"Embark on a journey of healing where advanced medical care meets compassionate expertise—India, your destination for hope and recovery in intestinal cancer treatment."
What is intestinal cancer?
Cancer is the uncontrolled growth of cells within the body. Usually, all of our cells have a specific lifespan of days to years that is genetically programmed in our DNA. When our DNA becomes damaged, either through the aging process, exposure to toxins such as radiation or chemicals or through inherited genes, some cells do not die a natural death but continue to grow. As they do, they form new cells with the same genetic misinformation. These extra cells may form masses or tumours that can be either malignant or benign. A benign tumour is a tumour that does not invade the surrounding tissue or spread around the body and stays in one place. A malignant tumour can invade the surrounding tissue or spread via the blood or lymph networks and affects other cells and organs.
Between 0.3% and 4.5% of the global population develops some form of intestinal cancer during their lifetime; of these, colon cancer is the most common. Most intestinal cancers are first diagnosed after the appearance of blood in the stool, unexplained weight loss, nausea and abdominal pain. Very early diagnosis is possible where intestinal cancer has run in families and the decision has been made to undergo regular screening. Other cases of early detection are found in populations suffering from chronic intestinal disorders such as Crohn’s disease. These groups usually visit their gastroenterologist at regular intervals and are well aware of the earliest signs of intestinal cancer.
Screening programs for intestinal cancer are mainly offered to men and women over 50 years of age, although it is often up to the patient to take the initiative and request this important opportunity. While both men and women are equally at risk of developing intestinal cancer, men are more likely to develop rectal cancer and women more likely to suffer from carcinoid tumours.
Treatments for intestinal cancer are primarily aimed at tumour removal and preventing further growth, as well as treating its symptoms.
Are there different types of intestinal cancer?
There are various forms of intestinal cancer and your medical notes may be difficult to understand. Most specific types are based upon the location and type of abnormal cells.
The intestines are split into sections, beginning where they connect to the stomach and continuing to the rectum. Gastro-intestinal cancer can also involve the oesophagus (alimentary canal) or stomach. You will find a separate article describing these two types of cancer here.
Small intestine cancer (small bowel cancer) refers to cancer of the duodenum, jejunum or ileum – these are collectively known as the small intestine. These cancer types are rare in comparison with cancers further down the digestive tract but are more likely to affect other, close-lying organs. Colon cancer describes the presence of cancerous cells in the large intestine; sigmoid cancer is found at the end of the colon, and rectal cancer is cancer of the last section of the intestine that runs from the end of the sigmoid to the anus. Cancers located in the colon, sigmoid and rectum are collectively referred to as colorectal or bowel cancer.
The other method of bowel cancer categorisation is according to the tumour cell type. The most common of these are listed below.
Adenocarcinoma
Most small and large intestine cancers are the result of adenocarcinomas that begin in the surface of the digestive tract walls. Tumours usually begin life as benign or noncancerous polyps. If you have been diagnosed with intestinal polyps or adenoma (not adenocarcinoma) your general practitioner will usually ensure you attend annual or biannual screening appointments with a specialist gastroenterologist. Detected polyps are removed before they can develop into malignant tumours. Once cancerous, different types of adenocarcinoma behave in different ways; those formed by mucus cells can spread more quickly; very rare signet ring adenocarcinomas are aggressive and difficult to treat.
Sarcoma
Intestinal sarcoma is the second most common type of intestinal cancer. This type develops in the inner layers of the intestine that lie within the muscular walls of this soft, pliable tube.
A variant form of an intestinal sarcoma is the gastrointestinal stromal tumour or GIST which forms through mutations in very specific cell types. Intestinal sarcomas usually begin later on in life; the majority of GIST patients are older than 50 years of age. This type of cancer does not seem to be hereditary.
If large, sarcoma tumours may first be treated with pharmaceuticals to shrink them. This is ‘targeted therapy’ that specifically targets the blood supply or growth factors of cancer cells. Surgery is nearly always indicated and further pharmaceutical treatment is necessary for up to three years after surgery to prevent recurrence.
Intestinal carcinoid tumours
Carcinoid tumours are notoriously slow-growing and commonly begin in the digestive tract. Older women are more likely to develop this type. Because they grow so slowly, they are often detected at a later stage; any symptoms they produce are vague, such as diarrhoea and nausea. Occasionally, flushing of the face and neck due to the release of hormones by a carcinoid tumour cells occurs. Treatment is nearly always surgical.
