It’s important to note that wherever the bowel cancer has spread to, the cells are still bowel cancer cells. For example, if your bowel cancer has spread to the liver, you have secondary bowel cancer in your liver – not liver cancer. Your treatment plan, therefore, must be designed to destroy bowel cancer cells.
As the news sinks in and you are ready to talk about what’s going to happen, the most important thing to remember is that it is your body you are discussing. Don’t be rushed into making decisions and don’t be frightened to ask the doctor to explain things more clearly, and more than once if necessary.
Your multi-disciplinary team will meet to discuss your case and the relevant specialist surgeon should be present, eg a hepato-biliary surgeon if the cancer has spread to your liver.
Your oncologist will recommend a treatment plan that is most likely to provide a balance between having the greatest benefits and the fewest risks or side-effects. This first-line treatment is usually based on what worked best in clinical trials for patients with the same type and stage of cancer. You will be closely monitored during your treatment. If your first-line treatment does not work, stops working, or causes serious side-effects, your oncologist may recommend a second-line treatment, which is a different treatment that it is hoped will be effective. In some cases, you may be a candidate for third-line therapy; this will depend on your fitness and what treatment has been given previously.
You can also ask to be referred to another hospital or consultant if you are unhappy with the information and treatment options available to you. This is usually done by speaking to your current consultant or your GP.
At any point during your treatment, you may consider asking your oncologist whether a clinical trial is an option. A clinical trial is a research study that tests a new treatment to prove it is safe, effective, and possibly better than the standard treatment you may already have had. Because many clinical trials require that you have had few or no previous treatments, it is best to ask about clinical trials early in your treatment pathway. Your healthcare team can help you review all clinical trial options that are open to you. For further details please see our ‘Clinical Trials’ factsheet.
Surgery remains the best chance of a cure for most bowel cancer patients with secondary disease, but it is not always possible to operate on metastatic disease straight away. In these cases radiotherapy, chemotherapy and/or targeted therapies are options for treatment which can help shrink metastases (tumours), making them easier to treat with surgery. This process is known as downstaging.
Where surgery is not a safe or acceptable option, there are other techniques which aim to target and kill the cells within the metastasis. Specialist techniques include infusions of active treatment directly into the blood vessels of the liver (hepatic infusions). Two examples of these treatments, currently being run as clinical trials in the UK, are chemo-embolisation with DC bead technology (DEBIRI) and selective internal radiation therapy (SIRT) for secondary disease limited to the liver.
Another example of an new technology being investigated is radiofrequency ablation or microwave ablation for treatment of metastatic disease.
There are some new treatments becoming more widely available on the NHS, as well as in private healthcare clinics. So far there is limited evidence of their long-term benefits to patients, however, it might be useful to discuss them with your medical team. Examples are stereotactic radiotherapy (cyberknife or gammaknife),lung laser, and HIPEC.
These new technologies are all designed to work alongside more mainstream chemotherapy and targeted therapies. They may benefit patients who might previously have had few treatment options open to them. Currently these newer treatments are only available within the NHS as part of clinical trials, and they may not be available within your local hospital. You will have to have this important discussion with your consultant if you wish to be considered for entry into any of these trials. However, it is important to consider that whilst these are effective treatments to extend life, they will not necessarily provide a complete cure.