There’s nothing ‘good’ about cancer. But the outlook for people with colorectal cancer, or bowel cancer as it’s more commonly known, is far brighter than it might’ve been just a few years ago.
In most cases, there’s no longer even any need for patients to worry about being left with a long-term stoma and colostomy bag after undergoing treatment for Australia’s third-most common type of cancer.
That’s thanks to the array of effective treatment options now available, as well as the wealth of information out there on how to make simple lifestyle changes to help prevent bowel cancer’s recurrence.
In fact, 90 per cent of people with bowel cancer in Australia can be successfully treated if the disease is diagnosed in its early stages, when many find that surgery alone is sufficient, Dr Marcel Knesl, radiation oncologist explains.
“If the cancer has spread through the bowel wall and has gone into the lymph nodes, the patient needs surgery and chemotherapy,” Dr Knesl adds. “If the bowel cancer is in the rectum, they often need radiation therapy, combined with chemotherapy and then surgery.”
Unlike some other cancers, bowel cancer isn’t treated with a one-size-fits-all approach and requires a multi-disciplinary team of doctors and specialists to design a treatment plan that’s specific to the patient – who ultimately decides which treatment path they’ll take.
“Quite often, if it’s a very early stage colon cancer or bowel cancer, they’ll have surgery and then we’ll see what the histology report shows,” Dr Knesl explains. “And according to the histology report, you’ll then tailor your treatment accordingly. Some patients may need to have chemotherapy, others may not.” (A histology report, which looks at a patient’s tissues and allows medics to see how a cancer has responded to treatment.) Surgery usually involves a hospital stay of five to 10 days, then a four-to-six-week recovery period.
But rather than being stuck in a hospital for even longer, people who do go on to receive radiation therapy or chemotherapy can be treated at an external oncology centre that allows them to schedule sessions at their own convenience, such as Icon Cancer Centres that provide a supportive and personal environment for patients and their families.
Chemotherapy can require multiple whole-day appointments, while radiation is often administered five days a week for up to six weeks – intensive treatment programs during which the support from a team of doctors, nurses and radiation therapists is vital for a patient’s wellbeing. Once treatment is complete, the patient’s oncologists, alongside dietitians play a key role in equipping patients for the changes they may have to make to their lifestyle.
“Going through chemotherapy or radiotherapy and the side effects of those two treatments can affect your bowel,” Dr Knesl explains. “You need to sometimes have a bit of diet modification.
“Moving forward post-treatment and to improve your recovery, you want to have a highly plant-based diet. When it comes to protein, you need it but want to limit it to about 150 grams per meal. That could be chicken, fish or a little bit of red meat and as much vegetables as possible, but not too much fruit because of the high sugar fructose content.”
Lifestyle changes can also help reduce the risk of bowel cancer returning. That’s because a meat-heavy diet, high alcohol consumption, a history of smoking or of being overweight are known to increase a person’s risk of developing bowel cancer (as does a family history of the disease and the existence of an inflammatory bowel condition such as ulcerative colitis and Crohn’s disease).
Dr Knesl says that maintaining a healthy body mass index is also key to warding off bowel cancer and its return, something he says over-60s can achieve by walking for 30 minutes each day.
In addition to aiding weight loss, a regular walk can bolster the immune system, which assists with recovery, and release endorphins that help patients fight off depression during their treatment and recovery.
“Exercise is really paramount and we find patients that exercise tend to get through their treatment a lot better. As their doctor, I want to ensure they are equipped with the right knowledge to continue to live a healthy lifestyle. I will often talk through exercise and diet concerns and provide them with the necessary access to any allied health services,” he says.
Bowel cancer survivors often find it takes some time before they’re able to return to some of their favourite pre-treatment foods, if at all. Dr Knesl notes many people are prone to diarrhoea after bowel cancer surgery and treatment, meaning they need to cut back on or give up spicy foods such as curries and opt for a less highly-spiced diet. Bowel Cancer Australia has a range of healthy recipes online that are specially created for people recovering from bowel cancer.
But while many people diagnosed with bowel cancer fear the disease will leave them requiring a stoma and external colostomy bag, they aren’t commonly used post-treatment over the long term any more. In many cases, a stoma is required for just a few months.
“Fortunately, it’s getting less and less common and it’s rare now to have a permanent stoma,” Dr Knesl says. “The reason we do a temporary stoma is the colon or bowel cancer gets [cut out] and then we’ve got to reconnect the bowel. For a couple of months, we’ve got to rest the bowel while the surgery where you reconnect back to the bowel heals.”
Modern colostomy appliances, meanwhile, now have charcoal-filled air filters in them that neutralise any smell, which means that although the person wearing it may be conscious of an odour from their bag, it won’t be noticeable to anyone around them.
While Dr Knesl acknowledges that a cancer diagnosis can be scary and the treatment sometimes tough, he emphasises how much help is now available to bowel cancer patients.
“There’s an enormous amount of support out there from various groups, from nurses, from councillors and other patients,” Dr Knesl says. “They can always turn to someone to have a chat about how they’re coping and any other complications. Our centres ensure patients can connect with these groups and feel supported even after they finish treatment.”