This type of cancer is more likely to occur in the small intestine; it is rarely found in the colon or rectum.
Intestinal cancer stages
Your medical notes may have listed a number of codes concerning your intestinal cancer diagnosis. Or perhaps you are waiting for further testing and prefer to be well-informed before receiving your results.
The majority of gastroenterologists adhere to the universal TNM staging system. In short, this system uses a scoring system for tumour, (lymph) nodes and metastasis according to biopsy and imaging results.
T stands for tumour. T plus a letter or number describes the size (in centimetres) and location of a tumour. Where more than one tumour is present, the letter ‘m’ (multiple) is added. T letter and number systems for intestinal tumours are:
TX: It is not possible to evaluate the tumour due to a lack of data
T0: No evidence of a primary tumour
T1: The tumour is local to the intestine and 7 cm or smaller
T1a: The tumour is local to the intestine and 4 cm or smaller
T1b: The tumour is local to the intestine and between 4 cm and 7 cm
T2: The tumour is local to the intestine and larger than 7 cm
T2a: The tumour is local to the intestine and between 7 cm and 10 cm in size
T2b: The tumour is local to the intestine and greater than 10 cm in size
T3: The tumour has grown into the outer lining of the intestinal wall but not through it
T4: The tumour has spread to areas beyond the intestinal wall
T4a: the tumour has grown through the intestinal wall and spread into the peritoneum – a sheet of tissue that covers the abdominal organs
T4b: the tumour has grown through the intestinal wall and into nearby organs
N stands for nodes or lymph nodes and the following codes apply:
NX: Regional (nearby) lymph nodes cannot be evaluated due to lack of data
N0: No spread to regional lymph nodes
N1: Tumour has spread to regional lymph nodes
N1a: cancer cells are present in 1 regional lymph node
N1b: cancer cells are present in 2 or 3 regional lymph nodes
N1c: no cancer cells are found in regional lymph nodes but cancerous cells have been found in other tissues close to the tumour
N2: cancerous cells in multiple regional lymph nodes
N2a: cancer cells are present in 4 – 6 regional lymph nodes
N2b: cancer cells are present in 7 or more regional lymph nodes
Finally, M stands for metastasis. The following codes apply:
M0: There is no spread to distant lymph nodes or other organs
M1: Distant metastasis is present in distant lymph nodes and/or to other organs.
M1a: cancer has spread to 1 distant site but not into or outside of the peritoneum
M1b: cancer has spread to 2 or more distant sites but not into or outside of the peritoneum
M1c: cancer has spread into and possibly outside the peritoneum
Intestinal cancer metastasis (M1a to M1c) is most likely to affect the liver, lungs, bones, and/or brain.
What are the symptoms of intestinal cancer?
If you are reading this page, you may have been diagnosed with gastro-intestinal or bowel cancer due to the presence of one or more symptoms.
The most common symptoms of intestinal cancer are:
Blood in the stool (dark or black faeces)
Loss of appetite and weight loss
Unexplained abdominal pain
Diarrhoea
Nausea or vomiting
Fatigue
Sometimes the amounts of blood found in the faeces are so small that only testing under a microscope can detect them. This is why most national screening programs consist of an initial faecal occult blood test (FOBT). Occult refers to ‘hidden’ blood that is not visible to the naked eye. These screening programs allow early detection of intestinal cancer and have saved countless lives. You should certainly take advantage of this opportunity to test for intestinal cancer or request one from your GP where national screening programs are not available.
Can I prevent gastro-intestinal cancer?
There are a number of ways in which you can lower the risk of developing intestinal cancer. Smoking significantly increases risk and this habit should be stopped. A lack of fibre in the diet and an excess of processed foods and saturated fats are proven risk factors for bowel cancer development. Diets should include daily portions of fresh fruit and vegetables, whole grains, vitamins and minerals. Regular exercise and a good night’s sleep promote digestion, as it is when we are at rest that optimal digestion occurs.
Other risk factors are obesity, a family history of some types of intestinal cancer, the presence of benign polyps, and chronic intestinal disorders including Crohn’s disease, celiac disease, familial adenomatous polyposis (FAP) and cystic fibrosis.
Some rectal cancers are caused by the human papilloma virus (HPV). Transmission of the virus occurs when taking part in unprotected anal sex with an infected partner. Both men and women are at risk of this type of cancer.
