Physical HealthTaha tinana
Seeking information about the bowel and bowel cancer can feel overwhelming or frightening, especially if you’re unsure about what’s ahead for you or a loved one. Having the right information can help lessen some of these feelings. Here you will find reliable information about the bowel and bowel cancer along with diagnosis, symptoms, risks, treatment, side effects, diet and nutrition and some useful websites to visit.
Nau mai rā, rarau mai rā ki tēnei whārangi mō ngā kōrero e pā ana ki te mate pukupuku kōpiro.
About the bowel
Mō te kōpiro
The bowel connects the stomach to the anus. It is part of the digestive system and is divided into two parts: the small bowel (also known as the small intestine) and the large bowel (also known as the large intestine).
The small bowel is 3-5 metres in length and is where most nutrients are absorbed.
The large bowel is about 1 metre in length and is made up of the colon and the rectum. The colon finishes absorbing water and electrolytes and the rectum stores the remaining contents until being passed out of the body as faeces.
Click here to view a diagram of the bowel | Pāwhirihia ki kōnei kia tirohia he hoahoa whakaahuahanga o te kōpiro
What is bowel cancer? | He aha tēnei mea te mate pukupuku kōpiro?
Bowel cancer occurs when abnormal cells in the bowel grow out of control. Bowel cancer, also called colorectal cancer and is the most common type of gut cancer. Nearly all bowel cancers arise in the large bowel, but a small number arise in the small intestine (136 cases) or the anus (70-80 cases).
Most bowel cancers develop from small benign growths, called polyps, on the inside lining of the bowel. Not all polyps become cancerous, and the risk of developing cancer in a polyp depends on the type of polyp and its size.
Symptoms & Risks
Tohumate & Tūraru
Common symptoms of bowel cancer | Ngā tohumate tōkau o te mate pukupuku kōpiro
Unexplained symptoms can be worrying for anyone. Here you will find information about some common symptoms of bowel cancer and how to manage them. It is important to note that having one or more of these symptoms does not necessarily mean that you have cancer, but if you have new or persistent symptoms that are out of the ordinary for you, it’s really important that you contact your GP to get checked out.
Click here to view symptoms of bowel cancer
Bleeding from the anus (rectal bleeding) without any obvious reason
Straining, soreness, lumps, and itchiness around the anus
A persistent change in bowel habit for example going to the toilet more often or experiencing looser stools for several weeks
Abdominal pain especially if severe
Any lumps in your tummy
Weight loss and tiredness
Managing symptoms | Whakahaere i ngā tohumate
You might notice that things change for you physically and emotionally following your diagnosis and you may have even noticed some of these symptoms prior to diagnosis. Understanding them can help you to prepare for them mentally and manage them if they do appear. If you do experience any of these symptoms, let your healthcare team know when you next see them. If they are extreme, or you are worried about them, get in touch with your healthcare team sooner.
Click below to learn about some ways you can manage these changes or symptoms | Pāwhirihia te momo tohumate mō ētahi atu mōhiohio.
Changes in diet | Ngā panonitanga o te whiringa Kai
Many people find that sorting out symptoms related to their diet makes the biggest difference to how they feel. Ask your doctor or nurse for a referral to a dietitian. They can help you with finding food to eat that is gentle on your digestive system.
Nausea | Whakapairuaki
Feeling sick (nauseous) is another common symptom. You may be prescribed anti-sickness medication, or you could try home remedies such as ginger, peppermint, or acupressure bracelets.
Fatigue | Ruha
You are bound to feel tired or exhausted sometimes, so be kind to yourself. Make sure you rest and prioritise what you want or need to do. Give yourself permission to accept offers of help for chores that feel overwhelming. Although you might not feel like it, gentle exercise such as stretching, or a short walk can help combat fatigue.
Intimacy | Mateoha
People of all genders can lose interest in sexual activity during cancer treatment, at least for a time. Although it can feel awkward, talking to your partner about what you find intimate, or soothing can help. There are many ways to be intimate, such as cuddling or gentle touch, or using warmth and comforting language. Your GP may be able to assist with medication or a referral to see a sex and relationship therapist.
