G U T   C A N C E R

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8. Treatments against gut cancer.

The three most important treatment methods are:
- operation
- chemotherapy
- radiotherapy

Depended on the stadium, the doctor can decide to make a combination of two or even three treatments methods. If a treatment method is focused on curing the patient the treatment is called a curative treatment. If curing isn't possible any more, we speak of a palliative treatment. The meaning of a palliative treatment is to reduce the disease and make the patient's life quality better.

Operation:

Large bowel:
The most important and first treatment against cancer in the large bowel is an operation, also called surgery. The cancer tumor, a normal piece of tissue which is surrounded around the tumor, and the lymph nodes which are close are being removed. The two ends of the large bowel which are cut before the operation are sutured. This operation is common and doesn't cause any serious side effects to the normal functioning of the intestine. Sometimes a stoma is placed (an opening via the stomach wall). This means that the excrement isn't removed via the anus, but via this stoma and caught in a special pouch. Most of the time the stoma is used for a short time. Patients can go home after about a week, and they are totally cured after six weeks. A small group of people can't be treated against the gut cancer.

Rectum:
There are different ways to remove the cancer form the rectum. It depends on the place where the cancer is located. An operation technique is based on the place where the cancer is found. Sometimes this means that an operation takes place via the stomach wall and sometimes via the anus. When the cancer is too close to the sphincter, or when the tumor is too big, a stoma (an opening via the stomach wall) is placed. A combination of operation and radiotherapy is used against cancer in the rectum.

Disseminations:
Sometimes disseminations can be removed during an operation when these are found in the liver or lungs. Liver metastasis is disseminations in the liver. These can be removed also with the help of cryosurgery (cold) or heat treatments. The cold bar or warm bar can be put in the stomach wall and with the help of echography or CAT-scan pointed at the right place. For this no operation is needed. The cryosurgery or heat treatment can also be used besides a normal operation. Before the operation chemotherapy is also given.

Radiotherapy
Radiotherapy is very important during the treatment against rectum cancer. Radiotherapy isn't as important during other treatments at other places in the large bowel. Radiotherapy is mostly used external so from the outside. Sometimes it is used internal (through a tube which is put in via the anus). External radiotherapy is used daily, five days a week, one to six weeks long. It is common that radiotherapy takes place just one week before the operation, and this makes the chance smaller that the cancer comes back.

The device is set up in a way that all the unfinished cells are found and destroyed. Most of the time not all the cells are destroyed in one time. That's the reason why you need to do more radiotherapy. The advantage of radiotherapy is that it looks for unfinished cells at one piece of the skin, and kill these.

Radiotherapy that takes 4 to 6 weeks is used for big tumors. It reduces the tumors, and can be removed easier. Moreover it takes care that nothing happens with the sphincter. After the operation, radiotherapy might be recommended. This depends on what the doctors found during the operation or during the laboratorial research from the removed tissue. It is very common that the radiotherapy which takes 4-6 weeks is done in combination with chemotherapy.

Chemotherapy

Chemotherapy is a treatment which includes medicines. This treatment however is very heavy because it can't be set at a certain part of your body. It removes all the cancer cells, but also the good and healthy cells. They can be given with the help of an injection or an infuse. But they can be swallowed up also. Due to the fact that these medicines get through your whole body, they also take care of the removal from disseminations.

Chemotherapy with an injection

There are always side effects because the chemotherapy also removes the healthy cells. The most common side effects are: loss of hair, sickness and throwing up, diarrhoea, tiredness, not being hungry, damaged mouth and nerve stimulation (neuropathy). Besides that people can get ill sooner when they use chemotherapy. The side effects are most of the time gone very soon, because new healthy cell will come back. The side effects can be gone also with the use of other medicines.

You can get chemotherapy in different ways:
- You can get it via an infuse. It is given for 24 to 48 hours long. This can be done every week or once in two weeks. This chemotherapy is called 5-FU.
- You can also take a pill which is called levamisol. This is the same as 5-FU but it is easier to use.
- If you are in stadium III and IV, you can get besides the 5-FU, oxaliplatin.
- When you are in stadium IV you can get besides the 5-FU and the oxaliplatin, irinotecan. This works better.

Alternative treatment.

Alternative treatment is a special treatment besides the other therapies (chemotherapy or operation). You'll first have to discuss it with your doctor if you want an alternative treatment. Sometimes you may use an alternative treatment besides your normal therapy. But this isn't always the case. Sometimes it is dangerous. That's why it's very important to discuss it with your doctor.