) a day of red and processed meat should cut down to 70g a day.
There's also evidence that suggests a diet high in fibre could help reduce your bowel cancer risk.
Smoking
People who smoke cigarettes are more likely to develop bowel cancer, as well as other types of cancer and other serious conditions, such as heart disease.
Alcohol
Drinking alcohol has been shown to be associated with an increased risk of bowel cancer, particularly if you regularly drink large amounts.
Obesity
Being overweight or obese is linked to an increased risk of bowel cancer, particularly in men.
If you're overweight or obese, losing weight may help lower your chances of developing the condition.
Inactivity
People who are physically inactive have a higher risk of developing bowel cancer.
You can help reduce your risk of bowel and other cancers by being physically active every day.
Digestive disorders
Some conditions affecting the bowel may put you at a higher risk of developing bowel cancer.
For example, bowel cancer is more common in people who've had extensive Crohn's disease or ulcerative colitis for more than 10 years.
If you have one of these conditions, you'll usually have regular check-ups to look for signs of bowel cancer from about 10 years after your symptoms first develop.
Check-ups involve examining your bowel with a colonoscope – a long, narrow flexible tube with a small camera at the end. This is inserted into your bottom.
The frequency of the colonoscopy examinations will increase the longer you live with the condition. This also depends on factors such as how severe your ulcerative colitis is and whether you have a family history of bowel cancer.
Genetic conditions
There are 2 rare inherited conditions that can lead to bowel cancer:
- familial adenomatous polyposis (FAP) – a condition that triggers the growth of non-cancerous polyps inside the bowel
- hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome – an inherited gene fault (mutation) that increases your bowel cancer risk
Although the polyps caused by FAP are non-cancerous, there's a high risk that over time at least 1 will turn cancerous. Most people with FAP have bowel cancer by the time they're 50.
As people with FAP have such a high risk of getting bowel cancer, they're often advised by their doctor to have their large bowel removed before they reach the age of 25.
Families affected can find support and advice from FAP registries such as The Polyposis Registry provided by St Mark's Hospital, London.
Removing the bowel as a precautionary measure is also usually recommended in people with HNPCC as the risk of developing bowel cancer is so high.
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 bottom (rectum).
The tests can be uncomfortable, and many people find an examination of their bottom a bit embarrassing, but they take less than a minute.
Your GP may 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 lack iron as a result of bleeding from the cancer.
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 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 bottom 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 if your lower bowel is empty when you have a sigmoidoscopy so you may be asked to use an enema (a simple procedure to flush your bowels) at home beforehand.
It 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 can 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 carried out, so you'll be advised to eat a special diet for a few days beforehand and take a medicine (laxative) to help empty your bowel before the examination.
You'll be given a sedative to help you relax during the test. The doctor will then insert the colonoscope into your bottom and move it along the length of your large bowel.
This is not usually painful, but it 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 carried out during the test.
A colonoscopy usually takes about an hour to complete, and most people can go home after recovering 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.
Occasionally, it may not be possible to pass the colonoscope completely around the bowel. In this case, a CT colonography may be necessary.
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 bottom. 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.
A CT colonography can help identify potentially cancerous areas in people who cannot have a colonoscopy because of other medical reasons.
It’s less invasive 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.
Further tests
If bowel cancer is diagnosed, further tests are usually carried out to check if the cancer has spread from the bowel to other parts of the body.
They 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 entered 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.
It involves using a home testing kit to send off some poo samples to be tested for blood.
This can help detect bowel cancer before symptoms appear, making it easier to treat and improving the chances of survival.
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, radiotherapy or 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 is not always possible and there's sometimes a risk that the cancer could come back at a later stage.
A cure is highly unlikely in more advanced cases that cannot 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.
Further information
- Lynn's Bowel Cancer Campaign: treatment
- Bowel Cancer UK: treatment
- Macmillan Cancer Support: treatment for colon cancer
- Macmillan Cancer Support: treatment for rectal cancer
- National Institute for Health and Care Excellence (NICE): diagnosis and management of colorectal cancer
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's possible for the surgeon to not be in the same hospital as the patient.
Robotic surgery is not available in many centres in the UK at the moment.
During surgery, nearby lymph nodes are also removed. The ends of the bowel can be joined together after bowel cancer surgery, but very occasionally this is not 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.
Further information
- Cancer Research UK: types of surgery for bowel cancer
Surgery for rectal cancer
There are a number of different types of surgery for rectal cancer, depending on how far the cancer has spread.
Some operations are carried out through the bottom, with no need for abdominal incisions.
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 bottom and removes the cancer from the wall of the rectum.
Total mesenteric excision
In most cases, a local resection is not 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, 1 of 2 main types of TME operations may be carried out.
