10years

Shortly after diagnosis and these further tests, you will discuss with your specialist the options open to you, including when and where treatment will take place, the process you will go through, what drugs will be available for your treatment, if required, and who will be treating you at each stage.

The specialist will put together a treatment plan with you.  This is developed depending on a number of factors such as:

  • the type and size of the cancer
  • what stage the cancer is at
  • your personal health condition and age

It is very important to discuss with your doctors the advantages and disadvantages of what is being suggested so that your individual needs may be fully considered.  You may want to know the possible effects of treatments on your fertility or sexual function.  If you are told you will need a colostomy or ileostomy you should be able to discuss this fully before surgery and have an indication of whether it may be reversible.  

Many people with bowel cancer want to take an active part in making decisions about their medical care.  It is natural to want to learn all you can about your disease and treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask your doctor.  It often helps to make a list of questions before an appointment.

To help remember what your doctor says, you may take notes.  You may also want to have a family member or friend with you when you talk to your doctor -- to take part in the discussion, to take notes, or just to listen.

You do not need to ask all your questions at once.  You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.

Your doctor may refer you to a specialist who has experience treating bowel cancer, or you may ask for a referral. 

Health professionals who treat bowel cancer include –

  • Gastroenterologists (doctors who specialise in diseases of the digestive system and colonoscopy)
  • Surgeons (colorectal surgeons or general surgeons who specialise in bowel cancer) 
  • Medical oncologists (responsible for chemotherapy)
  • Radiation oncologists (responsible for radiotherapy)
  • Dietitians (who recommend best eating plans to follow while you are in treatment and recover) 
  • Cancer Care Coordinators (who facilitate the continuity and quality of your care and support you and your family throughout your treatment)

If these health professionals work together to plan your treatment, they become known as your multidisciplinary care team. 

 


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Treatment for Colon Cancer

Most patients with colon cancer are treated with surgery.  Some people have both surgery and chemotherapy.  Some with advanced disease receive biological therapy.

A colostomy is seldom needed for people with colon cancer.

Although radiation therapy is rarely used to treat colon cancer, sometimes it is used to relieve pain and other symptoms.

 


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Treatment for Rectal Cancer

For all stages of rectal cancer, surgery is the most common treatment.  Some patients receive surgery, radiation therapy, and chemotherapy.  Some with advanced disease receive biological therapy.

About 1 out of 8 people with rectal cancer need a permanent colostomy.

Radiation therapy may be used before and after surgery.  Some people have radiation therapy before surgery to shrink the tumour, and some have it after surgery to kill cancer cells that may remain in the area.  

At some hospitals, patients may have radiation therapy during surgery.  Patients may also have radiation therapy to relieve pain and other problems caused by the cancer.

 


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Getting a Second Opinion

Options in the management of bowel cancer can be complex at times, but are well understood by surgeons who specialise in bowel surgery.

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan.

A second opinion regarding your particular cancer may be recommended by your doctor.

Surgeons who specialise in the management of bowel cancer, and particularly rectal cancer, are members of the Colorectal Surgical Society of Australia and New Zealand.

If your doctor is uncertain, the Soceity can advise regarding members near you. 


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Treatment Methods

The choice of treatment depends mainly on the location of the tumour in the colon or rectum and the stage of the disease. 

Treatment for bowel cancer may involve surgery, chemotherapy, biological therapy or radiation therapy.  Some people have a combination of treatments.  These treatments are described below.

Colon cancer sometimes is treated differently from rectal cancer.  Treatments for colon and rectal cancer are described separately above.

Your doctor can describe your treatment choices and the expected results.  You and your doctor can work together to develop a treatment plan that meets your needs.

Cancer treatment is either local therapy or systemic therapy:

  • Local therapy – surgery and radiation therapy are local therapies.  They remove or destroy cancer in or near the colon or rectum.  When bowel cancer has spread to other part of the body, local therapy may be used to control the disease in those specific areas.
     
  • Systemic therapy – chemotherapy and biological therapy are systemic therapies.  The drugs enter the bloodstream and destroy or control cancer throughout the body.

Because cancer treatments often damage healthy cells and tissues, side effects are common. 

Side effects depend mainly on the type and extent of the treatment.  Side effects may not be the same for each person, and they may change from one treatment session to the next.  Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.

You may want to ask your doctor these questions before treatment begins –

  • What is the stage of the disease?
  • Has the cancer spread?
  • What are my treatment choices?
  • Which do you suggest for me?
  • Will I have more than one kind of treatment?
  • What are the expected benefits of each kind of treatment?
  • What are the risks and possible side effects of each treatment?
  • How can the side effects be managed?
  • What can I do to prepare for treatment?
  • How will treatment affect my normal activities?
  • Am I likely to have urinary problems?
  • What about bowel problems, such as diarrhoea or rectal bleeding?
  • Will treatment affect my sex life?
  • What will the treatment cost?
  • Is this treatment covered by my private health insurance?

 


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Surgery

Unlike some other cancers where many treatment choices are available, surgery is the most common treatment for removing the cancer from your bowel.

However, some people will also require chemotherapy and radiotherapy to reduce the size of the tumour and prevent progression of the disease.  If surgery is not an option, then chemotherapy and radiotherapy are offered to halt progression of the disease and to help control the symptoms.
 

What happens during surgery?


During the operation the piece of bowel that contains the cancer is removed and the two open ends are joined together.  The lymph nodes near the bowel may also be removed because this is the first place to which the cancer may spread.

You will usually stay in hospital for about 10 days after surgery, and will be given antibiotics to prevent any infection.

You may want to ask your doctor these questions before having surgery –

  • What kind of operation do you recommend for me?
  • Do I need any lymph nodes removed? 
  • Will other tissues be removed? 
  • Why?
  • What are the risks of surgery? 
  • Will I have any lasting side effects?
  • Will I need a colostomy? 
  • If so, will the stoma be permanent?
  • How will I feel after the operation?
  • If I have pain, how will it be controlled?
  • How long will I be in the hospital?
  • When can I get back to my normal activities?

 

Colon cancer surgery with anastomosis. Part of the colon containing the cancer and nearby healthy tissue is removed,
and then the cut ends of the colon are joined.  Image courtesy of the National Cancer Institute.


Will you need a colostomy bag?

Most people diagnosed with bowel cancer do not need a colostomy bag.  However, in some cases, the bowel cannot be rejoined straight away, and one end if brought out onto the skin of the abdominal wall.  This is called a colostomy, and the opening of the bowel is known as a stoma.  Bowel motions pass through the stoma into a colostomy bag, which is worn over the stoma.

For most people, the stoma is temporary and can be reversed after a few months.  It is needed only until the colon or rectum heals from surgery.  After healing takes place, the surgeon reconnects the parts of the bowel and closes the stoma.   

Only a very small number of people with bowel cancer cannot have a stoma reversal.  Some people, especially those with a tumour in the lower rectum, need a permanent stoma.

If you do need a colostomy bag after surgery, you will be given support and advice from specialist stoma care nurses.  People who have a colostomy bag may have irritation of the skin around the stoma.  Your doctor or nurse can teach you how to clean the area and prevent irritation and infection.  Life can carry on as normal with a stoma, including sporting activities.


 
Colon cancer surgery with colostomy. Part of the colon containing the cancer and nearby healthy tissue is removed,
a stoma is created, and a colostomy bag is attached to the stoma.  Image courtesy of the National Cancer Institute.

 

Open surgery or keyhole surgery?

Open surgery is currently the most common form of surgery for bowel cancer patients.  In the majority of cases, open surgery to remove bowel cancer is highly successful and can be completely curative if the cancer is caught at an early enough stage.

After open surgery you will have a wound (incision) that goes in a straight line from just below the breastbone for a variable length down to the pelvis.  However, this scar will heal and fade over time.  You can expect to be in hospital for an average of 8-10 days.

The time it takes to heal after surgery is different for each person.  You may be uncomfortable for the first few days.  Medicine can help control your pain.  Before surgery, you should discuss the plan for pain relief with your doctor or nurse.  After surgery, your doctor can adjust the plan if you need more pain relief.

It is common to feel tired or weak for a while.  Also, surgery sometimes causes constipation or diarrhoea.  Your health care team monitors you for signs of bleeding, infection, or other problems requiring immediate treatment.

National Health & Medical Research Council guidelines recommend laparoscopic (or keyhole) surgery, in experienced hands, as a safe and feasible alternative to open surgery for benign bowel cancer.  

The decision about whether to use open or laparoscopic surgery should be made after informed discussion between the patient and the surgeon.  In particular, they should talk about whether the patient’s condition is suitable for laparoscopic surgery, the risks and benefits of the two procedures, and he surgeon’s experience.

Laparoscopic surgery involves carrying out an operation through small cuts in the abdomen.  This type of procedure is often called keyhole surgery.  The surgeon inserts a narrow telescope attached to a camera and other special instruments through the cuts to remove the part of the bowel with the tumour.  Most of the operation is performed through these small cuts, but a slightly larger opening is needed to remove the section of bowel from the body.

Laparoscopically assisted surgery is similar, but involves using the larger opening to carry out part of the surgery as well as to remove the section of bowel.  Both procedures need smaller cuts than open surgery. 

