Radiotherapy uses high-energy beams of radiation to destroy cancer cells. It’s one of the main treatment options for rectal cancer. You may have radiotherapy on its own or with other therapies. If you have colon cancer, you’re unlikely to have radiotherapy.

The main ways radiotherapy is used to treat bowel cancer are:

• Before or after surgery (neoadjuvant or adjuvant radiotherapy)
• At the same time as chemotherapy (chemoradiotherapy)
• To help control your symptoms (palliative radiotherapy)

Most people have external beam radiotherapy where radiation is given from outside the body in short, daily sessions over several weeks. Internal radiotherapy is less common and is only available at specialist clinics.

At GenesisCare, we’re the leading private provider of radiotherapy in the UK and offer a range of proven radiotherapy options, such as:

• Stereotactic ablative radiotherapy (SABR) – effectively delivers high-intensity radiotherapy with minimal damage to healthy tissue and in fewer sessions. Often used for situations of limited cancer spread
• Volumetric modulated arc therapy (VMAT) – a continuous beam of radiation that automatically changes shape and dose as it moves around you
• Surface-guided radiotherapy (SGRT) – uses 3D camera technology to accurately locate and treat the cancer

For patients diagnosed with rectal cancer, MRI-guided SABR delivered on the MRIdian MR linac, is an advanced technique combining live, high-resolution MRI imaging with powerful radiation to deliver treatment accurately and precisely to the tumour. If the machine detects even the slightest tumour movement, the beam will automatically turn off to protect the surrounding healthy bowel tissue. That way, side effects are minimised, and treatment can be completed in fewer sessions so you can continue with your everyday life.  In addition, we can give a higher dose which provides better tumour control, especially in patients who want to avoid surgery

This innovative technique is delivered on the MRIdian MR Linac; which is exclusively available to rectal cancer patients across the UK, at our centres in Oxford and London.

Everybody reacts to radiotherapy differently. How you may react depends on the dose and technique used, whether you’re having other treatment, and your overall wellbeing.

General side effects include:

• Feeling tired and weak
• Changes to bowel habits e.g. constipation, diarrhoea, cramps, going more often
• Bladder problems e.g. pain when urinating, going more often
• Skin changes at the treatment site e.g. redness, darkening, soreness, itchiness, hair loss

These side effects are often temporary and begin to improve once treatment is finished. Your care team can advise you on how to effectively manage them.

Sometimes, side effects take a while to appear. They’re called late side effects and may happen months or sometimes years after treatment is completed. Some examples are:

• Fertility issues in men and women
• Pelvic bone pain
• Soreness and inflammation of the vagina
• Problems having and maintaining an erection

Your doctor will explain all side effects, risks, and benefits of your treatment in advance. They’ll support you throughout the process with any concerns and issues you may have as well as how to minimise their effect.

At GenesisCare, we take great care in minimising side effects during radiotherapy by using the most innovative technologies. But, if you notice anything that isn’t normal for you, your care team will work with you to help control and manage those side effects. They can give you medication and specialist advice about diet and physical activity, as well as emotional support with wellbeing therapies.

Surgery is one of the main treatments for bowel cancer. Your doctor will consider where the cancer is and how much it has spread when deciding which procedure will be best for you. They’ll aim to remove all the cancer while leaving as much healthy tissue as possible.

The main procedures for bowel cancer are:

• Polypectomy – removing the small growth in the bowel lining (polyp) containing the cancer during a colonoscopy
• Local resection – removing a small part of the bowel lining or rectum where the cancer is. Usually for small stage one colon and rectal cancer (also called trans anal endoscopic microsurgery in rectal cancer).
• Colectomy – removing some (hemi or partial colectomy) or all of the colon (total colectomy). Usually for locally advanced stage two or three colon cancer.
• Total mesorectal excision – removing parts of the rectum affected by the cancer, and some of the surrounding healthy tissue and fatty tissue. Usually for locally advanced stage two or three rectal cancer.

After your procedure, you may have a stoma. A stoma is where the end of your bowel is connected to a bag (stoma bag) through an opening in your stomach. Waste will empty into this stoma bag to let your bowels heal. It can be temporary or permanent.

Sometimes, surgery is a suggested bowel cancer treatment for stage four cancer. The procedure will depend on where the cancer has spread to.

If you choose us for your bowel cancer care, you’ll receive effective treatment and aftercare by our expert colorectal surgeons. Your treatment will be conveniently arranged at one of our nationally recognised partner hospitals with the highest standard equipment and technologies.

Our specialist dieticians will work with you, your consultant, and your surgeon to help prepare you for surgery, and take care of you during your recovery and rehabilitation.

Any other treatment and care ou need will continue at one of our GenesisCare treatment centres.

Side effects often depend on which procedure you had and your general wellbeing.

If you had a bigger operation, it’s normal to feel disorientated and tired, and be in pain when you wake up. Your care team will support you as much as they can with medication, food and drink, and moving around.

If there are leaks where the ends of your colon were joined together, you’ll need immediate treatment. This might mean no food or drink, antibiotics, a drain, and sometimes further surgery.