Certain types of work with continuous exposure to chemicals such as benzene, solvents, herbicides and asbestos can also increase risk. When inhaled through the nose and mouth and swallowed, these hazardous chemicals can attack the cells of the intestinal lining and cause mutations in their DNA. Safety equipment such as breathing apparatus and protective clothing should always be used.
If you are able to make lifestyle changes, you may be able to significantly lower your risk of developing intestinal cancer. Alternatively, if you have a positive family history or are 45 years of age or older, opting for regular screening can catch intestinal cancer in its early stages where subsequent treatment is often curative.
How is intestinal cancer diagnosed?
If you arrive at your general practitioner’s office complaining of nausea, weight loss and dark stools, he or she should immediately refer you to a gastroenterologist. This specialist will ask for a sample of your stool to test for the presence of blood, palpate your tummy to check for lumps or painful areas and ask questions about your lifestyle and family history. If blood is found in your stool, you will be sent for further testing.
Blood tests rarely indicate intestinal cancer but might show whether other organs have been affected. While it is possible to visualise the stomach, and small and large intestine with X-rays and CT scans, many gastroenterologists prefer to use the techniques known as gastroscopy and colonoscopy. These procedures require you to be sedated. The doctor inserts a thin, flexible tube with light and camera (endoscope) through the mouth (gastroscopy) to view the stomach and small bowel lining in real time. If he or she finds any evidence of unusual growth or discolouration, an immediate biopsy can be carried out. During a colonoscopy, the endoscope is inserted (under sedation) into the anus in order to view the walls of the rectum, sigmoid and large intestine.
Today, it is also possible to request a video capsule endoscopy. You swallow a capsule that contains its own light source and wireless camera. The capsule takes pictures of the stomach and intestinal lining at extremely regular intervals as it travels through the entirety of your digestive system. Thousands of images are stored in a recorder you wear around your waist. The capsule exits the digestive tract via the faeces and the recorder device is returned to the specialist who checks the photographs for any abnormalities. However, this often requires significant time on the specialist’s part, which is why endoscopy procedures are preferred.
In the case of intestinal sarcoma, a test known as a Dotatate PET scan is required. This scan requires some medications to be stopped up to two months beforehand – your GP or our specialist physicians will be able to tell you if this applies to you. For this test, you will be administered a small quantity of radioactive tracer via an intravenous catheter then wait for 45 minutes until this tracer reaches the site of potential cancerous cells. The scan itself takes up to 30 minutes and is carried out in the same way as a PET scan.
Depending on the type of intestinal cancer that is diagnosed, further tests may be planned. These include blood tests together with CT, PET, MRI or bone density scans that can indicate whether cancer cells have spread into other areas of the body.
Very occasionally, a specialist may recommend a laparotomy in order to perform a biopsy. This technique means that he or she then immediately remove an obvious area of cancerous cells in a single session. In early-stage, small intestinal tumours this may be the only surgery necessary.
How is intestinal cancer treated?
The most common and recommended treatment for intestinal cancer is surgery. Carcinoid tumours in older patients with little to no symptoms may be treated with active surveillance. Active surveillance does not treat the cancer but relies on regular diagnostic tests. Should the tumour then begin to show signs of growth or activity, systemic therapies or surgery can be administered.
Treatment type depends on the location of the cancer and its progression. Surgery is always the preferred intervention wherever possible. Occasionally, intestinal stents are placed during an outpatient procedure under sedation and using a coloscope or gastroscope when inoperable tumours obstruct part of the small or large intestine.
Nonsurgical treatments for intestinal cancer
Nonsurgical treatments are offered to those unable to undergo surgery due to low overall levels of health or those who need to keep metastatic or potentially recurring intestinal cancer under control. These treatments include radiofrequency ablation of the tumour that destroys cancer cells using electrical current, and microwave ablation which uses needles that emit microwaves to produce localised heat. Target cells are accessed by way of needles and these procedures are carried out under sedation and with a local anaesthetic together with medical imaging machines. Another option is cryotherapy where, instead of electricity, low temperatures are applied directly to a tumour to freeze and kill the cancerous cells. This type of procedure is carried out under a general anaesthetic.