 


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Radiotherapy

Radiotherapy (also called radiation therapy) uses high-energy rays to kill cancer cells.  It works by destroying the cancer cells in the treated area, and can be given before or after surgery.  Sometimes radiotherapy and chemotherapy are given at the same time.

Doctors use different types of radiation therapy to treat cancer.  Sometimes people receive two types –

  • External radiation – the radiation comes from a machine.  The most common type of machine used for radiation therapy is called a linear accelerator.  Most patients go to the hospital or clinic for their treatment, generally 5 days a week for several weeks.
     
  • Internal radiation (implant radiation or brachytherapy) – the radiation comes from radioactive materials placed in thin tubes put directly into or near the tumour.  The patient stays in the hospital, and the implants generally remain in place for several days.  Usually they are removed before the patient goes home.
     
  • Intraoperative radiation therapy (IORT) – in some cases, radiation is given during surgery.   


Will you suffer from side effects?


Radiotherapy can destroy cancer cells, but it can also have an effect on some of the surrounding normal cells.

Side effects depend mainly on the amount of radiation given and the part of your body that is treated.  Radiation therapy to your abdomen and pelvis may cause nausea, vomiting, diarrhoea, bloody stools, or urgent bowel movements.  It also may cause urinary problems, such as being unable to stop the flow of urine from the bladder.  In addition, your skin in the treated area may become red, dry, and tender. The skin near the anus is especially sensitive.

You are likely to become very tired during radiation therapy, especially in the later weeks of treatment.  Resting is important, but doctors usually advise patients to try to stay as active as they can.

Although the side effects of radiation therapy can be distressing, your doctor can usually treat or control them.  Also, side effects usually go away after treatment ends.

You may want to ask your doctor these questions about radiation therapy –

  • Why do I need this treatment?
  • When will the treatments begin? 
  • When will they end?
  • How will I feel during treatment?
  • How will we know if the radiation treatment is working?
  • What can I do to take care of myself during treatment?
  • Can I continue my normal activities?
  • Are there any lasting effects?

 


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Chemotherapy

Chemotherapy uses anti-cancer drugs to kill cancer cells.  The drugs enter the bloodstream and can affect cancer cells all over the body.

Chemotherapy is used at several different stages of treatment –

  • ‘Neo-adjuvant’ – to shrink the tumour(s) before surgery in order to get a better outcome following the operation.

     
  • ‘Adjuvant’ – to destroy any microscopic cancer cells that may remain after the cancer is removed by surgery and reduce the possibility of the cancer returning.

     
  • 'First-line' – chemotherapy that has been shown, through extensive clinical trails and research, to be the best option for the type of cancer being treated.

     
  • 'Second-line' – chemotherapy that has been shown, through extensive clinical trials and research, to be the best option if the disease has not responded to first-line chemotherapy or has recurred.

     
  • 'Palliative' – to relieve symptoms and slow the spread of the cancer, if a cure is not possible.

In order for the chemotherapy to destroy cancer cells in the body, the drugs have to be absorbed into your blood and carried throughout your body.

The chemotherapy drugs can be given in different ways, for example -

  • Oral chemotherapy – if your chemotherapy drug is available as a tablet which you swallow, this can be taken at home.  You would only need to go to the hospital for routine outpatients' appointments, which would include a blood test.  As oral chemotherapies can cause side effects it is important to be aware of these and report them to your medical team immediately.
     
  • Intravenous (IV) injection – the treatment is injected into a vein - either over a few minutes, up to 30 minutes, or over the course of a couple of hours.  IV chemotherapy can be given via 4 different methods:
     
    1. Cannula: a small tube inserted into a vein in the back of your hand, or your arm.

       
    2. Central Line: a thin, flexible tube inserted though the skin of the chest into a vein near the heart.

       
    3. PICC Line (a peripherally inserted central catheter): a thin, flexible tube passed into a vein in the bend or upper part of your arm and threaded through the vein until the end of the tube lies in a vein near the heart.  PICC lines can stay in place for many months.

       
    4. Portacath: a thin, soft plastic tube that is put into a vein.  It has an opening (port) just under the skin on your chest or arm.

If your oncologist believes you will benefit from chemotherapy, they will discuss the proposed treatment plan with you.  You may be prescribed one drug or a combination of drugs.  Ask your specialist about what they are recommending for you, how the chemotherapy will be given and the choices you have.

The side effects of chemotherapy depend mainly on the specific drugs and the dose. The drugs can harm normal cells that divide rapidly –

  • Blood cells – these cells fight infection, help blood to clot, and carry oxygen to all parts of your body.  When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired.

     
  • Cells in hair roots – chemotherapy can cause hair loss.  Your hair will grow back, but it may be somewhat different in colour and texture.

     
  • Cells that line the digestive tract – chemotherapy can cause poor appetite, nausea and vomiting, diarrhoea, or mouth and lip sores. 

Chemotherapy for bowel cancer can cause the skin on the palms of the hands and bottoms of the feet to become red and painful.  The skin may peel off.

Your health care team can suggest ways to control many of these side effects.  Most side effects usually go away after treatment ends.

You might want to ask your oncologist these questions before having chemotherapy therapy –

  • What drugs will I have? 
  • What will they do?
  • When will treatment start? 
  • When will it end? 
  • How often will I have treatments?
  • Where will I go for treatment? 
  • Will I be able to drive home afterward?
  • What can I do to take care of myself during treatment?
  • How will I know the treatment is working?
  • Which side effects should I tell you about?
  • Will there be long-term side effects?

 

Side effects

Because chemotherapy kills dividing cells,which might be cancerous, it can also affect parts of your body where normal cells divide frequently, such as the mouth, hair, bone marrow and so on.

The risk of side effects depends on the drugs used and the dose you need.  You should talk to your specialist or chemotherapy nurse about side effects and should be given written information about the dif­ferent drugs.  Then try to weigh up the side effects against the overall benefits of the treatment.

Cancer-related anaemia and the fatigue associated with it has a profound impact on patient's lives, yet it is still commonly under-diagnosed and under-treated.  Chronic fatigue in bowel cancer may be caused by the chemotherapy or radiotherapy, or by surgery.  If you are experiencing this, talk to your specialist - it can be treated.  You may be offered a blood transfusion, or a treatment called EPO which you can take as a simple injection at home. 

 


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Availability of drugs

In Australia there are a number of government bodies responsible for the regulation and availability of bowel cancer treatments.

The Therapeutic Goods Act 1989, Regulations and Orders provide a national framework for the regulation of therapeutic goods in Australia to ensure quality, safety and effectiveness of medicines.  They also set out the requirements for inclusion of therapeutic goods in the Australian Register of Therapeutic Goods (ARTG), including advertising, labelling and product appearance, for example.

The Therapeutic Goods Administration (TGA) is a unit of the Australia Government Department of Health and Ageing.  It carries out a range of assessment and monitoring activities to ensure therapeutic goods available in Australia are of an acceptable standard.  At the same time the TGA aims to ensure that the Australian community has access, within a reasonable time, to therapeutic advances.

All treatments used to prevent, cure or alleviate bowel cancer must be entered on the Australian ARTG before they can be supplied in Australia.  Once approved and entered on the ARTG, they are available for human use and can be accessed privately.

Some treatments can then be recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) to be listed on the Pharmaceutical Benefits Scheme (PBS) as a subsidised treatment.  The Scheme is available to all Australian residents who hold a current Medicare card.

The PBAC is an independent statutory body established to make recommendations and give advice to the Minister for Health & Ageing about which treatments should be made available as pharmaceutical benefits.

No new treatment may be made available as a pharmaceutical benefit unless the Committee has so recommended.

The Committee is required by the National Health Act 1953 to consider the effectiveness and cost of a proposed benefit compared to alternative therapies.  In making its recommendations the Committee, on the basis of community usage, recommends maximum quantities and repeats and may also recommend restrictions as to the indications where PBS subsidy is available.

When recommending listings, the Committee provides advice to the Pharmaceutical Benefits Pricing Authority (PBPA) regarding comparison with alternatives or their cost effectiveness. 

Some treatments may not be recommended by the PBAC if they are deemed not cost-effective, even if they are clinically proven.

The issue of drug availability has received a lot of media attention and can be confusing and complicated.  You should discuss all the options with your oncologist, and if a drug would be of benefit but it is not available via the PBS, you may consider accessing this privately or applying to a manufacturer to see if you are eligible to enter an access program or the drug made available on compassionate grounds.

Also, ask about clinical trials.

A list of the applications for consideration at each PBAC meeting is published six(6) weeks prior to each meeting.  The sponsor of the submission will have already provided the PBAC with detailed clinical and economic data in support of the submission.  However, you are welcome to provide comments from a personal (i.e. patient, carer, member of the public, health professional) or group perspective for consideration by the PBAC when the submission is considered.

Further details, including closing dates for input, can be found at www.health.gov.au.

In 25 May 2011 the Minister for Health and Ageing confirmed on Hansard that the Government is "concentrating on listing medicines on the PBS that treat serious and life threatening conditions where there are no alternative treatments on the PBS." 

In doing so, the Government will rely "upon information provided by the PBAC in relation to clinical need for each medicine or vaccine, including whether alternative treatment options exist, and whether there were comparable listings in the past three years.  Additional information taken into account is whether the listing provides expenditure savings and other technical information that the PBAC considered.  The Government also relies on the expert advice from the Department of Health and Ageing and the Chief Medical Officer." 