Stress, pain, and anxiety | Kohuki, Mamae, Anipā
Simple relaxation techniques can help you cope with stress, pain, and anxiety. Having a warm bath, deep breathing or listening to soothing music are easy things to do at home. You might want to try complementary therapies like reflexology or aromatherapy massage. Talking to others can also help. There are many cancer-specific psychologists available to you in New Zealand – ask your oncologist, nurse, or GP for a referral.
Keep perspective | Kia whakataurite
Each individual will feel and react differently to treatment. What might work for someone else may not always work for you. Acknowledge that not every day will be as easy to manage as the last, and that every day may be different. Focus on what you know works for you and be very gentle with yourself.
Keeping active | Kia kori
Physical activity can also make you feel better, though how much activity will depend on how well you feel. Even a walk round the block or 10 minutes of stretching each day can help.
Risks of developing bowel cancer | Ngā tūraru whakawhanake mate pukupuku kōpiro
There are some known risk factors that can increase the chance of bowel cancer developing. Having a risk factor does not automatically mean that you will develop bowel cancer, but they do increase the likelihood of it happening.
Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.
Some risk factors are environmental and within your control which is why it is important to understand what they are.
Risk factors that cannot be controlled
Family history and genes
About 5% of bowel cancers occur due to changes in genes that are passed on from one generation to the next (Familial Bowel Cancer). Familial Bowel Cancer can be diagnosed by special tests to detect these gene changes. It is more common in young patients and those with a strong family history of cancer. Special counseling is available for people who have a diagnosis of Familial Bowel Cancer
Age | Pakeke
The risk of developing bowel cancer increases with age.
Crohn's disease or ulcerative colitis
Having Crohn’s disease for more than 10 years increases the risk of developing bowel cancer.
Societal and environmental risk factors that can be controlled | Ngā pūtake tūraru-ā-porihanga, ā-taiao whai here
Smoking tobacco
Obesity
Alcohol consumption
Lack of exercise
Diagnosis
Tautohunga
Diagnosing bowel cancer | Te tautohunga i te mate pukupuku
Being diagnosed with cancer can be a scary time for anyone. Here you will find information to help you understand some of the terms you might have heard.
In order to diagnose bowel cancer, your oncology specialist will do a range of tests. There might be one test or a mix of tests, some of which are explained below.
Colonoscopy | Tiro oranga kōpiro
Bowel cancer is usually diagnosed by colonoscopy. A colonoscopy is a procedure in which a long thin flexible tube with a tiny camera (colonoscope) is passed through the anus and around the bowel.
A colonoscopy can detect and take biopsies of polyps and remove them if necessary to reduce the risk of developing bowel cancer.
The procedure is sometimes uncomfortable, and you may feel pressure in your bowels, but should not be painful. The colonoscopy usually takes place in a hospital setting and takes about 45 minutes. You will need to wait at the hospital until most of the sedative has worn off and so you should prepare yourself for being there for 2-3 hours. You will also need someone to drive you home and stay with you for the rest of the day until the sedative has fully worn off.
In preparation for the procedure, you may be asked to:
Eat a special diet and/or take laxatives in the days before the procedure as the bowels need to be completely empty
Remove your clothes and change into a hospital gown on the day of the procedure
The procedure is a safe one with very low chances of complications. If you do have complications, they may include:
Bleeding if a tissue sample is taken for testing. This usually stops on its own or can be controlled through the colonoscope
Allergic reaction to the sedative
Tearing of the bowel wall or a perforation.
Click here to view a diagrammatic representation of the colonoscopy procedure | Pāwhirihia ki kōnei kia tirohia he hoahoa whakaahuahanga o te mahinga Tiro Oranga Kōpiro
Barium enema | Kuhitou waitāmura
X-Rays alone do not provide a good image of the bowel and so a heavy white fluid (barium) needs to be added into the bowel through a small soft tube inserted into the rectum (bottom). Some air may be pumped through the tube to expand your bowels for a clearer picture. X-Rays will then be taken.
