Side Effects of Colon and Rectal Cancer Treatments

Side Effects of Surgery

Side effects that can occur as a result of colorectal surgery include bleeding from the surgery, blood clots in the legs, and damage to nearby organs during the operation. Rarely, the connections between the ends of the intestine may not hold together completely and leak. If an infection occurs, it is possible that the incision might open up, causing a gaping wound. Later after the surgery, you might develop what are called adhesions, which could cause the bowel to become blocked.

Side Effects of Radiation

Side effects of radiation occur mainly in the area where the radiation is given and may include skin irritation, diarrhea, rectal irritation, and bladder irritation. Nausea and fatigue may also occur. These slowly build up during treatment and often disappear on completion of treatment. Long-term effects such as scarring or bleeding are possible. Irritation of the rectum is called radiation proctitis, and irritation of the colon is called radiation colitis. Occasionally, chronic irritation of the rectum or bladder persists.

Side Effects of Chemotherapy

careful attention must be given to avoiding or reducing side effects, which depend on the type of drugs, the amount taken, and the length of treatment. The most common side effects might include loss of appetite, mouth sores, diarrhea, which can sometimes be quite severe and life threatening (particularly if irinotecan is given), or a rash on the patient’s hands and feet. Hair loss can also occur. Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts. This can result in an increased chance of infection (due to a shortage of white blood cells), bleeding or bruising after minor cuts or injuries (due to a shortage of blood platelets), and fatigue (sometimes due to low red blood cell counts). Fatigue also occurs often even when blood counts are normal.

Most side effects disappear once treatment is stopped. Hair will grow back after treatment ends. There are remedies for many of the temporary side effects of chemotherapy. For example, antinausea drugs to prevent or reduce nausea and vomiting can be given (see the ACS/NCCN Nausea and Vomiting Treatment Guidelines for Patients with Cancer).

Side Effects of Immunotherapy

Although monoclonal antibodies are similar to normal parts of the immune system, treatment with them can cause side effects. Common side effects of these agents are high blood pressure, blood clots, diarrhea, fatigue, decreased white blood cell counts, headache, and skin rashes like acne.

Body Image and Sexuality Issues

Surgery and radiation therapy may sometimes affect how people feel about their body and may lead to specific physical problems that affect sexuality. Men who have an AP resection can have “dry” orgasms following surgery because of damage to the nerves that control ejaculation. Sometimes the surgery only causes retrograde ejaculation, which means the semen goes backward into the bladder. AP resection should not stop your erections or ability to reach orgasm. However, your pleasure at orgasm may be less intense. Radiation may also cause sexual dysfunction in men. Women who have an AP resection should not expect any loss of normal sexual function.

Your cancer care team can discuss these issues with you, so don’t hesitate to share your concerns and ask questions.

Other Things to Consider During and after Treatment

During and after treatment for your colon or rectal cancer, you may be able to hasten your recovery and improve your quality of life by taking an active role. Learn about the benefits and disadvantages of each of your treatment options, and ask questions of your cancer care team if there is anything you do not understand. Learn about and watch for side effects of treatment, and report these promptly to your cancer care team so that they can take steps to reduce them.

Remember that your body is as unique as your personality and your fingerprints. Although understanding your cancer’s stage and learning about your treatment options can help predict what health problems you may face, no one can say how you will respond to cancer or its treatment.

You may have special strengths such as a history of excellent nutrition and physical activity, a strong family support system, or a deep faith, and these strengths may make a difference in how you respond to cancer. There are also experienced professionals in mental health services, social work services, and pastoral services who may assist you in coping with your illness.

You can also help in your own recovery from cancer by making healthy lifestyle choices. If you use tobacco, stop now. Quitting will improve your overall health, and the full return of the sense of smell may help you enjoy a healthy diet during recovery. If you use alcohol, limit how much you drink. Have no more than 1 or 2 drinks per day. Good nutrition can help you get better after treatment. Eat a nutritious and balanced diet, with plenty of fruits, vegetables, and whole grain foods. Ask your cancer care team if you might benefit from a special diet — they may have specific recommendations for people who have had radiation therapy, a colostomy, or other colorectal surgery.

If you are being treated for cancer, be aware of the battle going on in your body. Radiation therapy and chemotherapy add to the fatigue caused by the disease itself. Give your body the rest it needs so that you will feel better as time goes on. Ask your cancer care team about including a regular program of exercise in your daily routine to help in your recovery.