Any PBS listings with a financial impact will now have to be considered by Cabinet.

 


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Performance status

Doctors use the WHO performance status to describe how well you are.  They also call it your ‘performance status'.  The World Health Organisation designed the scale that doctors use most often.  It has categories from 0 to 4.  Here is what they mean –
 
0 – you are fully active and more or less as you were before your illness
1 – you cannot carry out heavy physical work, but can do anything else
2 – you are up and about more than half the day; you can look after yourself, but are not well enough to work
3 – you are in bed or sitting in a chair for more than half the day; you need some help in looking after yourself
4 – you are in bed or a chair all the time and need a lot of looking after
 
Clinical trials often include performance status as one of the criteria you must meet to join the trial as researcher have to make sure people are well enough to take part.
 
Similarly, a patient’s WHO performance status is often a criteria you must meet to be eligible for some PBS-subsidised bowel cancer treatments.
 
 


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Chemotherapy drugs

Chemotherapy treatment for bowel cancer is improving dramatically.  Although the most common chemotherapy is 5-fluorouracil (5-FU) which has been the main treatment for over 40 years, there have been several new drugs developed to help fight bowel cancer which have improved the results set by 5-FU.

Frequently, two or more chemotherapy drugs are given together.  This is known as combination therapy.  Studies have shown that patients receiving combination therapy have significant advantages both in response rate and survival.  Sometimes monoclonal antibodies are added to chemotherapy to further improve the results.  

Treatment At what stage is
this treatment used?
Is this treatment PBS subsidised? Click to download 
Consumer Medicine Information (CMI)
5-Fluorouracil (5-FU)

At any stage of bowel cancer. 

It is usually combined with folinic acid (Leucovorin Calcium).

Yes.

 

Oxaliplatin (Eloxatin) 
Adjuvant treatment of stage III (Dukes C) colon cancer after complete resection of primary tumour. 
 
Treatment of metastatic colorectal cancer.
Oxaliplatin in combination with 5-FU and folinic acid (FOLFOX) is PBS-subsidised as a treatment option for the adjuvant treatment of patients with stage III (Dukes C) colon cancer following complete resection of the primary tumour. 
 
Oxaliplatin in combination with 5-FU and folinic acid (FOLFOX) or capecitabine (XELOX) is PBS-subsidised as a treatment option for metastatic colorectal cancer in
patients with a WHO
performance status of 2 or less.
 
Oxaliplatin is not PBS-subsidised for the treatment of patients with stage II (Dukes B) colon cancer.  Oxaliplatin is not PBS-subsidised for the adjuvant treatment of patients with rectal cancer.
 

From 1 December 2011, capecitabine in combination with oxaliplatin (XELOX) will be listed as a PBS-subsidised treatment option for the adjuvant treatment of stage III (Dukes C) colon cancer.  This latest recommendation will allow Xeloda to be reimbursed as both monotherapy and as part of the XELOX combination. 

 
Capecitabine (Xeloda)
Adjuvant treatment of stage III (Dukes C) colon cancer. 

Treatment of advanced or metastatic bowel cancer alone or in combination.

 

Capecitabine is PBS-subsidised as a treatment option for advanced or metastatic colorectal cancer.  It is also PBS-subsidised as a treatment option for adjuvant treatment of stage III (Dukes C) colon cancer, following complete resection of the primary tumour.

Capecitabine is not PBS-subsidised for the treatment of patients with Stage II (Dukes B) colon cancer.  Capecitabine is not PBS-subsidised for the adjuvant treatment of patients with rectal cancer.

From 1 December 2011, capecitabine in combination with oxaliplatin (XELOX) will be listed as a PBS-subsidised treatment option for the adjuvant treatment of stage III (Dukes C) colon cancer.  This latest recommendation will allow Xeloda to be reimbursed as both monotherapy and as part of the XELOX combination. 

 

lrinotecan 
(Camptosar)

1st line combination and 2nd line monotherapy treatment of advanced colorectal cancer.

Irinotecan is PBS-subsidised as a treatment option for metastatic colorectal cancer in patients with a WHO performance status of 2 or less.

Note: In first-line usage, effectiveness and tolerance may be improved when Irinotecan is combined with an infusional 5-fluorouracil regimen (e.g. FOLFIRI).

 

 


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KRAS testing

Scientists now understand that bowel cancer starts when the building "blue print" (the genes) for individual cells in the bowel are damaged and changed in some way.

Understanding how these abnormal cells behave means that doctors now also increasingly understand how the new cancer medicines available will work when bowel cancer spreads to other parts of the body.

They may be able to select an individual treatment plan for you that will have a better chance of success.  Importantly, they may also be able to avoid giving you medicines if they know they won't work.

 

When would I have a KRAS test done?

Changes to the genes, identified as KRAS, usually happen slowly, in stages, to the same gene in the affected cells.  The KRAS change occurs first, and is a useful marker when deciding which patients will respond to certain treatments for bowel cancer that has spread to other parts of the body.

If your bowel cancer has spread only to your liver and your liver surgeon believes that these tumours could be removed by surgery, then you should have this test done automatically.

You may also be able to ask to have the test done, if you have both liver metastases that can be removed and another limited area of potentially treatable, secondary disease.

Secondary bowel cancer can be treated with a range of medicines called monoclonal antibodies.

KRAS testing does not affect the way your chemotherapy is prescribed.  Instead, it gives your oncologist the information they need to work out which other medicine from the monoclonal antibodies group may work for you.

Some monoclonal antibodies are given at the same time as your chemotherapy, whilst others are given on their own.


How are the tests done?

These tests are usually done on the cancer cells from the tumour or biopsy that was removed during your operation or endoscopy.  Samples of the cancer will have been preserved and stored in the hospital laboratory.  Your medical team will arrange for this tissue sample to be tested, which will confirm whether your tumour is - 

  • Wild-type  KRAS (also called  'normal')
  • Mutated KRAS  

How long do the test results take to come back?
 
Once the tissue sample has been located, the test results typically take 5-7 working days to come back to your oncologist.
 

What are the treatment options once the KRAS status is known?
 
Monoclonal antibodies are a group of drugs which work to stop the cancer cells growing and developing by interfering with their reproduction processes (anti-EGFR) or by cutting off their blood supply (anti-VEGF). 
 
Up to 60% of bowel cancer tumours do not carry the KRAS gene mutation.  These tumours are commonly referred to as KRAS wild-type.  Clinical studies have shown that tumours which are KRAS wild-type can be successfully treated with anti-EGFR monoclonal antibodies cetuximab (Erbitux) and panitumumab (Vectibix), as well the anti-VEGF monoclonal antibody bevacizumab (Avastin).

Around 40% of bowel cancer tumours that carry the KRAS gene mutation are referred to as KRAS positive tumours.  Clinical studies have shown that patients with KRAS positive tumours may be successfully treated with the anti-VEGF therapy bevacizumab (Avastin), but do not respond to anti-EGFR therapy.  

 


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Monoclonal Antibodies

Some people with bowel cancer that has spread receive a monoclonal antibody, a type of biological therapy and are a different type of treatment to chemotherapy.

  • ‘Monoclonal’ means all one type.
     
  • ‘Antibody’ is a protein in your immune system that recognises and attacks foreign substances.

So a ‘monoclonal antibody’ is a treatment designed to recognise and target only one type of foreign substance (e.g. cancer cells).

The development of monoclonal antibody treatments is an exciting development in the treatment of cancer as it may be possible to kill cancer cells without damaging other healthy cells.

The monoclonal antibodies bind to bowel cancer cells.  They interfere with cancer cell growth and the spread of cancer.  People receive monoclonal antibodies through a vein at the doctor's office, hospital, or clinic.  Some people receive chemotherapy at the same time.

During treatment, your health care team will watch for signs of problems.  Some people get medicine to prevent a possible allergic reaction.  The side effects depend mainly on the monoclonal antibody used.  Side effects may include rash, fever, abdominal pain, vomiting, diarrhoea, blood pressure changes, bleeding, or breathing problems.  Side effects usually become milder after the first treatment.

 


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Monoclonal Antibody Treatments for Advanced Bowel Cancer

There are three Monoclonal Antibody (MAB) treatments for bowel cancer -

  • Bevacizumab (Avastin)
  • Cetuximab (Erbitux)
  • Panitumumab (Vectibix)

These treatments seek out cancer cells that produce too much of a particular growth factor (a substance which stimulates a cell to grow and divide) and block the cell's receptors so the cell can't receive the signal to grow.
 

Treatment At what stage is
this treatment used?
Is this treatment PBS-subsidised? Click to download 
Consumer Medicine Information (CMI)
Bevacizumab
(Avastin)

Used for first and later treatment lines of advanced or metastatic colorectal cancer in combination with a fluoropyrimidine based chemotherapy. 

Use of bevacizumab is not dependent on KRAS status.

In July 2008, bevacizumab was recommended for PBS listing by the PBAC.

On 1 July 2009, Bevacizumab was added as an initial PBS-subsidised treatment, in combination with first-line chemotherapy, of a patient with previously untreated metastatic colorectal cancer with a WHO performance status of 0 or 1.

Bevacizumab is also listed as a continuing PBS-subsidised treatment, in combination with first-line chemotherapy, of a patient with metastatic colorectal cancer who has previously been issued with an authority prescription for bevacizumab and who does not have progressive disease and who remains on first-line chemotherapy. 