Pharmaceutical and radiological treatments for intestinal cancer are used to increase the curative goals of surgery by killing off any remaining cells that may have been missed. These therapies can also be implemented to slow down tumour growth in those with inoperable or metastasized tumours. Targeted therapies stop the formation of blood vessels that feed the tumour or slow down tumour growth by inhibiting growth-inducing proteins. For intestinal cancers, tyrosine kinase inhibitors (TKIs) target specific proteins called kinases. This type of targeted therapy blocks the growth and spread of tumour cells without significantly damaging healthy cells. TKIs are often used to treat GIST. Immunotherapy (or biologic therapy) increases the body’s natural immunity and help it to fight abnormal cells. Immunotherapy may be used in late-stage metastatic intestinal cancer. Chemotherapy is most often used as an adjuvant (supplementary) treatment for intestinal cancer, helping to destroy any cells that may have spread or been missed after surgery. Radiation therapy has the same goals and is also used as an adjuvant to surgery or in cases where surgery is no longer an option. Finally, some women may be offered hormone therapy in the form of oestrogen although research into this treatment form is still in its infancy.
Why do I need intestinal cancer treatment?
Treatment is always necessary for any type of intestinal cancer to try to prevent cancerous cells from travelling to other organs via the many surrounding blood vessels of this part of the anatomy. Furthermore, when treated early to mid-stage, intestinal cancer can be cured. Even in more advanced stages, new therapies and procedures are continuously increasing longer-term survival.
How do I prepare for gastrointestinal cancer surgery? What can I expect?
Pre-travel intestinal cancer preparation
Approximately 3 to 8 weeks before an intestinal cancer procedure you will be asked to supply the results of your blood and stool tests and copies of any diagnostic and imaging results (colonoscopy, gastroscopy, CT, MRI and/or PET). This means we can see how your intestinal cancer is progressing and help us to advise the best treatment options. We will also need any information regarding medication use, other illnesses or disorders and your overall state of health.
You will need to undergo an MRI, PET or CT scan and possibly a bone scan – if these have not yet taken place - which will help us to see if cancer has spread to other organs. If intestinal cancer has spread or metastasised you may need to consider both surgical and nonsurgical treatments.
Approximately 2 weeks before your intestinal cancer treatment you will need to ask your home doctor to take blood for a preoperative blood test. Remedazo will inform you well beforehand which tests your doctor will need to take blood for. For surgical procedures, some blood-thinning medications will need to be temporarily stopped, others do not. Our or your own doctor will advise you what to do.
Intestinal cancer treatment in the hospital
Please scroll down to the appropriate section. The given information covers all available treatments for intestinal cancer at Remedazo. If you would like information on any treatment not covered here, please do not hesitate to contact us.
Intestinal stent placement
The placement of an intestinal stent is usually an outpatient procedure, carried out under sedation. The surgeon will use a gastroscope or coloscope to place the stent. You will be back in your accommodation by the evening and can fly home after 24 hours.
Cancer of the small bowel
Pancreaticoduodenectomy or Whipple procedure
This procedure is carried out where cancer is found in the top section of the small intestine or duodenum. As this area is linked to other organs such as the stomach, pancreas and gall bladder, these organs may be affected and also removed. Part of the large intestine which passes close to this area of the small bowel may also require surgical resection.
A complex operation, the Whipple procedure requires a full anaesthetic. Depending on your cancer type and location, this procedure can be carried out with a large incision (laparotomy), using specialist instruments and a camera (laparoscopy) or as a robotic-assisted laparoscopic procedure. Robotic-assisted and non-robotic laparoscopic surgeries use 6 small incisions of approximately 2 to 5 cm each. Open surgeries require an incision of approximately 25 cm. You will have been given details of your options regarding robotic-assisted surgery, laparoscopic surgery and laparotomy.
Recovery from a Whipple procedure requires time and certain medications must be taken for life. Open procedures take advantage of an epidural anaesthetic pump system where you can administer your own pain medication on an as and when basis for 24 to 48 hours after surgery. All Whipple procedures require medium care or intensive care unit stays of up to 72 hours and a hospital stay of at least 1 week. Recovery time varies between 6 to 10 weeks. Radiation or chemotherapy is usually prescribed after surgery. Remedazo arranges longer stays to accommodate further treatment, accommodation, home nursing care, catering, transportation and follow ups.
You may usually fly home within a fortnight after surgery, although you will need to wear compression stockings and perhaps split long-haul flights into shorter journeys.
Small bowel resection
Where tumours are localised in the small intestine, a minimally invasive laparoscopic resection may be enough to cure the cancer. Sometimes regional lymph nodes are removed as an extra precaution. The affected area of duodenum (rare), jejunum or ileum is taken away and the remaining healthy areas connected to each other.