Barium enemas usually take about 45 minutes and take place in an outpatient clinic. It may feel uncomfortable but should not be painful. You may be provided with a medicine to help you relax as it is important that you do not tense your bottom muscles during the test.
To prepare for the barium enema, you may be asked to:
Eat a light diet for a few days leading up to the test as your bowel needs to be completely clear to be able to produce a good image of the bowel
Take laxative medicine to help empty your bowels
Drink plenty of clear fluids in the 24 hours before the test
Take off clothes and change into a hospital gown for the test
Remove all jewellery.
After the test you may feel a little unwell and so you may want to bring someone with you who can drive you home after the appointment. You may also find that you need to stay close to a toilet for a little while afterwards.
Click here to view a diagram of a barium enema | Pāwhirihia ki kōnei kia tirohia i te hoahoa whakaahuahanga o te Kuhitou Waitāmura
Computed tomography (CT) scan | Matawaitanga-ā-rorohiko
Radiology tests can also be used to diagnose bowel cancer a special type of CT scan called CT colonography.
A CT scan combines a series of x-ray images that are taken from different angles around the body. You will lie on a motorised bed that passes through a doughnut shaped tube. It is important that you lay still for good quality images to be taken and so a strap and/or pillows may be used to help with this.
Before the CT scan takes place, a small tube is inserted into the rectum (bottom) and air is pumped into the bowel to open it up. This allows any folds inside the bowel to be stretched out so that it is easier to see any polyps that may be difficult to see in the folds.
A CT colonography usually takes place in an outpatient clinic and takes about 15minutes. Insertion of the tube into the rectum may feel uncomfortable but should not be painful. The CT scan itself is not a painful procedure.
In preparation for the scan, you may be asked to:
Eat a special diet and/or take laxatives in the days leading up to the scan to ensure that your bowels are completely clear on the day of the scan
Take some medicine called barium or iodinate liquid the night before to help produce clear pictures of the bowel
Remove all clothing and change into a hospital gown on the day of the scan
You may want to wear comfortable loose-fitting clothing after the scan.
Click here for an example of a CT colonography | Pāwhirihia ki kōnei kia tirohia te hoahoa whakaahuahanga o te Haumanu Iraruke Kōpiro.
It's important to acknowledge that some of these tests can be confronting or sometimes frightening. Taking a friend or whānau member with you can help ease anxiety. Be encouraged to tell staff if you need extra reassurance during the test, you'll find some very compassionate people working in healthcare.
Waiting to have tests carried out | E tāria ana kia whakamātauhia
Even if you have been given an urgent referral for a particular scan or investigation you may have to wait several days or possibly weeks for your appointment. This can be frustrating and worrying, especially if you are already feeling unwell.
Several weeks of testing to confirm a diagnosis or awaiting appointments is relatively common and is unlikely to alter overall outcomes. Cancer growth is considered to be negligible over a period of weeks, and this waiting period is unlikely to cause you harm if your symptoms are stable.
If your symptoms get worse or you start to feel more unwell while you are waiting, it is a good idea to get in touch with your GP or specialist if you already have one. If you cannot get in contact with them, you may need to present to the closest emergency department if your symptoms cannot be controlled at home.
How long will I have to wait for my test results | Ka hia te roa e tatari ai kia puta ngā kitenga whakamātautau?
Depending on which tests you have had it may take from a few days to a few weeks for the results to come through. Waiting for test results can be an anxious time.
It is a good idea to ask how long you may have to wait when you go for tests. If you think you have been waiting too long, then contact your GP or a specialist to follow up on the progress of your results. Usually, the doctor who does the test will write a report and send it to your specialist. If your GP sent you for the test, the results will be sent to the GP clinic.
You will need an appointment with your specialist or GP to discuss the test results and how they might affect your treatment. Usually, your specialist will discuss your results and plan your subsequent care.