Bevacizumab is not for use as monotherapy.

 
Cetuximab(Erbitux)

Used for the treatment of patients with epidermal growth factor receptor (EGFR)-expressing, KRAS wild-type advanced or metastatic colorectal cancer in combination with chemotherapy.

Cetuximab can also be given as a single agent in patients who have failed or are intolerant to oxaliplatin-based therapy and irinotecan-based therapy.

In July 2010, cetuximab was recommended for PBS listing by the PBAC.

On 1 September 2011, cetuximab was added as an initial PBS-subsidised treatment, as monotherapy or in combination with an irinotecan based therapy, of a patient with a WHO performance status of 2 or less and with
K-RAS wild type metastatic colorectal cancer after failure of first-line chemotherapy.

Cetuximab was also listed as a conitnuing PBS-subsidised treatment, as monotherapy or in combination with an irinotecan based therapy, of a patient with K-RAS wild type metastatic colorectal cancer who has previously been issued with an authority prescription for cetuximab and who does not have progressive disease.
 
Cetuximab is not PBS-subsidised for use in combination with bevacizumab or oxaliplatin based therapies.
 

Panitumumab
(Vectibix)

As monotherapy for the treatment of patients with EGFR-expressing metastatic colorectal carcinoma with non-mutated (wild-type) KRAS after failure of irinotecan and oxaliplatin containing regimens.

In November 2008, the PBAC rejected a submission to add Panitumumab to the list of subsidised drugs under the PBS for patients with advanced bowel cancer, citing uncertain clinical benefit and the resultant high and highly uncertain cost effectiveness.  The (unsibsidised) drug is available privately to patients via their oncologist.

 

 

You might want to ask your oncologist these questions before having biological therapy –

  • What drugs will I have?
  • What will they do?
  • When will treatment start?
  • When will it end?
  • How often will I have treatments?
  • Where will I go for treatment?
  • Will I be able to drive home afterward?
  • What can I do to take care of myself during treatment?
  • How will I know the treatment is working?
  • Which side effects should I tell you about?
  • Will there be long-term side effects?

Improving the lives of patients with bowel cancer through recognition of the value of prolonged, quality of life is one of the aims of the Bowel Cancer 2012 Challenge, presented to Government on 7 May 2009.

  


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Clinical Trials

What is a clinical trial?

Clinical trials are carefully designed and regulated research studies.

Clinical trials are essential for improving cancer care.  They help to determine whether new cancer treatments, diagnostic tests or preventive interventions are effective, and identify best practice cancer care.

Are there different types of trials?

  • Diagnosing trials evaluate ways of detecting certain types of disease.
     
  • Prevention trials can either be ‘action studies’ e.g.: does exercising three times a week reduce your risk of cancer, or ‘agent studies’ e.g.: does taking a certain vitamin reduce your risk of cancer.
     
  • Quality of life trials can measure an individual’s sense of well-being and quality of life during treatment.
     
  • Screening trials can find new methods of screening for cancer which would mean that more cases could be diagnosed at an earlier stage.
     
  • Treatment trials look at new ways of treating and managing a specific condition.


Why are clinical trials needed in cancer?


Carrying out clinical trials is the only way to find out if a new approach is better than the approach currently being used and can include –

  • Testing new treatments, e.g. new drugs or ways of giving treatment.
     
  • Examining new combinations of treatments, or when/how they are given.
     
  • Looking at the effect of different treatments, such as psychological or complementary therapy.
     
  • Discovering which treatments cause which side effects, and how these can be managed.
     
  • Investigating the convenience of different treatments (e.g. oral tablets versus intravenous injections).
     
  • Studying whether treatment (for example, chemotherapy) should be given before or after surgery.

 


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Treatment Trials

What are the different phases of treatment trials?

Treatment trials go through a series of ‘phases’ to test whether they are safe and if they work. All new cancer drugs are tested in the laboratory before they are given to people in trials.

Phase 1 trials involve a small number of people, in a specialist research unit, and aim to discover appropriate doses, the effect the drugs have on the body, side effects etc. Researchers start with very small doses and only increase the amount given if the participants experience no or minor side effects.  If the drug is effective and a safe dose is found following a number of phase 1 trials, it will progress to phase 2 trials.

Phase 2 trials, still involving a small number of patients, aim to discover on what types of cancer the treatment is most effective, the side effects, the best dose, and if larger, more extensive phase 3 studies would be appropriate.  Throughout these studies patients are very closely monitored.  Sometimes phase 2 trials may include testing the best way to give a treatment, for example by tablet or injection.

Phase 3 trials aim to compare the effectiveness of the new treatment with current, standard treatment and only start when the treatment has successfully passed through phase 1 and 2 trials.  This phase provides more information on outcomes and side effects.  These trials often last a year or more, and can include hundreds or thousands of patients, from different hospitals, often across several countries.  Phase 3 trials always involve randomisation (see below for details).

Phase 4 trials are carried out after a drug has received a license (meaning doctors can prescribe it outside of trials) and has been demonstrated to be effective.  The studies further investigate long term risks/side effects and how the treatment works outside of clinical trial environments.  Phase 4 studies are not required for every medicine.


What is randomisation?


‘Randomisation’ is a way that a patient is assigned within the trial to either receive the ‘trial’ treatment or the standard ‘best currently available’ treatment.  Randomisation works by chance, is done via a computer, and means that each patient has an equal chance of being given the new treatment.  If the trial you are entering into is randomised, it does mean you may not get access to the treatment being tested.


Should you take part in a clinical trial?


There are a number of reasons why you may wish to take part in a clinical trial.  These include:

  • Access to new treatments before they become widely available.
     
  • Contributing to medical knowledge and the research of cancer.
     
  • The potential to be the first to benefit from new methods of treating cancer.
     
  • Receiving healthcare provided by leading clinicians in the field of cancer research.
     
  • Close monitoring of your health during the trial.
     
  • If you wish to do so, discuss the trial with friends, family and your doctor.  It is important that you know that you can leave the trial at any time, without giving a reason.  If, however, you are receiving new treatment as part of the trial, you may not be able to continue to have this treatment if you leave the trial. 


What is informed consent?


Informed consent is a process in which you will receive information, either from your doctor or a dedicated research nurse, before you decide whether or not to take part.  You will be told –

  • About the trial, why it is taking place and why you have been asked to take part.
     
  • How the trial is going to work (you may or may not get the treatment being trialled).
     
  • The standard treatment available if you do not enter the trial.
     
  • Information on the treatment options, possible risks/benefits and tests.

You will then arrange to meet with your oncologist at a separate appointment to discuss your choice.  At this appointment you will provide written informed consent if you have opted to participate in the trial.  You may have to undergo blood tests/scans to confirm your eligibility and will then be ‘randomised’ into the trial.  You should only agree to take part in a trial if you are completely happy with what you are being asked to do.
 

Are there any risks of taking part?


Clinical trials involving patients are the end of a long and careful research process.  Potential risks, however, can include -

  • Side effects or risks that are as yet unknown to doctors.
     
  • The treatment may be less effective than current approaches.
     
  • Benefits to some patients, but it may not work for you.


How do you get involved in a clinical trial?


Some people are offered to take part in a clinical trial by the medical team treating them, whilst others actively seek to enter a clinical trial to potentially get access to treatment that is not currently available in Australia.
 

Click here to find out more about current clinical and treatment trials being conducted in Australia.

 

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Real Life Stories

Russell's story (72, NSW)

1

Let me introduce you to an insidious silent killer.   My name is Russ and I have been a Rotarian for 42 years.  It was 1996 when I was asked to take on the role of District Chairman for Rotary Bowelscan, a project designed to raise community awareness of bowel cancer and encourage early detection.  With the participation of pharmacies around Australia, Rotary Bowelscan sells test kits designed to detect blood in the stool, which is one of the best early indicators of bowel cancer. ...

John S' story (65, NSW)

1

I was diagnosed with stage one bowel cancer at the age of 62. Everything seemed to happen so quickly. I took part in the Rotary Bowelscan program in April and in early June received notification that my test results were positive. I saw my GP on 6 June and she booked a colonoscopy for 7 July. Just four days later I was having an x-ray and CT scan, which revealed a 4cm tumour on my sigmoid colon. By the end of July I had seen a surgeon, who recommended an operation to remove the tumour and outlined my treatment options....

Monica's story (85, QLD)

1

My bowel cancer diagnosis was a huge shock. I had been experiencing frequent constipation, a general change in bowel habits and some rectal bleeding, all of which my GP felt needed further investigation. I was referred for a colonoscopy and endoscopy in order to pinpoint the source of the problem....

Vicki's story (57, NSW)

1

Some people are known for their sense of humour, some for their compassion, others for their courage.  Anyone who knew bowel cancer victim Vicki Morris will tell you she was all of this and more. Vicki’s husband Peter writes:  Cancer is one of those things that you think happens to someone else and it is a shock when it comes to your own household.  It doesn’t need to be a death sentence, but the odds are difficult to beat. It takes someone exceptional to deal with it as bravely as Vicki did....