A cancer diagnosis and its treatment are major life challenges, with an impact on you and everyone who cares for you. Before you reach the point of feeling overwhelmed, consider attending a meeting of a local support group. If you need individual assistance in other ways, contact your hospital’s social service department or the ACS for help in contacting counseling or other services.

About Clinical Trials

Studies of promising new or experimental treatments in patients are known as clinical trials. A clinical trial is only done when there is some reason to believe that the treatment being studied may be valuable to the patient. Treatments used in clinical trials are often found to have real benefits. Researchers conduct studies of new treatments to answer the following questions:

• Is the treatment helpful?
• How does this new type of treatment work?
• Does it work better than other treatments already available?
• What side effects does the treatment cause?
• Are the side effects greater or less than the standard treatment?
• Do the benefits outweigh the side effects?
• In which patients is the treatment most likely to be helpful?

Types of clinical trials: A treatment is studied in 3 phases before it is eligible for approval by the US FDA.

Phase I clinical trials: The purpose of a phase I study is to find the best way to give a new treatment and how much of it can be given safely. The treatment has been well tested in laboratory and animal studies, but the side effects in patients are not completely known. Doctors conducting the clinical trial start by giving very low doses of the drug to the first patients and increasing the dose for later groups of patients until side effects appear. Although doctors are hoping to help patients, the main purpose of a phase I study is to test the safety of the drug.

Phase II clinical trials: These studies are designed to see if the drug works. Patients are given the highest dose that doesn’t cause severe side effects (determined from the phase I study) and closely observed for an effect on the cancer. The doctors also look for side effects.

Phase III clinical trials: Phase III studies involve large numbers of patients. Some clinical trials may enroll thousands of patients. One group (the control group) receives the standard (most accepted) treatment. The other groups receive the new treatment. All patients in phase III studies are closely watched. The study will be stopped if the side effects of the new treatment are too severe or if one group has had much better result than the others.

If you are participating in a clinical trial, you will have a team of experts taking care of you and monitoring your progress very carefully. The study is especially designed to pay close attention to you. However, there are some risks. No one involved in the study knows in advance whether the treatment will work or exactly what side effects will occur. That is what the study is designed to discover. Although most side effects disappear in time, some can be permanent or even life threatening. Keep in mind, though, that even standard treatments have side effects. Depending on many factors, you may decide to enroll in a clinical trial.

Deciding to enter a clinical trial: Enrollment in any clinical trial is completely up to you. Your doctors and nurses will explain the study in detail to you and will give you a form to read and sign indicating your desire to take part. This process is known as giving your informed consent. Even after signing the form and after the clinical trial begins, you are free to leave the study at any time, for any reason. Taking part in the study will not prevent you from getting other medical care you may need.

To find out more about clinical trials, talk to your cancer care team. Among the questions you should ask are:

• Is there a clinical trial for which I would be eligible?
• What is the purpose of the study?
• What kinds of tests and treatments does the study involve?
• What does this treatment do?
• What is likely to happen in my case with, or without, this new research treatment?
• What are my other choices and their advantages and disadvantages?
• Will I know which treatment I receive?
• How could the study affect my daily life?
• What side effects can I expect from the study? Can the side effects be controlled?
• Will I have to be hospitalized? If so, how often and for how long?
• Will the study cost me anything? Will any of the treatment be free?
• If I am harmed as a result of the research, what treatment would I be entitled to?
• What type of long-term follow-up care is part of the study?
• Has the treatment been used to treat other types of cancers?

The American Cancer Society offers a clinical trials matching service for patients, their family, and friends. You can find this service on our Web site (www.cancer.org) or through our national call center at 1-800-ACS-2345. Based on the information you provide about your cancer type, stage, and previous treatments, this service will compile a list of clinical trials that match your medical needs.

You can also get a list of current clinical trials by calling the National Cancer Institute’s Cancer Information Service toll free at 1-800-4-CANCER or by visiting the NCI clinical trials Web site at (www.cancer.gov/clinicaltrials).

TYPES OF COLON AND RECTAL CANCER TREATMENTS

For more information on these treatment guidelines, or on cancer in general, call the NCCN at 1-888-909-NCCN or the American Cancer Society at 1-800-ACS-2345. Or you can visit these organizations’ web sites at www.cancer.org (ACS) and www.nccn.org (NCCN).

© 2005 by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS). All rights reserved. The information herein may not be reproduced in any form for commercial purposes or downloaded and stored in any information-retrieval system without the express written permission of the NCCN and the ACS. Single copies of each page may be printed out for personal, noncommercial use only.