All these tests will give the specialist more information about the cancer such as where it is, if it is growing, and if it has spread. This is called staging. Staging helps to work out the best treatment plan for you.
Bowel cancer stages | Ngā tūātupu mate pukupuku kōpiro
You may have heard people talk about the stages of cancer. Staging provides an indication of the size of the cancer and if it has spread to other areas of the body and contributes to the treatment planning.
There are two ways in which the stage of cancer can be described. One uses numbers (stage 1, 2 etc) and the other uses letters and numbers (T1, N0 M0 etc) also known as TNM (Tumour-Nodes-Metastases) staging. The cancer may be described in one or both ways by your healthcare team.
Click here to learn more about the stages of cancer | Pāwhirihia kia whai mōhiotanga mō ngā tūātupu mate pukupuku
TNM (Tumour-Nodes-Metastases) staging | Te Tūātuputanga Pukupuku, Tīpona, Hora-mate
The TNM gives a number according to tumour size (T), how many lymph nodes are affected (N), and how far the cancer has spread, or metastasised, to distant parts of the body (M). This may be expressed as, for example, T1, N0, M0. This information is used to help decide the best treatment.
TX |
| Unable to measure the size of the tumour | |
T0 | A tumour has not been identified | ||
Tis | The tumour is only in the outer layers of tissue. Sometimes called pre-cancer or in-situ cancer. Click here to view a diagram illustrating this. | ||
T1 | The tumour is in the inner lining only of the bowel | ||
T2 | The tumour is in the inner lining and the muscle layer of the bowel | ||
T3 | The tumour is in the inner lining, the muscle layer, and the outer layer of the bowel. It is contained within the bowel (i.e., has not penetrated through the outer wall of the bowel) | ||
T4 | The tumour is in all layers of the bowel and has penetrated through the bowel wall. | ||
NX | Unable to assess the lymph nodes | ||
N0 | Lymph nodes not affected | ||
N1 | There are 3 stages of N1:
| ||
N2 | There are 2 stages of N3:
| ||
M0 | The cancer has not spread to other tissues or organs | ||
M1 | The cancer has spread to other tissues or organs |
Staging using numbers | Tūātuputanga ā tau
Stage 0 |
| Abnormal cells (pre-cancerous cells) have been detected. Although they are not cancerous, they have the potential to develop into cancer. |
Stage 1 | The cancer is confined to the lining of the bowel and there is no sign of spreading elsewhere. These cancers are treated with surgery alone and there is a high chance of cure. | |
Stage 2 | The cancer has penetrated the deeper layers of the bowel wall but has not spread to the lymph glands or elsewhere. Stage 2 cancer is usually treated by surgery alone, but chemotherapy may be advised in certain circumstances to reduce the risk of the cancer coming back. These circumstances include bowel blockage or bowel perforation, or certain features of the tumour that the pathologist looks for under the microscope. | |
Stage 3 | Cancer cells have been detected in the lymph glands that were removed with the bowel at the time of surgery. Stage 3 bowel cancer has a higher chance of coming back, and chemotherapy can reduce the risk of the cancer returning. It is therefore treated with surgery followed by chemotherapy. The treatment of rectal cancer differs in some ways from the treatment of colon cancer. Radiotherapy is often used prior to surgery in rectal cancer to reduce the risk of the cancer coming back in the pelvis. The radiotherapy is usually given, in combination with chemotherapy, prior to surgery. Because the rectum is the very lowest part of the bowel, some patients with rectal cancer will also need a stoma (bag). This is usually temporary, but sometimes it is permanent. | |
Stage 4 | The cancer has spread to other organs or tissues. It can spread inside the abdomen or to other parts of the body. This type of spread is called metastasis or secondary spread. The liver is the most common organ affected. Stage 4 disease can sometimes be cured by surgery, usually in combination with chemotherapy. However, it is often not possible to cure stage 4 colon cancer. If this is the case, treatment may be able to control the cancer for some time. Treatment may also reduce symptoms and help provide a better quality of life. |
Prognosis (Life expectancy) | Matapaenga (Te wā ora)
Like any cancer there are many things that can impact on survival rates, so it is best to talk to your cancer specialist for guidance about your own care and outcomes. Remember, even with a diagnosis, no one can know for certain how long anyone will live. Estimates of life expectancy are based on historical data, however treatments are becoming more effective over time which changes these estimates.