Adam's story (25, NSW)

1

I was diagnosed with stage 3 bowel cancer two years ago at the age of 23.  I had been experiencing a range of symptoms for about five years, including rectal bleeding, mucous in my stools, diarrhoea, stomach pain and cramps to changes in my bowel habits.    Coincidentally, my mother was also having these problems, so we were both seeing a doctor to try to discover their cause....

Margaret's story (50, VIC)

1

I was diagnosed with bowel cancer in 2007 at the age of 50. I had been noticing changes in my bowel habits for some time but it wasn’t until my abdomen was severely distended and I lost the use of my bowels that I was admitted to hospital. I was on holiday in Port Douglas at the time, so I was taken to Mossman Hospital....

Janice's story (29, NSW)

1

 My father was a fit and healthy man. He ate well, never smoked, almost never drank to excess and played a lot of sports. As a result of old work and football injuries, he suffered from chronic knee and back pain for many years. He also suffered frequent digestive upsets, which he rationalised to be a side-effect of the anti-inflammatory medication he needed to take for his pain....

Milly's story (30, VIC)

1

I believe it is important for all of us to fight to be healthy. After experiencing years of diarrhoea and stomach pain, Mum was diagnosed with bowel cancer at age 55. After a urinary infection that persisted, Mum’s doctor suggested an ultrasound where ‘masses’ were discovered on her bowels. She was then referred for an abdomen scan....

Sharon's story (47, QLD)

1

My journey with bowel cancer came as a surprise to me, even though I have an extensive family history of the disease due to Lynch Syndrome (a type of inherited cancer of the digestive tract). My mother, brother and uncle have all had bowel cancer and survived to tell the tale. I suppose I thought it wouldn’t happen to me as I have always been healthy, eaten lots of fruit and veggies plus I’m quite a positive person....

Gayle's story (53, QLD)

1

In 2000 I was diagnosed with pneumonia. While I was in hospital the specialist did a cancer marker test which came back really high. However the subsequent colonoscopy was not very clear as the prep had not been very effective. In September 2011 I underwent a second colonoscopy as I was experiencing continual bad diarrhoea. During the procedure a carcinoid tumour was discovered....

Chelsea's story (38, WA)

1

It was very frightening to realise I might die and leave my two small children (aged 1 and 4 at diagnosis) without their mum after being diagnosed with Stage 3 rectal cancer at the age of 37 in April 2012. I noticed occasional rectal bleeding and after about six weeks I went to my GP. She didn’t think it was urgent but recommended a colonoscopy. After a six week wait and a substantial increase in rectal bleeding, the colonoscopy showed a tumour in my mid to low rectum, plus two polyps in my bowel. Over the next few...

Donna's story (45, QLD)

1

I would recommend for anyone reading this to please listen to your body, take notice of your symptoms and get it followed up with your doctor. We all need to push to get looked at when we think there is a problem, because like me, there probably is.  For a couple of years I had experienced bowel changes, which I mentioned to my GP but I was told my symptoms were related to others things. I was tested for coeliac disease as my brother is a coeliac; however, no further tests were done....

Bobby's story (57, NSW)

1

My message to anyone out there reading this would be to stay positive and keep moving forward. Despite what I’ve been through I feel better now than I have in a long time. Prior to my diagnosis, I hadn’t been feeling well for some time. A driving holiday to Melbourne prompted me to see a doctor. I was fine sitting down but as soon as I stood up I had to rush to a toilet. Back in Sydney my GP sent me off for blood tests and a CT scan. The results showed my tumour markers were up so things were not looking good. A...

Maureen's story (55, QLD)

1

When Maureen received a screening kit in the mail just after her 55th birthday, she had no reservations about doing the test. “It was just too simple not to do. The test was hygienic, quick to complete and extremely straight-forward,” she said. Just as well, because ultimately this unusual birthday present saved her life.  When the test returned a positive result, Maureen was not overly concerned as she had read in the accompanying booklet that the presence of blood may be due to conditions other than ca...

Joy's story (39, NSW)

1

In May 2011 Mum began losing weight and starting experiencing pain on the right side of her abdomen. A colonoscopy discovered a large mass and she was diagnosed with stage 4 bowel cancer. She was 66. Mum was treated with surgery and has since had chemotherapy. Sadly three months ago she started finding it difficult to speak. It seemed as though her nerves were not working effectively, causing her to not be able to eat or talk properly. At that point I didn’t have a good feeling about things so we went back to Mum&rsqu...

Nicole's story (41, VIC)

1

My mother passed away with breast cancer when I was 10, so I have always been diligent with screening and looking after my health.  I would go to my doctor on a regular basis to make sure everything was all OK.   In February of this year I had been quite tired, had a lot of back and abdominal pain so I went for a check-up with my GP.  Blood tests taken read an Hb of 72 so I was called immediately to go to hospital for a blood transfusion.  From there I underwent a colonoscopy and gastroscopy to find out...

Martin's story (60, NSW)

1

My name is Martin and I’m a happily married father of three and grandfather of one, working as a General Manager in the building industry. I want people to hear my story so that they understand that bowel cancer can happen to anyone at any time. I was sent the bowel screen test kit in 2006. I took the test and the results came back negative. In mid-April 2011, I noticed blood in my stools and thankfully I acted immediately. I am normally a procrastinator, but in this instance I acted swiftly. I saw my GP straightaway...

Stephanie's story (21, QLD)

1

I woke from what was supposed to be a routine, last resort colonoscopy and was advised that my undertaking of this small procedure had saved my life. I was diagnosed with bowel cancer last year in October 2012 at the age of 21....

Ron's story (60, VIC)

1

I’d had rectal bleeding and unusual bowel habits for six to eight weeks before going to see my GP in 2008. I was 60 at the time. My GP gave me an internal examination but found nothing. Nonetheless, he was insistent that I see a specialist and made the call while I sat in his surgery, getting me an appointment for the very next day.  I had a colonoscopy within the week and was diagnosed with stage III bowel cancer.  I had a CT scan the next day, then an ultrasound for tumour staging....

Damien's story (26, VIC)

1

When I was first diagnosed with bowel cancer I did not have enough time to feel ‘sad’ or ‘worry’ too much. I am naturally an optimistic person and an ‘action man’. “I can get through this!” I thought to myself. Prior to my diagnosis at age 26, I had been experiencing dull pains in my pelvic area for 3 to 4 years, extending up through to my belly button and around to the right side of my body....

Eileen's story (50, NSW)

1

Even though there is a history of bowel cancer in the family, I never thought it would happen to me. My diet had been considerably healthy throughout my life and I had previously used a Rotary Bowelscan kit, which had come back clear. This all changed in July 2007 when I was diagnosed with Dukes stage 3 bowel cancer....

Anis' story (72, NSW)

1

This story is about my father who was diagnosed with bowel cancer three days before Christmas in 2010 and passed away just five weeks later.   Dad was a young 72-year-old – he was healthy and active, ate well, enjoyed long walks, wouldn’t hesitate to climb up on the roof if necessary, and had never even been to hospital – so his diagnosis was a shock. He had lost his appetite and begun to lose weight about a month before his diagnosis but his doctor didn’t think it was a problem; in fact, he th...

Rick's story (63, NSW)

1

I was diagnosed with advanced bowel cancer in September 2011 after seeing my GP about a very small amount of blood being present on my toilet paper. ** The GP asked me to get a home testing kit from the chemist, conduct the test and return it to him. The test showed it was a positive result so I was referred to another doctor to conduct a colonoscopy. The colonoscopy took place on September 26 and the results showed two tumours in my large bowel. I was booked in for a CT scan the next day. After the scan my doctor told...

Brian's story (53, VIC)

1

I was diagnosed with bowel cancer in May 2011 after experiencing changes to my bowel habits over approximately 2 months, which was followed by abdominal pain.  This led me to my GP who thought the stomach upsets were nothing serious so prescribed a reflux medication and sent me on my way.    I soon returned to my GP after experiencing rectal bleeding, when he then referred me for a faecal occult blood test immediately. ...

Seher's story (30, NSW)

1

My family was shocked by the news in April 2011 when first told my Dad had bowel cancer. It was difficult to process as my Dad is such a healthy man. Initially my Dad went to his GP to have a check up on his prostate. It was after his assessment that the GP was concerned Dad’s bowel may require further investigation. After discussing his health with his doctor it was apparent Dad had experienced a change in his bowel habits, was anaemic and had noticed gradual weight loss....

Carol's story (63, QLD)

1

The main symptom that led to my diagnosis of bowel cancer was a change in my bowel habits, which I discussed with my GP. I was referred to a gynaecologist who diagnosed a uterine prolapse, which affects the working of the bowel, and was sent to a physiotherapist who put together an exercise program for me to help with the problem. When I went back to the gynaecologist after 12 months as requested, I was still having bowel problems so he recommended a colonoscopy....

Ella's story (35, ACT)

1

At the age of 35 I started experiencing rectal bleeding so my GP recommended I have a colonoscopy. The colonoscopy confirmed three growths located within my bowel. After seeing my GP it all happened within weeks, it all seemed so fast yet very professional. After being diagnosed I was required to undergo radiation and chemotherapy. Two weeks before Christmas I commenced my radiation cycle which included trips to radiology every day for 6 weeks and chemotherapy in a tablet form, which included 3 pills, twice a day....