Minimally invasive small bowel resection is carried out as a laparoscopic procedure with 3 – 4 incisions of between 3 and 6 cm. This is a much less complicated procedure than a Whipple; however, where a tumour has spread into surrounding tissues, this surgery becomes more complex and may require an open incision.
A small bowel resection is performed under a general anaesthetic and takes between 90 minutes and 2 hours to complete. Hospital stays are short – approximately 3 days. You will be able to resume your normal activities after approximately 2 – 4 weeks after surgery, although work or activities requiring heavy lifting must be avoided. You will be able to fly home within the week but need to wear compression stockings and perhaps split long-haul flights into shorter journeys.
Radiation or chemotherapy may be necessary if it is suspected that localized cancer has or may spread. Remedazo arranges longer stays to accommodate further treatment, home nursing care, catering, transportation and follow ups.
As the small intestine is responsible for extracting a broad range of nutrients from the diet you may need to take lifelong nutritional supplements. This will depend on the length of small intestine that is removed. Any surgery in which a portion of the small bowel is removed may lead to malnutrition. In fact, small bowel surgery is the basis of today’s popular weight loss surgeries. Remedazo will ensure you are given all important dietary advice after your surgery.
Cancers of the large bowel
Colectomy for colon cancer
A colectomy removes a part or the entire colon (large intestine). Depending on the length of colon that needs to be removed, this procedure is performed as a laparoscopic, robotic-assisted laparoscopic or open surgery (laparotomy).
Colectomy procedures are named according to the amount or location of colon that is removed. A total colectomy is the removal of the entire colon, from the end of the ileum of the small intestine all the way to the rectum. The last part of the small intestine is then directly attached to the rectum. A partial colectomy (subtotal colectomy) removes a portion of the colon and attaches the two healthy colon ends to each other. A hemicolectomy involves the removal of the left or right sections of the large intestine. A sigmoidectomy removes the last few centimetres of the colon before the rectum. Finally, a proctocolectomy removes either part or all of the colon, the rectum and in some instances the anus. A colectomy often requires the placement of an ileostomy or colostomy (see the following paragraph).
In some cases, it may not be possible to immediately or permanently reattach the healthy ends of the gut. In these cases, a colostomy or ileostomy may need to be performed that attaches the small intestine or colon to the skin of the abdomen where it drains into a bag via an opening called a stoma. In many cases, a second surgery restores normal intestinal function and the stoma is no longer necessary and can be removed, leaving a small scar of 3 – 5 cm in length. A nurse specialist will show you how to clean your stoma and replace colostomy or ileostomy bags as well as answer any of your questions. You will also be able to discuss these procedures during your free Remedazo Second Opinion.
Colectomy surgery is performed under a general anaesthetic. Open surgeries require a slightly longer hospital stay and sometimes an additional epidural anaesthetic for perioperative pain control. Procedures last between 1 and 4 hours and hospital stays range from 3 to 7 days. With total recovery times varying from 4 to 8 weeks. As the colon aids digestion through the extraction of certain vitamins and water, you may need to take lifelong supplements and experience watery stool.
You can fly home 3 - 5 days after discharge from your chosen hospital but will need to wear compression stockings and perhaps split long-haul flights into shorter journeys.
Radiation or chemotherapy may be necessary if it is suspected that localized cancer has or may spread. Remedazo arranges longer stays to accommodate further treatment, home nursing care, catering transportation and follow ups.
Total mesorectal excision for rectal cancer
A total mesorectal excision can be a laparoscopic procedure (LaTME) or be carried out using the newer transanal technique (TaTME), which a number of Remedazo surgeons have extensive experience in. You can discuss either procedure during your free Second Opinion.
The transanal approach requires no incisions to the abdomen or to the skin surrounding the anus as this technique uses special instruments that remove the rectum via the internal wall. It is rare that a stoma is required. This surgery removes part or the entire rectum and many of its surrounding lymph nodes and requires a temporary or permanent stoma. This is an extremely complex technique and requires an experienced surgeon.
Lower localized rectal tumours can be cured with this type of surgery but radiation or chemotherapy may be necessary if it is suspected that localized cancer has or may spread. Remedazo arranges longer stays to accommodate further treatment, home nursing care, catering, transportation and follow ups.
