Answers to 4 questions about colorectal cancer treatment and survivorship
By Jessica Saenz
Colorectal cancer treatment is unique to each person's cancer, but it's common for you to question what life will be like during and after treatment.
David Etzioni, M.D., a colorectal surgeon and chair of the Department of Surgery at Mayo Clinic in Arizona, says he hears similar concerns from people who need colorectal cancer treatment. Here's how he addresses them:
"How do I know I'm getting the right treatment for colorectal cancer?"
Colorectal cancer treatment can be complex, especially when surgery and a combination of treatments are necessary, so having a health care team that specializes in each part of your care is essential. "Colorectal cancer treatment is a team sport. When a patient is looking for a place to be treated, they shouldn't just look at the name of one particular physician; they should look for the name of a trusted team," says Dr. Etzioni.
Your cancer care team should be able to review your colorectal cancer treatment options with you and address your concerns. "Make sure they are offering you a menu of options for treatment. There are situations where there's one treatment that is fairly standard, but you want to make sure they are putting the appropriate care options in front of you and going through what each one can offer you," he says.
As you discuss treatment options, your care team should explain what you can expect from the treatment. This should include side effects and complications, but you should also discuss your goals for treatment and what's most important to you in terms of quality of life. "Make sure you feel like they are the professionals you want to have at the other end of the video or phone call when you have a problem," says Dr. Etzioni.
"How will colorectal cancer treatment affect my quality of life?"
Colorectal cancer treatment might affect your quality of life in both short-term and long-term ways. Dr. Etzioni says each person's experience might be different depending on their overall health and the treatment they receive.
"While each treatment has a different spectrum of side effects, surgical side effects are probably the most predictable: pain, fatigue, inability to drive or take charge of all of your daily activities," says Dr. Etzioni, adding that these are usually temporary and improve after surgery recovery.
If you need chemotherapy, which is a common treatment for colorectal cancer, you may experience side effects, such as nausea, fatigue or numbness and tingling in the fingers and toes. If you need radiation treatment, which is often necessary to treat rectal cancer, you may experience inflammation, increased bowel movements, increased bowel urgency (urgent need to have a bowel movement) or bleeding from the GI tract.
Dr. Etzioni says these side effects improve after treatment, and your health care professional can help ease your discomfort. "There are a lot of things that surgeons and care teams can do to help improve these side effects of treatment. It's almost universal — after treatment for colorectal cancer, we can get a patient to a gastrointestinal quality of life that they are happy with," he says.
"Will there be permanent changes in how my body functions after colorectal cancer treatment?"
While some side effects of colorectal cancer treatment are temporary, advanced surgery may lead to permanent changes. "There are a lot of different things that can happen to you as a result of your surgery," says Dr. Etzioni. "Rectal cancer treatment, especially, is more complex and impactful for patients than colon cancer treatment. And operations of the pelvis can result in problems with urination or sexual function."
When all or a large part of the colon and rectum must be removed to eliminate cancer, you may need an ostomy. For this procedure, your surgeon creates an opening in the abdomen and attaches the remaining colon or small intestine to the abdominal wall so waste can leave the body. Waste is then collected in a bag attached to the opening.
An ostomy can initially sound alarming, but Dr. Etzioni says familiarization and education can help ease worries about the procedure. "Our patients really suffer with tolerating the concept of ending up with a bag — either temporary or permanent," says Dr. Etzioni. "That's one of the places where I think education, especially education from people who have already gone through it, is essential."
Dr. Etzioni says he finds support groups and talking to someone who has had an ostomy can help you feel more comfortable with the idea. He encourages people preparing for an ostomy to ask their care team about support resources. "Having someone who's been through an ostomy — who you can talk to on the phone or even meet in person — can help patients get over that hump and accept that possibility for their cancer treatment," he says.
It's essential to find a health care professional you are comfortable with and openly discuss the side effects impacting your life so they can help you.
"Will my colorectal cancer come back after treatment?"
"Recurrence is one of the biggest fears our patients with colorectal cancer face. I have patients who come to see me for a follow-up exam who are nervous, almost to the point of tears. And it's something we are very sensitive to," says Dr. Etzioni.
Steps can be taken to reduce your risk of recurrence, and your cancer care team can help create a follow-up plan specific to your needs. "Once treatment is done, we generally start five-year surveillance to monitor for recurrence. It's tailored to each patient, cancer type, location, and aggressiveness, based on what we learned about the cancer before and during surgery," says Dr. Etzioni. Surveillance may include physical exams, lab tests, colonoscopies, CT scans or MRIs, depending on the type of cancer, he adds.
Be sure to talk to your health care professional about the best follow-up plan for you. And if you find anxiety about colorectal cancer recurrence interfering with your daily life, seek support from friends, family or a medical professional.
It's normal to have concerns about colorectal cancer treatment and recurrence, but the right support system and care team will help ease your adjustment to any side effects or changes that may result. "Patients who undergo treatment with strong, consistent, omnipresent support simply do better. Not just emotionally, but in their ability to tolerate treatment and surgical outcomes," says Dr. Etzioni.
And to caregivers, family and friends of people with colorectal cancer, Dr. Etzioni gives this piece of advice: "Patients need to know that no matter what happens to them, no matter what their body looks like, whether or not they have a colostomy bag, they're going to be OK."
Watch Dr. Etzioni discuss what patients can expect after colorectal cancer treatment and how they can achieve the best quality of life on this "Mayo Clinic Q&A" podcast video:
Join the Colorectal Cancer Support Group on Mayo Clinic Connect.