Managing Colorectal Cancer
Dealing with a cancer diagnosis can be enormously challenging. In addition, dealing with the long-term effects of treatment, even if it has successfully beaten back the disease, may require some adjustments.
This section includes information on:
Bowel management
Surgery and radiation can alter the function of the bowel and produce an increase in the number of daily bowel movements. In addition, increased urgency to defecate can occur. To reduce these symptoms, physicians recommend:
- increasing your fiber intake by adding psyllium (an ingredient in many over-the-counter fiber supplements) to your diet; and
- eating smaller meals and avoiding the consumption of liquids, especially hot ones, with meals (liquids and large meals prompt bowel movements)
Eventually you may also be able to regulate the timing of your bowel movements by using stimuli such as large meals, hot liquids, prune juice, or suppositories to prompt a bowel movement when it is most convenient. Use of anti-motility agents such as loperamide (Imodium) or diphenoxylate (Lomotil) can sometimes help.
Colostomy
Colostomies are performed much less commonly than in the past, largely because of improved surgical techniques. But some patients, particularly those whose tumor is very low in the rectum, may require a permanent colostomy. This operation typically is performed when the rectal cancer invades too close to the anal sphincter muscles, requiring removal of the anus. To allow wastes to leave the body, the surgeon creates an opening in the abdomen, called a stoma. The wastes are collected in a special bag that adheres to the skin and covers the stoma. Because there is no sphincter muscle, the timing of bowel movements isn't controllable the way it was before surgery. Patients can achieve some measure of control over the timing of a bowel movement, however, by regularly irrigating, or flushing fluid into, the stoma once every day or two.
After a brief period, most patients can adjust well to a colostomy. Nurses and experts known as enterostomal therapists can help with the transition by teaching patients how to care for their colostomy as well as guiding them in their return to normal activities.
Lifestyle considerations
Research suggests that colon cancer survivors who participate in regular exercise can halve their chance of a tumor recurring or death. Walking at 2 or 3 miles per hour six times a week does the trick, as do jogging or playing tennis three to four times per week.
Eating a healthy diet is also a good idea, including fruits and vegetables containing fiber.
Our section on colon cancer prevention offers more information on lifestyle choices and colon cancer.
For more information on exercise and losing weight, see our section on weight control.
Surveillance
Postoperative surveillance of colorectal cancer is critical due to the risk of a recurrence of the disease. Most recurrences become evident within the first three years after surgery. Initially, patients should be seen at three-to-six-month intervals for three years. Subsequently, they should be seen every six to 12 months for five years.
A repeat colonoscopy should be performed after one year and every one to three years after that to detect possible new polyps or cancer. Doctors may also perform a blood test that may signal that the cancer has returned. This tumor marker test is called serum CEA (carcinoembryonic antigen) and is performed every three to six months for five years after surgery.
Sexual function
Having cancer can affect an individual's feelings about his or her body and the ability to enjoy sexual intimacy. Problems might include lack of desire or worries about what is safe or appropriate while undergoing treatment. Common factors that contribute to problems with sexual function include negative feelings about one's body after surgery, hair loss, and weight gain or loss; pain and fatigue; anxiety about the illness or such related issues as the cost of treatment; and new tensions in the relationship.
Patients should know that challenges to sexual functioning are common and can be addressed and that people living with cancer can continue to enjoy a pleasurable sex life. Doctors or nurses can provide guidance.
Fertility
Young patients with colon and rectal cancer may want to discuss their fertility options with their physician before surgery or treatment. Patients receiving radiation for rectal cancer, which can destroy sperm and eggs in the ovaries, may consider banking sperm, harvesting eggs, or moving the ovaries outside of the radiation field. Since radiation is now often done prior to surgery, patients should consider their options early.
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