Stacey B's story (29, WA)

1

I went to my GP in early 2009 complaining of tiredness and lethargy, rectal bleeding and a change in my bowel habits.  But because of my age and the fact that I had recently given birth, I was given only a blood test and told that further investigation wouldn’t be necessary.  The blood test showed low iron levels so my tiredness was put down to that....

Mary-Anne's story (49, NT)

1

When I was diagnosed with bowel cancer on 23 June 2011, I didn’t even ask what stage the cancer was at – I just wanted to know what I had to do to fight it. My initial symptoms were rectal bleeding, a change of bowel habit and stomach pain. Eighteen months prior, I had started bleeding and had a colonoscopy which showed nothing. The last colonoscopy five years prior to that had showed a polyp and an unknown growth, neither of which were diagnosed as a cancer. There is no family history of bowel cancer on eith...

Eve's story (22, SA)

1

In 2005 when I was 14, my father was diagnosed with stage 3 bowel cancer.  Dad was just 38 at the time and given a low chance of surviving five years.  That was eight years ago and he is still with us, happy and healthy today.   Finding out dad had bowel cancer was a complete shock.  Following his diagnosis, he underwent surgery and half of his large intestine was removed.  He then was prescribed Xeloda as chemotherapy and, like most cancer patients, experienced a lot of difficulty with the treatme...

Vicki S' story (36, QLD)

1

I was diagnosed with bowel cancer in 1999 at 36 years of age. Twelve months prior to my diagnosis I had visited my GP and raised concerns about weight loss, rectal bleeding, changes in my bowel habit, stomach pain and feeling tired. My GP told me it was stress-related. After numerous visits I felt like I a hypochondriac so I stopped going to the doctor to report the same symptoms and accepted it was stress (even though I didn’t feel it was stress related). I was a single mother with two young children so I told myself...

Mandi's story (29, NSW )

1

I was diagnosed with bowel cancer at 24 years old, just before I was due to leave for Europe with a group of girlfriends after finishing university. I had experienced some bleeding from my rectum only one week prior to this time, but at the time I really wasn’t too fussed about getting it looked at because I was so excited about my European adventure, and because of my age....

Stacey's story (35, SA)

1

My symptoms were fairly vague.  In January 2010 I had one incident of a very upset tummy, I had had slight rectal bleeding for about 8 months but put it down to having haemorrhoids from having had a baby in the past year, and my bowel movements had been more regular. I was actually at the GP in January 2010 about getting my moles checked for cancer when right at the end I mentioned the above symptoms.  My GP who I now thank for my life, said that at my age I should have nothing and immediately referred me to a gas...

Gillian's story (62, VIC)

1

I was diagnosed with bowel cancer at 58 years old. I’d had dull stomach pain and occasional bleeding for several months but it wasn’t until I saw a lot of blood in the toilet that I booked an appointment with my GP.  He sent me for a colonoscopy and I was referred to a surgeon within a week. I was very shocked when I was told I had cancer, but I tried to remain positive throughout my treatment and I really think that helped me cope....

Lynette's story (73, VIC)

1

I was diagnosed with bowel cancer at 72 – just two weeks shy of my 73rd birthday. I’d experienced a little bit of rectal bleeding, but initially thought it was nothing and would go away. When it didn’t, I visited my GP who recommended a colonoscopy....

Christine's story (54, QLD)

1

Kim was diagnosed with bowel cancer in June 2012 and passed away on 8th May 2013. We are just coming up to 6 months since his passing and I am here to share his dreadful journey. Kim was being treated for constipation, no bleeding or anything to let us know there was a problem. After 10 days he started vomiting and I took him to the hospital in Brisbane. He spent a week in hospital to clear his bowel, then a big op to remove a large cancer in his bowel that had burst through the bowel wall. He had chemo 24/7 but still h...

Felicity's story (38, VIC)

1

In August 2010 my life changed forever.  Nothing can prepare you for a bowel cancer diagnosis at just 38 years old.   I had been given what I thought was a routine colonoscopy to investigate the cause of my iron deficiency, which my doctor thought was probably due to an ulcer. But as I lay in bed in the recovery room after being told they had found a tumour, I remember thinking: ‘I’m too young.  I have a husband and two young boys.  This can’t be happening to me’.  ...

Steve's story (66, NSW)

1

Three weeks prior to my diagnosis I had been sent a National Bowel Screen Kit. I looked at it and thought, “I should really do that one day”. Needless to say, I left the kit on the bench and three weeks later ended up seeing my GP on a Wednesday afternoon for a prescription. At the time I complained of having had a slight pain in my abdomen. The GP asked to examine my abdomen and it was then he felt a mass....

Cris' story (34, QLD)

1

I was only two years old when I lost my grandmother to bowel cancer. My Grandmother and my Auntie, were both diagnosed at ages 60 and 40 years respectively. By the time my grandmother was diagnosed, the cancer was terminal. My Auntie was checked out for bowel cancer due to the high family history of the disease. I was here in Australia when she was diagnosed with bowel cancer in Brazil. She had the chance to fight it but could not stand the pain caused by the radiotherapy treatments. I was fortunate enough to be able to vis...

Mary's story (43, VIC)

1

Unlike many people, I had severe symptoms for some time before I got my diagnosis. For four weeks during the time of seeing my doctor and being diagnosed I had very bad stomach pains and was completely unable to eat.  My condition continued to deteriorate all the time – the stomach pain came and went, becoming sharper and more intense as time passed, and I was generally very sick. By the end of this 4 week period, I was unable to walk.   During this time I saw four GPs, each of whom had a different opinion...

Helen's story (65, NSW)

1

Unlike many people, I had a lot of symptoms before I was diagnosed with bowel cancer.     I saw my doctor many times about the ongoing pains in my stomach, back and bottom and the mucous in my bowel motions but was told I was probably suffering emotional strain or irritable bowel syndrome.     I was given blood tests but they never revealed anything significant.  It felt like doctors gave me the run-around for nearly a year until I finally found one who took me seriously. ...

Kylie's story (36, QLD)

1

I had been seeing bright red blood in my stools for between four and six weeks before I saw a doctor.   Because a similar thing had happened after my children (now four and six years old) were born, the experience wasn’t totally unfamiliar to me.  I felt otherwise OK and my energy levels were normal. Nothing felt unusual or different. I had a sigmoidoscopy on my doctor’s orders on 19 April 2010 and they found a growth which they biopsied....

Aly's story (57, VIC)

1

It’s hard not having control and not knowing what is happening. I first went to my GP in Nov 2011 after a government bowel screen test sent back a positive result for blood in the stools. My GP recommended a colonoscopy, which I had in late February 2012. I was shocked to find out I had rectal cancer. There was no indication and no family history of bowel cancer either....

Amanda's story (37,WA)

1

My mum was in her mid to late 40s when she was diagnosed with bowel cancer. She died at the age of 50, when I was 27, 11 years ago this year. Mum had experienced symptoms for some time, starting with bowel upsets, stomach pain and changes in her bowel habits. The doctors suggested it was gastro, then Irritable Bowel Syndrome - you name it, they suggested it. When I look back it felt as though they were fobbing her off. They never suggested looking into what was causing the problems....

Paula's story (54, WA)

1

I was diagnosed in 2008 when I was 54. I had been complaining to doctors for years about various symptoms but I was never sent for tests – not even a bowel screen – until I started bleeding from the rectum. I’ve been an athlete for more than 26 years, competing in marathons, triathlons, even an IronMan event. When you run a lot, diarrhoea is quite common, so everyone – including doctors – kept telling me that my various symptoms were the result of an intense training schedule. I knew things wer...

Antonia's story (62, QLD)

1

I had not been feeling well for a couple of months, tired, lost weight, feeling sick, and then I had 2 episodes of rectal bleeding, the second worse than the first. I went to my GP, after having done some research. I wanted a referral for a colonoscopy. My GP was initially hesitant to refer me on as he thought it was possibly only haemorrhoids, I knew this wasn’t correct. I had blood tests and I was referred to a general surgeon for a colonoscopy. A week after the colonoscopy, the specialist looking after me told...

Brent R's story (32, VIC)

1

I’ve seen the effects of bowel cancer first hand and know I never want to go through it. My Dad was diagnosed with bowel cancer in February 2000. He was just 49 years old. He had had some rectal bleeding and back pain so went to the GP who sent him for a colonoscopy. After this plus scans and blood tests, Dad was diagnosed with bowel cancer which had spread to the liver. He had successful surgery to remove the cancer from the bowel but when the surgeons opened him up to remove the tumour from his liver, they discovere...

Barbara's story (60, NSW)

1

I had a bowel cancer test in November 2006 which came back all clear, therefore when symptoms started occurring in February 2007 I ignored them, at the age of 57, blamed my new job, the change of lunch hours etc. Initially the symptoms were changes in my bowel habits, rectal bleeding with froth and bubbles. Eventually the symptoms started to get serious, with some stomach pain, a heaviness in the back passage and generally feeling uncomfortable. In September 2007 I couldn’t ignore any of this any longer....

Lorna's story (56, NSW)

1

As a registered nurse for over 30 years, I understand the value of good health and pride myself in maintaining a healthy lifestyle. I see my GP every year for routine blood tests and always attend for routine mammogram when requested. However, when the bowel screening test arrived, I put it in a cupboard until I had time....

