Colorectal (Bowel) Cancer

Colorectal cancer develops in the lining of the large bowel (colon) or the rectum, usually from a pre-cancerous growth called a polyp. It is highly treatable when found early, which is why the national bowel cancer screening program and colonoscopy for symptoms are so important.

Symptoms can include bleeding from the bowel, a persistent change in bowel habit, abdominal pain or bloating, unexplained weight loss, or tiredness from iron-deficiency anaemia. Many early cancers cause no symptoms at all and are found on screening.

The diagnosis is usually made at colonoscopy, where the tumour is seen and a biopsy taken. Scans, most commonly a CT scan of the chest, abdomen and pelvis and, for rectal cancer, an MRI of the pelvis, are then arranged to establish the stage of the cancer and to plan treatment.

Every patient is discussed at a multidisciplinary team (MDT) meeting with surgeons, medical and radiation oncologists, radiologists and pathologists. Sydney Surgical Oncology works closely with medical oncology colleagues so that your surgery and any chemotherapy or radiotherapy are planned together.

Surgery removes the section of bowel containing the cancer together with its lymph nodes, and the healthy ends of the bowel are then joined back together. Most operations are performed using robotic or laparoscopic (keyhole) techniques, which mean smaller wounds, less pain and a quicker recovery. Some patients need a temporary or, less commonly, permanent stoma; if this is likely, it will be discussed with you in detail beforehand.

For rectal cancer, chemotherapy and radiotherapy are often given before surgery to shrink the tumour. Smaller rectal tumours may be suitable for transanal minimally invasive surgery, in which the tumour is removed through the anus without an abdominal operation.

Most patients are in hospital for a few days and follow an enhanced recovery program with early eating, walking and pain control. The pathology results are reviewed with you at your follow-up appointment and at the MDT meeting, where a decision is made about whether chemotherapy after surgery is recommended.

After treatment you will be followed up regularly with clinical review, blood tests, scans and colonoscopy so that any recurrence or new polyps are found early.