Laparoscopic procedures use 1 (single port laparoscopic surgery or SPLS) 2cm incision or 2 incisions where a stoma is required in a combination laparoscopy and transanal approach commonly referred to as a TATAR. Purely laparoscopic surgeries require 4 – 5 small incisions, depending on whether a stoma is placed or not. Hospital stays vary from 1 to 4 days and recovery requires 2 to 5 weeks.
Initially, your stool will be watery and attention is paid by nursing staff to avoid the discomfort of constipation. This postoperative aspect may mean you want to put off flying until a degree of healing has taken place and diarrhoea is no longer a side-effect.
General information about intestinal cancer surgery
All intestinal cancer surgeries require you to drink an oral bowel preparation or have an enema the day before surgery. The great majority of surgeries require insertion of a drain through an incision to remove fluids from the operation site. This drain will remain in place for 24 to 48 hours after surgery. In addition, a urinary catheter may be placed to lower discomfort after open surgery but will usually be removed 24-hours post-surgery; a Whipple procedure will require the urinary catheter to remain in place for 48 – 72 hours.
For all types of intestinal cancer surgery, you will be admitted to your chosen clinic on the day of the procedure. Certain people such as those with a very high BMI, breathing difficulties, diabetes or other chronic illnesses usually benefit from spending the night before the operation in a hospital setting. This also applies to those requiring more complex Whipple surgery or those who do not want to drink the oral bowel preparation in a home setting.
From midnight of the day before your surgery, you will be asked to refrain from eating. Undigested stomach contents can create serious complications during general anaesthesia. Smokers should stop smoking at least 24-hours before an operation as this improves oxygen levels throughout the body. Between midnight and six hours before anaesthesia you may only drink water or clear liquids. You are not permitted to eat, drink or smoke in the six hours preceding anaesthesia. Failure to comply may mean the anaesthesiologist and surgeon will be forced to postpone your procedure. This is purely for your own safety. It is possible to brush your teeth during this period but no water may be swallowed. In certain circumstances, medical staff will administer oral medications with a little water. This is administered under the advice of the anaesthesiologist and is therefore permitted.
Approximately thirty to ninety minutes before the planned procedure time you will be collected from your room and brought to the surgical department either in your bed, on a gurney, in a wheelchair or on foot.
Preoperative intestinal cancer surgery preparation requires:
An intravenous line
A blood pressure cuff placed on the upper arm
The completely painless placement of electrodes to the chest to measure heart activity
A finger or ear sensor to measure oxygen levels in the blood
A possible epidural catheter for open nephrectomy procedures
A general anaesthetic
An arterial catheter for more invasive and open surgeries
A urinary catheter for open procedures and Whipple procedures (usually placed after you are asleep)
At the surgeon’s signal, you will be anaesthetised.
H5 What happens after intestinal cancer surgery? What can I expect?
You will be woken by the anaesthesiologist immediately after surgery and transported from the operating theatre to the recovery room. Here you will be carefully monitored. All patients remain in the recovery ward until they are fully responsive and any pain is well under control.
When the anaesthesiologist is satisfied you are fully awake and comfortable you will be brought to a surgical ward; Whipple patients and those undergoing more complex surgeries will be taken to the intensive care or medium care unit where they will remain for 24 to 72 hours before being transferred to a regular ward. Pain medication is given as standard for the first 24-hours and then upon request and according to your personal doctor’s prescription. Arterial lines are usually removed within 12-hours after surgery; those in intensive care or medium care units retain the arterial line until transfer to a general surgical ward. The intravenous catheter will continue to administer fluids for at least 24 hours and your drain will be removed by a trained nurse or doctor within 2 - 4 days, depending on the complexity of your operation. Urinary catheters are usually removed after 24-hours post-surgery. Again, open and Whipple surgeries may mean this time is extended according to your level of comfort and ability to use a bed pan or urinal or get out of bed to use the bathroom with or without nursing staff assistance.
The majority of intestinal cancer patients are out of bed within 8 hours of exiting the recovery room. For open surgeries and Whipple procedures this period of time extends up until you are taken to a general surgical ward. Upon discharge from the hospital you will be transported to your accommodation and supported by your personal Remedazo team until you have safely and comfortably returned home or have completed further treatment.
Long-term postoperative care includes the removal of stitches after 10 to 14 days. This can be done by your general practitioner at home if you are not attending further treatment sessions. It is advised not to lift heavy objects for at least 6 - 8 weeks after surgery.