Helen's story (44, QLD)

1

My experience with bowel cancer began with a niggly pain, not unlike wind pain, that lasted for about 10 days. I had always suffered with endometriosis so I put the pain down to that. Thankfully my husband encouraged me to go and get checked out. When the doctor examined my tummy it was very painful. The doctor diagnosed me as having a burst appendix and before I knew it, I was flown out from our small town to the nearest teaching hospital. I spent three days there on intravenous antibiotics to reduce what they thought...

Carolyn's story (45, VIC)

1

When I was diagnosed with stage III bowel cancer in 2006, I was 45 years old. I am a wife and a mother of three (now 23, 20 & 16 years old) and an office manager.  I had no family history of bowel cancer and I led a healthy lifestyle before my diagnosis, although I was told further along the process that I carry the HNPCC gene, which is a strong indicator of the disease. ...

Howard's story (52, QLD)

1

I was diagnosed with bowel cancer in February 2010 at the age of 51.  I was seeing a specialist at Toowoomba Hospital about my renal condition.  He asked if there were any other health problems; I mentioned the blood in my stool, which I had seen off and on for the last six years.  I didn’t think it that important, as I had had ulcerative colitis over the years.  My GP did not think it was a concern.  Also I had recently done a FOBT test as part of the National Bowel Cancer Screening...

Lisa's story (41, NSW)

1

I had rectal bleeding and abdomen pain for a year and a half before finally going back to my GP to tell her I thought the diagnosis of piles was wrong! At one point, there was so much blood and mucous that I thought I had haemorrhaged. My GP finally referred me to another doctor who gave me a colonoscopy in January 2008, where he discovered a tumour and a number of polyps, which were removed....

Hollie's story (24, WA)

1

Despite experiencing horrible stomach pains and bloating and visiting a few different GPs about my symptoms, I was told I had IBS and female problems. My mother has Crohns so I finally found a GP who would send me for a colonoscopy to test me for this. After being on the waiting list for a while I finally had a colonoscopy in April 2011; however, it had to be abandoned due to the extreme pain I suffered during the procedure. I was scheduled to have another colonoscopy as they had found a polyp during the first procedure. Th...

Jo's story (45, NSW)

1

I was diagnosed with bowel cancer at 44 years old.   I went to see my GP after about twelve months of changed bowel habits and intermittent rectal bleeding, which I assumed was caused by haemorrhoids.  The pain I had been experiencing on and off had become quite bad, so I wanted to talk to my GP about other treatment options.  I was given a colonoscopy as part of this visit – and that’s when they discovered the tumour in my rectum....

Kym's story (33, VIC)

1

I was diagnosed with bowel cancer in May 2010 at the age of 31. My bowel habits had started to change about two years before, including small amounts of blood on the toilet paper, but I had been told earlier that I had a haemorrhoid so I thought that might explain the bleeding. I was also diagnosed with anaemia just before I fell pregnant about a year after; I would later learn that anaemia can be an indicator of bowel cancer. It wasn’t until two months after giving birth that I went to see my GP about the bleeding,...

Sandy's story (38, NSW)

1

Was it not for me having a totally random check-up back in 1999, I would not be alive today.  Still to this day I’m not quite sure what got me to go and have a check up as I was fit and healthy, but what happened next still amazes me. My Gastroenterologist calls me the “luckiest girl in the world” as having that check up saved my life.  Being told at 28 years old that had I not come in for a check-up I would have only had a couple of years to live was a huge wake up call for me.   So to me...

Karen's story (45, NSW)

1

In summary, over the last two years I have had three operations, two colonoscopies, six weeks of chemoadiation, four months of chemotherapy, an ileostomy, a hernia on my bowel surgery scar, gone through instant menopause and had to give up work. However, since going through bowel cancer, all my tests have been clear and my last CT is in September 2013, which will be two years since the operation....

Peter's story (62, QLD)

1

I was first diagnosed with a hernia, which seemed to explain the changes in my bowel habits and the stomach pains I had been experiencing. But in the lead up to the Easter long weekend in 2009, I started feeling pretty unwell. We had family arriving so I didn’t really want to make a fuss – we were meant to be enjoying Good Friday together, after all – but I felt much worse as the day went on and started vomiting....

Brent C's story (64, NSW)

1

Prior to her diagnosis in 2006, my wife’s concerns about her health were dismissed as a trivial condition because her only symptoms were occasional and very slight rectal bleeding. Each time she raised her concerns with her GP, the GP thought the bleeding was related to other things such as beetroot (we ate a lot of vegetables) or haemorrhoids. However after insisting, her GP finally ordered a colonoscopy which showed my wife had late stage bowel cancer, with metastases in the liver and lungs (stage 4)....

Lorraine (50, NSW)

1

We all need to know that cancer does not discriminate. I am a healthy fit woman, with no history of bowel cancer in my family, yet it affected me. I was diagnosed with bowel cancer at the age of 50 after participating in the National Bowel Cancer Screening program. I received the positive results approximately two weeks after sending the test away....

Stacey B's story (36, WA)

1

My husband Peter was diagnosed with bowel cancer in June 2012 at age 36. He was referred for a colonoscopy by our GP as he had been experiencing rectal bleeding and a consistent change to his bowel habits. The colonoscopy results found a tumour which was biopsied and confirmed to be cancerous. Peter was then sent for a CT scan and MRI to confirm locations and check for the possibilities of metastasis....

Cherie's story (24, WA)

1

I was diagnosed with bowel cancer at the age of 24. Over the period of a few months, I noticed that the urge to go to the toilet was becoming more frequent but I assumed that was because I was pregnant. The other key symptom was severe pain in my tailbone area. I would later find out that this was where the tumour was, though at the time it was also attributed to pregnancy....

Andrew's story (22, VIC)

1

In April 2010, I suffered a huge amount of bleeding when I went to the toilet.  I had no warning signs – it just happened out of the blue.  It was so bad that I went straight to the emergency ward at the hospital.  I think they thought it was just haemorrhoids so I was given a DRE (digital rectal examination) and the doctor took some blood and sent me home. ...

Sandra's story (49, SA)

1

In 2008 I had lap band surgery to help reverse obesity. Since having the surgery, I have had routine blood tests every six months. Prior to one check-up appointment, I noticed a speck of blood in the toilet so during my consultation with my GP (and after she had written a referral for my bariatric specialist) I told her about the blood in the toilet. Straightaway she added this piece of information to the referral just to be sure....

Richard (48, NT)

1

I was diagnosed with bowel cancer in 2007. Ironically, I had just given up smoking and was trying to get fit. I was even riding my bike to work for exercise but I was feeling more and more tired. That’s when I knew something was wrong. Three months prior to my diagnosis, I had been experiencing stomach pains and eventually I ended up in the emergency department of hospital.   The doctors there thought I had Crohn’s disease and arranged for me to have a CT scan. That’s when they discovered the tumour....

David G's story (51, NSW)

1

I was diagnosed with bowel cancer (first stage) at the age of 51 as a result of a routine check-up with my GP. Previously I had no symptoms or warning signs of the cancer. During a check-up with my GP I asked about the Government Screening Kit which I had received but ignored. My GP handed me another kit and recommended I do it. I undertook the stool test which came back positive. My GP recommended I have a colonoscopy as soon as possible - it was booked and undertaken two weeks later. Three weeks later I went in for s...

David B's story (65, NSW)

1

I was diagnosed with bowel cancer in 1993 at the age of 47.  I had taken a Rotary Bowelscan test (FOBT) and, when it returned a positive result in May, my GP referred me to a specialist.  I was given a colonoscopy in June and told I had a 10 per cent chance of having cancer… turns out, I was in that unlucky 10 per cent!  In July I had a bowel resection.  Looking back, it all happened so quickly.   I felt I coped really well with the cancer at the time but I experienced more problems about se...

Rachel's story (40, QLD)

1

I had noticed some blood in the toilet for about a month but thought it was due to constipation. I was working fulltime and have four children to look after – being so busy I just carried on and didn't dwell on it. One morning, however, I thought I had diarrhoea but all I could see was a lot of old blood in the toilet bowl. I left my husband with the kids at home and took myself straight off to hospital.Staff at the hospital found evidence of bleeding with no obvious cause. The doctor said he would write a referral...

Kathy's story (47, WA)

1

During a routine pap smear in August 2011, I mentioned to my doctor that I’d had an uncle who died from bowel cancer at only 51. Immediately the doctor suggested I give a stool sample and, when the results came back positive, a colonoscopy was arranged. A small tumour was found during the procedure, which fortunately was only at stage one. My doctors recommended surgery to remove the tumour as my best option so I went ahead with an operation. No stoma was required. I started chemotherapy after surgery to help minimise...

Trevor's story (40, QLD)

1

Life was quite normal, albeit very busy with a young family and a very time consuming career.  Things changed for me one night when I experienced severe stomach pains after eating a chicken sandwich and immediately self-diagnosed myself with "food poisoning."  The next morning I was severely sick and started to vomit. At this stage I thought I was getting better as I had got it all out of my system....

Ben's story (28, VIC)

1

I was 28 when I was diagnosed with bowel cancer in January 2011. I’d had rectal bleeding, changed bowel habits and stomach pain for a while but had put off investigating the symptoms – I was living in China at the time so I figured it was either an intestinal infection that I couldn't seem to shake or a reaction to something I’d eaten. ...