Other complications after your surgery may include slow bowel function, infections, bleeding, sexual problems, bladder problems and blood clots. These can be treated with having fluids through a drip, taking antibiotics, and simple exercise once you’re able to move.

Chemotherapy uses one or more anti-cancer (cytotoxic) drugs to destroy cancer cells. Bowel cancer treatment for stage one cancer does not normally involve chemotherapy. It’s usually given in combination with other therapies to treat stage two, three, and four bowel cancer.

The main ways chemotherapy is used to treat bowel cancer are:

• To stop the cancer returning after surgery (called adjuvant chemotherapy)
• To shrink the cancer before surgery (called neoadjuvant chemotherapy)
• To slow cancer growth and progression when the cancer has spread elsewhere in the body (called palliative chemotherapy)
• With radiotherapy before or after surgery for rectal cancer (called chemoradiation)

Chemotherapy is often given in cycles at the hospital where you have a week of treatment followed by a week or two of rest.

We invest in the latest chemotherapy drugs so that our patients have access to the most recent, proven treatments available. At GenesisCare, you’ll have your chemotherapy with smart infusion pumps in your own private room at one of our Macmillan accredited treatment centres. Our compassionate team of oncology nurses will be there for you 24/7 whenever and wherever you need them.

As with all treatments, chemotherapy may cause some unwanted side effects. Fortunately, they can be well-managed with medication and support from your care team, and they usually go away once treatment is completed.

Potential side effects depend on the type of chemotherapy drugs you’re taking. But in general, chemotherapy side effects include:

• Appetite and weight loss
• Nausea and vomiting
• Low energy and fatigue
• Bleeding and bruising easily
• Higher chance of infection
• Diarrhoea or constipation
• Sensations in your hands and feet e.g. numbness, tingling, soreness
• Hair loss

Certain chemotherapy drugs may also affect your memory or concentration (chemo brain), your heart, your sex life, and fertility. Your doctor will explain the risks and benefits of any medication you may need to take.

If you choose to have chemotherapy with us, we have a range of services specifically designed to help with the side effects of chemotherapy such as:

• Hilotherm ChemoCare – a cooling therapy designed to minimise nerve damage in the hands and feet from chemotherapy
• Paxman scalp cooling – a cool cap system designed to help with hair loss during chemotherapy
• Wellbeing sessions – a unique partnership with the charity Penny Brohn UK offering services such as counselling and acupuncture with your own Wellbeing Consultant

These complementary therapies are proven to help patients manage their treatment-related side effects and sometimes prevent them altogether. Your GenesisCare consultant can help arrange them for you if and when you need them.

Immunotherapy helps your immune system recognise and fight cancer cells. Currently, it’s not widely used to treat bowel cancer. However, it may be offered through a clinical trial to people who have advanced or metastatic bowel cancer.

Immunotherapy drugs work in different ways. In bowel cancer, the most common are:

• Checkpoint inhibitors – which stop cancer cells from turning off the immune system, so that immune cells can fight the cancer[AG1]  e.g. pembrolizumab, ipilimumab, nivolumab

At GenesisCare, we strive to move cancer medicine forward and find new bowel cancer treatments. You can ask your consultant about whether there are any clinical trials you can join for new immunotherapy drugs for bowel cancer.

Side effects are different between people and depend on the immunotherapy drug you’re taking. Most side effects are a result of the immune system being too active and attacking normal cells.

General side effects of immunotherapy include:

• Fatigue and low energy
• Skin changes e.g. a rash, dry and itchy skin, sun sensitivity
• Bowel problems e.g. diarrhoea, cramps
• Stiff, sore, weak, or swollen joints and muscles
• Low thyroid or adrenal levels

Your doctor will explain all potential side effects of the medication you’re taking as well as medication and advice to control their impact.

Targeted therapies are drugs that disrupt processes cancer cells rely on to grow and survive. They’re often used as an advanced bowel cancer treatment without surgery or with chemotherapy. The goal is to slow cancer growth and shrink the tumour.

The main targeted therapy drugs used are:

• Cancer growth inhibitors – block cancer cells from receiving growth signals e.g. cetuximab, panitumumab, fruquintinib
• Angiogenesis inhibitors – block signals cancer cells need to make blood vessels e.g. bevacizumab, aflibercept,

Not all bowel cancers respond to targeted therapy. Your doctor will run tests to decide whether targeted therapy is suitable for you, such as genomic testing on the cancer cells.

If you and your consultant decide targeted therapy is suitable for you, you’ll have access to the latest angiogenesis inhibitors and cancer growth blockers at GenesisCare. We regularly conduct clinical trials to find new and improved targeted therapies, which you may have the opportunity to be a part of.

The most common side effect is an allergic reaction, which can cause flu-like symptoms, a sudden drop in blood pressure, and nausea.

Your doctor will take steps to minimise the risk of an allergic reaction by closely monitoring you during your first session and waiting sometime between your first and second dose.

Other side effects will depend on the drug you’re taking, which your doctor will explain to you before you start your treatment. They may include a rash, diarrhoea, changes to your hair, and high blood pressure.