H5 Benefits of intestinal cancer surgery
Intestinal cancer surgery aims to remove the tumour in its entirety and so has the potential to be a curative procedure. Surgery is nearly always recommended, even in cases of metastatic intestinal cancer; however, the further cancer spreads the higher the chance you will need additional therapies. These are usually chemotherapy and radiotherapy. Open, laparoscopic and robotic-assisted surgeries do not require significantly long stays in the hospital and have relatively rapid recovery times. Aftercare can involve dietary changes, nutrient supplementation, pharmaceutical replacement of digestive hormones, pharmaceutical replacement of digestive enzymes and a permanent or temporary colostomy or ileostomy.
H5 Disadvantages of intestinal cancer surgery
Postoperative infection is always a risk with this type of surgery and patients are administered antibiotics as a preventive measure before surgery commences. Due to the high levels of bacteria in the gut, seepage can occur into the abdominal cavity. Your chosen clinic’s doctors and nurses are trained to recognise the symptoms of infection very early on. Other short-term risks include bleeding, adverse reactions to the anaesthesia, blood clots, an urge to urinate in the presence of a urinary catheter, and breathing problems.
Long-term complications include the inability to absorb certain nutrients from your food or produce enough of certain hormones or enzymes necessary for digestion. Significant weight loss can occur where large sections of small bowel and/or stomach are removed. Scar tissue formation may increase your risk of intestinal obstruction. More complex surgeries may require lifelong medication, colostomy or ileostomy bags and/or nutritional supplements. We recommend you visit your local gastroenterologist early on so he or she can keep an eye on your progress.
Intestinal radiation therapy
Radiotherapy may be given before surgery in order to shrink a larger tumour (neo-adjuvant radiotherapy), after surgery to reduce the risk of the cancer recurring or as a palliative measure for advanced intestinal cancer to help control uncomfortable symptoms.
Radiotherapy as a stand-alone cancer therapy is rare but the new and ground-breaking Papillon technique is being increasingly used for certain cases of small, localised, early-stage rectal cancer. Furthermore, a stoma is not necessary with this procedure. The Papillon technique uses a probe to administer low energy X-rays directly onto the tumour and should be undertaken in combination with EBTR and chemotherapy.
Fractionated external beam radiation therapy (EBTR) may be given prevent the growth of potentially remaining cancer cells. This therapy is given over the course of 3 to 7 weeks in low doses. More recently, stereotactic body radiation therapy (SBRT) has provided patients with a higher dose, shorter course of radiation therapy.
Post-surgical radiation therapy is used if it is unsure whether all cancer cells have been removed. For advanced cases of intestinal cancer, repeated radiation therapy can slow down tumour growth and keep cancer cells under control.
Radiotherapy therapy for intestinal cancer is composed of two main types – external beam radiation therapy (EBRT) and stereotactic body radiation. If intestinal cancer has spread to the bone tissue (bone metastasis), patients may be offered radiopharmaceuticals. These are drugs that contain radioactive substances that are injected and settle in areas of damaged bone. Here, they emit radiation that kills cancer cells. These drugs also relieve bone pain caused by metastasis and can extend life in advanced intestinal cancer.
External beam radiation therapy focuses beams of radiation into the affected area of intestine and requires short (10 to 30 minute) visits to the hospital 5 times a week for several weeks. Long-term stays with all accommodation, home nursing care, catering, transportation and follow ups can be seamlessly arranged by your Remedazo team.
EBRT is a painless treatment and recent technology now enables oncologists to be even more precise with dosage and range. Additional options such as three-dimensional conformal radiation therapy or 3D-CRT use computers to map the area that requires treatment and shape the radiation beams to avoid damaging non-cancerous tissues. The even more advanced intensity modulated radiation therapy (IMRT) machine moves around the patient, shapes the beams and adjusts radiation intensities. This may be done with built-in scanners (image guided radiation therapy or IGRT) or using a more rapid but not necessarily more effective technique called volumetric modulated arc therapy or VMAT. You will be able to discuss all of these alternatives with a Remedazo oncology specialist.
The side effects of radiation therapy often depend on its effects upon healthy tissues that are found close to the intestine such as blood vessels, lymph nodes, stomach, liver, pancreas, spleen and gall bladder. In addition, radiation treatments can make you feel tired for weeks to months. At Remedazo, all associated information will be given upon or shortly after your consultation; you can then make an informed decision regarding the types of radiotherapy available to you.