Eve's story (51, VIC)

1

I have been a vegetarian for over 30 years, have never smoked and have drank very little alcohol – so to get bowel cancer has been such a rude awakening. I feel I no longer have the security of my health and I worry that the cancer could come back at any time… I first started feeling something was wrong in January 2008. I suffer from many auto immune problems, including Sjogren’s syndrome which causes irritable bowel type symptoms (this threw my GP off the scent and complicated the situation even more)....

Jane's story (41, QLD)

1

In early November 2010 I noticed some weight loss and a change in my bowel habits, including rectal bleeding. I went to the doctor in mid-November and was diagnosed with anaemia and booked in for a colonoscopy later that month. I was told on the day of the colonoscopy that I had bowel cancer. The next step was surgery, a high anterior resection, which was done in mid-December. It all happened so quickly that I didn’t really have time to dwell on what was going on, but it never occurred to me before my diagnosis tha...

Alison's story (46, QLD)

1

This story is about my mum’s ordeal with bowel cancer. She was diagnosed in 2005 at the age of 73, but her diagnosis had taken some time.  Her rectal bleeding was initially thought to be haemorrhoids, and the GP gave her a cream to treat the condition, but the bleeding persisted and, when she finally had a colonoscopy two months later, they found advanced bowel cancer....

Ann's story (37, ACT)

1

I was diagnosed with bowel cancer at the age of 37, totally unexpected at such a young age. The only real experience I’d had with the disease was watching my grandfather live with a colostomy bag after the removal of his bowel when I was a child. But I no longer consider this an ‘old man’s disease’....

John's story (40, QLD)

1

I started experiencing a change in my bowel habits, stomach pains and rectal bleeding in February 2010 so I saw my GP and was sent for blood tests to investigate the cause of the problems. The results came back normal. However, a month later when the bleeding persisted I was referred for a colonoscopy in mid April. The colonoscopy revealed a 4cm tumour on my sigmoid colon....

Kersti's story (56, NSW)

1

My story with bowel cancer began in February 2009 but if I’m honest, it began much earlier with symptoms of rectal bleeding and constipation which I didn’t follow up on with my GP. After my mum died, I went through a stage of not looking after myself; just lying on the lounge, eating way too much pizza and drinking excessively. I kept putting my symptoms down to haemorrhoids, bad diet and grief. My constipation was so bad I was twice forced to go to hospital. Scans were done but nothing showed up. On my third vis...

Michelle's story (35, VIC)

1

It’s not so long ago I went to the GP and told her about a few concerns I had and the symptoms that I was experiencing, which my GP considered not to be a big deal. The GP thought it was possibly haemorrhoids. I decided that I could allow myself to be more relieved, seeing as I had expressed my concerns but the GP had predominantly dismissed it being anything serious…. after all....

Robert's story (61, NSW)

1

When I was diagnosed with Bowel Cancer I was 61 years old, fit and healthy (at least I thought I was).  I was working in the entertainment industry with a part time job as a spruiker (sales motivator) and also did freelance work in the entertainment industry as a DJ/MC for various events. Approximately 6 years ago, during a prostate check at the local GP, my doctor found a mass on my appendix, protruding into my bowel, fortunately this was benign, however I still required a resection to the right side of my large bowel...

Moya's story (69, NSW)

1

In 2007, the government sent out free bowel cancer test kits to a range of people and I did my test as soon as I received it. The results indicated blood in my samples and I was told to see my GP immediately. I wasn't overly worried at this stage because I had seen blood in my stools on and off for some time and had always put this down to taking iron tablets, which can cause dietary problems like constipation.   After my GP appointment, things started to move very quickly, with a colonoscopy, blood tests, i...

Ian's story (65, QLD)

1

“It’s an unusual birthday present, but it is probably the best gift I have received.” Ian, a retired merchant seaman, never thought the simple act of emptying his post box would ultimately save his life. At 65, Ian, like many Australians, was unaware the risk of developing bowel cancer increased with age. He was physically fit and believed he was in good health. As an active fisherman determined to make the most of his retirement, bowel cancer was the last thing on Ian’s mind....

Sinead's story (31, NSW)

1

I was only 26 when I went to my doctor concerned about changes in my bowel habits and feeling very tired. My doctor put it down to stress which frustrated me because I felt I wasn’t being listened to. I went to the ED and remember crying saying, “I know there is something wrong with me”. Coming from a medical background (registered nurse) I demanded to speak with a gastro specialist. The doctor who came along spoke and listened to me as human being, he was empathetic and asked the right questions. He s...

Hazel's story (58, SA)

1

If you have any irregularities in your bowel movements, don’t ignore it. See your GP straight away and don’t be embarrassed! The whole experience of being diagnosed with bowel cancer has been emotionally devastating for me. In February 2010, I noticed blood in my faeces and made an appointment to see my GP. I’d had bleeding from haemorrhoids before but this was different. I had also been experiencing an urgency to open my bowels for a few years which I had put down to my history of haemorrhoids....

Renay's story (41, VIC)

1

I used to think cancer was the worst thing that had ever happened to me until it became the best thing. This might sound crazy but it is true. I am a wife and mother to a now 6 year old son. I was diagnosed with bowel cancer in May 2011 at the age of 41. I had been suffering from exhaustion, stomach pain and unusual bowel habits for three or four months and finally saw my GP when the pain started getting much worse....

Warren's story (31, ACT)

1

I am 31 years old and happily married with two children (3 years and 18 months old) and another little boy on the way, due any time now. I'm an Australian  Federal Police Officer currently attached to the Specialist Response and Security Tactical Response Team. Bowel cancer was the last thing on my mind when I started to experience small amounts of rectal bleeding. ...

Richard's story (63, NSW)

1

I successfully beat prostate cancer in 2007 so being diagnosed with bowel cancer so soon after came as a real shock. I did the Rotary bowel cancer test (FOBT) in March 2009 and the results were negative. But later that year, my bowel habits began to change – mainly increased urgency and frequency – and when I twice noticed blood in my stools I decided to take the FOBT again. This time the results were positive.   I was overseas when the results came through in April 2010 so I talked to my GP in Australia...

Alan's story (48, WA)

1

I got my Rotary bowel test kit from a chemist in 2009. The staff was giving them away so I thought I might as well do one. Two weeks later, the results of the test were sent to my GP and they were positive. I was on holiday in New Zealand when I received an email from the surgery asking me to contact my doctor as soon as possible. When I got back, I went straight to my doctor and was told I had bowel cancer....

Peter F's story (41, NSW)

1

Buying a $40 FOBT kit is so much cheaper when compared to your life. I was diagnosed with bowel cancer at the age of 40 after finally getting around to using an FOBT kit. I had purchased the kit in June 2012 and it sat in my cupboard until I finally used it in early September. The results came back positive....

Geoffrey's story (70, NSW)

1

Six years ago at 64, I began to notice blood in my stool and reported it straight away to my GP, who referred me to a colorectal surgeon.  A colonoscopy revealed cancer and an operation was recommended as my best option. I’d estimate that from the moment I noticed the blood to finally being operated on took no more than six weeks, which isn’t very long to come to terms with the fact of bowel cancer.  I was given an ileostomy during surgery, which also took some getting used to....

Dale's story (49, TAS)

1

Us men rarely go to doctors, let alone get our proper checks. But I recommend to all other men to please listen to your doctor and do exactly what they tell you. Put your faith and trust in them and you will be managed appropriately. I was diagnosed with Bowel Cancer in 2011. Passing blood made me go to my GP to have a check-up. My GP suggested doing a Digital Rectal Examination and having a colonoscopy....

Katie's story (35, WA)

1

My brother Jeff was just 31 when he was diagnosed with bowel cancer. He passed away nearly two years later in June 2013. He left behind his beautiful wife Nicole and two gorgeous daughters, aged six and four. Jeff did not have any symptoms that rang any alarm bells until he started to feel like he had no energy. He looked pale and we urged him to visit his doctor for some blood tests which showed him to be anaemic. He then had a colonoscopy and gastroscopy, which showed up a large doughnut- shaped tumour in his colon....

Carolina's story (33, NSW)

1

I was six months pregnant with my first baby when I started experiencing blood in my stool. I talked to my obstetrician, who said that a little bleeding can often happen during pregnancy but that the amount I was experiencing sounded a little suspicious. She referred me to a gastroenterologist and I decided to wait until after my baby was born to book the appointment....

Are you at risk?

           
Both men and women are at risk of developing bowel cancer.  The risk is greater if you -

  • are aged 50 years and over; or
     
  • have a personal or family history of bowel cancer or polyps; or
     
  • have had an inflammatory bowel disease such as Crohn’s disease or ulcerative colitis.

There is emerging evidence regarding type 2 diabetes as a potential risk factor for bowel cancer, however further research is required.

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Bowel Cancer Australia publishes a quarterly email Newsletter - highlighting all the latest developments in bowel cancer advocacy, awareness, education, support and research, as well as important services available to bowel cancer patients, loved ones and the community.

To receive all the latest bowel cancer news, sign up to receive our eNewsletter now!

 

 

Healthy eating can be a challenge, particularly for bowel cancer patients.  Making things easier and providing practical support is really important to us here at BCA, so check out the helpful high and low fibre recipes, put together by Nutrition Adviser, Teresa.

We also have a range of nutritional resources developed specifically for bowel cancer patients.