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 need 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 rectal cancer in the lowest section of your rectum.
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.
Stoma surgery
Where a section of the bowel is removed and the remaining bowel joined, the surgeon may sometimes decide to divert your poo away from the join to allow it to heal.
Poo is 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 poo.
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 before surgery.
The nurse will take into account factors such as your body shape and lifestyle, although this may not be possible where surgery is carried out 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 for people who've 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:
- Colostomy UK
- Ileostomy & Internal Pouch Association – this organisation provides a unique visiting service for anyone wishing to speak with someone who has been through similar surgery
Cancer Research also has more information and advice about coping with a stoma after bowel cancer.
Side effects of surgery
Bowel cancer operations carry many of the same risks as other major operations, including:
- bleeding
- infection
- developing blood clots; usually in the legs (deep vein thrombosis)
- 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 cannot have surgery
- as palliative radiotherapy – to control symptoms and slow the spread of cancer in advanced cases
Radiotherapy before surgery for rectal cancer can be given in 2 ways:
- external radiotherapy – a machine is used to beam high-energy waves at your rectum to kill cancerous cells
- internal radiotherapy (brachytherapy) – a tube that releases a small amount of radiation is inserted into your bottom 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 pee
- a burning sensation when peeing
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.
Long-term side effects of radiotherapy can include:
- a more frequent need to pee and poo
- blood in your pee and poo
- infertility
- erectile dysfunction
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.
Further information
- Bowel Cancer UK: radiotherapy for bowel cancer
- Cancer Research UK: radiotherapy for bowel cancer
- Macmillan Cancer Support: radiotherapy for rectal cancer
- National Institute for Health and Care Excellence (NICE): preoperative brachytherapy for rectal cancer
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 medicines 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 1 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 and being sick
- 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.
Medicines 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.
Targeted therapies
Targeted therapies are medicines designed to target 1 or more of the biological processes that bowel cancer uses to spread inside the body.
For example, cetuximab and panitumumab are medicines that target proteins called epidermal growth factor receptors (EGFRs), which are found on the surface of some cancer cells.
As EGFRs help the cancer grow, targeting these proteins can shrink tumours and improve the effect of chemotherapy.
Targeted therapies are sometimes used in combination with chemotherapy when the cancer has spread beyond the bowel (metastatic bowel cancer).
Side effects of targeted therapies include:
- skin rash
- diarrhoea
- sore eyes
Some targeted therapies can also trigger an allergic reaction the first time a person takes them. You may be given an anti-allergy medicine to try to prevent such a reaction.
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 1 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
- do not try to do too much or overexert yourself
- make time for yourself
Bowel Cancer UK has more information about living with and beyond bowel cancer.
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.
Macmillan Cancer Support also has more information about cancer support groups
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 difficult 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.
Macmillan Cancer Support has more information about the emotional effects of cancer.
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 2 hours before the operation to give you energy.
During and after the operation, the anaesthetist carefully controls the amount of intravenous fluid you need. 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 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 able to go home within a week of their operation.
The exact 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 returning. It's becoming increasingly possible to cure cancers that reoccur after surgery.
Diet after bowel surgery
If you've had part of your colon removed, it's likely you'll experience some diarrhoea or frequent bowel movements.
One of the functions of the colon is to absorb water from poo and empty when going to the toilet.
After surgery, the bowel initially does not empty as well, particularly if part of the rectum has been removed.
Tell your care team if this becomes a problem, as medicine 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 affect 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 keep having problems with your bowels as a result of your diet, or you're finding it difficult to maintain a healthy diet. You may be referred to a dietitian for further advice.
Cancer Research UK has more informaton about eating after bowel cancer.
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.
For more information and advice about living with a stoma – including stoma care, stoma products and stoma-friendly diets – see 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:
- Colostomy UK
- Ileostomy & Internal Pouch Association – this organisation provides a unique visiting service for anyone who wants to speak with someone who has had similar surgery
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 a stoma.
Talking to your partner about how you feel may help you both support each other. Or you may feel you would like to talk to someone else about your feelings. Your doctor or nurse will be able to help.
Cancer Research UK has more information about sex life after bowel cancer.
Financial concerns
A diagnosis of cancer can cause money problems because you're unable to work, or someone close to you has to stop working to look after you.
Financial support is available if you or a carer has to take time 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 medicine, including medicine to treat unrelated conditions.
The certificate is valid for 5 years. Speak to your GP or cancer specialist if you want to apply for one.
Further information
- Care and support
- Get help with prescription costs
- GOV.UK: benefits
- Macmillan Cancer Support: financial issues
- Money Advice Service
Dealing with dying
If you're told there's nothing more that can be done to treat your bowel cancer, your GP will still give you support and pain relief. This is called end of life care.
Support is also available for your family and friends.