Intestinal cancer chemotherapy
Intestinal cancer is most often treated with surgery and sometimes in combination with chemotherapy. Chemotherapy for small intestine cancer may be given to treat cancer that has or may spread to other areas of the body, to cancer types with the potential to return, and also to kill any cancer cells left behind after surgery. Chemotherapy drugs are often given in combination, such as folinic acid, fluorouracil and irintecan which together are referred to as FOLFIRI. Multiple combinations exist, all of which can be discussed with a Remedazo oncology specialist.
Chemotherapy drugs are administered intravenously via a portacath, PICC line or central venous catheter. Drug cycles last for 14 days and, depending on your type of cancer, may be repeated up to 12 times. This can mean 6 months of therapy with regular blood tests and follow ups of symptoms and side effects. Ask Remedazo for more information regarding longer-term stays where all of your physical, psychological and emotional needs are catered for during this stressful time. Alternatively, we can arrange similar accommodation and familiar, trusted team members for regular returns to your clinic of choice and cater for your accompanying family members or friends.
Intestinal cancer immunotherapy
Checkpoint inhibitors allow your immune system to respond to the presence of specific cancer cells and attack them. Often, this response is absent during tumour growth. It has been shown that some intestinal cancers respond well to immunotherapy treatment but this certainly does not apply to all types. Ask about immunotherapy options during your free Second Opinion.
Drugs such as pembrolizumab and the combination therapy of nivolumab and ipilimumab block the activity of a protein that prevents your immune cells from recognizing and attacking inflamed tissues and cancer cells. These intravenous treatments require at least a 2-hour stay in a clinical setting every two to three weeks and have been shown to increase survival times in metastasised intestinal cancer; however, immunotherapy is rarely offered before other types of therapy have been administered. The usual first-line treatment for metastatic intestinal cancer without surgery is chemotherapy plus targeted therapy.
The side effects of immunotherapy are many and can be serious. Those offered this type of treatment are given in-depth information regarding side effects and the detection of their early signs. Remedazo can put you in touch with one of our specialist oncologists to discuss your eligibility for immunotherapy based upon your personal medical history.
Intestinal cancer pharmaceutics
Tyrosine kinase inhibitors (TKIs) in combination with checkpoint inhibitors (immunotherapy) have been proven to be effective in the treatment of metastatic intestinal cancer; however, not every type of intestinal cancer responds in the same way to either inhibitory drugs or immunotherapy. Tyrosine kinase inhibitors are drugs that prevent the growth of a tumour’s own blood supply network and are often combined with early treatment modalities such as colectomy. When used together with immunotherapy treatment, TKIs may extend survival and reduce discomfort in cases of inoperable metastasised intestinal cancer.
Intestinal cancer cryotherapy
Cryotherapy uses cold temperatures to freeze cancerous cells. This can be a first-line treatment with very small, localised tumours where a patient is unable to undergo surgery. In metastasized intestinal cancer where cancer cells have infiltrated the liver, this method can be used to remove areas of mutated cells in this organ.
Multiple cryotherapy procedures may be required if cancer cells are left behind. Cryotherapy or cryoablation of the liver is performed under a general anaesthetic and requires 1 – 2 nights in hospital after the procedure has been performed. Cryotherapy via the oesophagus using a gastroscope and cryotherapy via the rectum using a coloscope requires sedation and is an outpatient procedure. Using a laparoscopic camera, the gastroenterologist locates the area of intestine where an earlier biopsy has shown that cancer is present and inserts hollow needles through which an extremely cold gas is passed. These extremely low temperatures freeze and kill cancer cells.
Intestinal Cancer alternatives
It is possible that you have been given a choice of one or more alternative treatments or have not yet made an appointment for your free e-consult and are simply browsing the possibilities.
The accepted and current intestinal cancer treatment alternatives have been described in the necessary detail above. Complementary and alternative intestinal cancer remedies are unproven and should not take the place of accepted treatment courses. Cancer stem cell treatments for intestinal cancer are, as yet, insufficiently developed to be used as first-line treatment.
Of course, there is no alternative for professional medical advice. Please call us to arrange your free e-consult and the opportunity to speak personally with specialist urologists and oncologists to determine the best treatment type for you. You can discuss all intestinal cancer treatment alternatives with them, ask for second or third opinions, and take the first step towards your personalised Remedazo holistic care package.
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