Prognosis is usually improved the earlier the cancer is detected. Your doctor will be able to give you the best idea of prognosis.
Often, statistics talk about survival rates which are taken from an average of other patients. These are usually described in 1, 5 and 10-year survival rates. A 10-year survival rate is the proportion (or percent) of people who have not died 10 years after having cancer, however many people live much longer than this.
Click here to view bowel cancer statistics related to morbidity (number of diagnoses) and mortality (survival rate). Remember that everyone is different, and statistics are only a guide | Pāwhirihia ki kōnei kia tirohia ngā tauanga tahumaero, matenga ā te Mate Pukupuku Kōpiro
Sadly, New Zealand has one of the highest rates of bowel cancer in the world with over 3,515 new cases diagnosed each year. That this equivalent to about 69 people for every 100,000.
Overall, the survival rate for bowel cancer is 79.5% at one year, 60.8% at year 5 and 56.5% at year 10. Around 1248 New Zealanders die from bowel cancer each year.
Below describes the prognosis for bowel cancer by stage for New Zealand.
Stage 1 and 2 Bowel Cancer
Patients with stage 1 and 2 bowel cancer have a good chance of being cured with surgery alone.
Stage 3 Bowel Cancer
At least half of stage 3 patients can be cured with a combination of surgery and chemotherapy.
Stage 4 Bowel Cancer
The prognosis for stage 4 bowel cancer depends on the circumstances. In the best circumstances cure may still be possible, however it is often not possible to cure stage 4 bowel cancer. If a cure is not possible, treatment may be able to control the cancer for some time, reduce symptoms and help provide a better quality of life.
Remember that everyone is different, and statistics are only a guide.
Seeking a second opinion | E rapu ana i te whakaaro kē atu
Following diagnosis, some people choose to request a second opinion because they want to have peace of mind that they have explored all options and opinions available to them before starting treatment.
If you would like to know more about your care team and how to seek a second opinion, click here.
Treatment
Ngā momo rongoā
Treatment options | Ngā kōwhiringa rongoā
There are a number of treatment options available, and it may feel confusing and unsettling not knowing which will be the best for you.
Treatment of bowel cancer depends on its location, the stage of the cancer (how advanced it is at the time of diagnosis), and whether the person is otherwise medically fit.
The choice of treatments will be discussed with you and your whānau and your preferences will be considered. Your treatment will be discussed by a multidisciplinary team (MDT), which means that experts in different areas of cancer treatment (e.g., surgeons, gastroenterologists, radiologists, oncologists, and nurses) come together to share their expertise in order to provide the best patient care.
It is also important to note that more than one treatment may be needed to get the best results.
See below to read more about the treatment options. | Tirohia atu ētahi kōwhiringa rongoā ki raro nei.
*Not all the options below will be applicable to everyone's situation. Some treatments listed may not be funded and would require the patient to pay directly. It is important to discuss all your options with your specialist team.
Surgery | Poka tinana
Surgery to remove the affected part of the bowel is one of the main treatments for bowel cancer.
For some patients, surgery is the first step in their bowel cancer treatment, others will receive chemotherapy, radiotherapy or both before surgery.
Surgery to remove part of the colon is called a colectomy. Surgery to remove the rectum is called a proctectomy or anterior resection. These surgeries may be dome using an open, keyhole (laparoscopic resection) or robotic approach. It involves making small cuts (incisions) into the skin on your abdomen and working with long thin instruments through the cuts to remove the area of the bowel that is affected. Once the affected section of the bowel is removed, either the two ends of the bowel are reattached (anastomosed), or a passageway is created to the outside of your body, onto which a stoma bag is attached to collect faeces. The stoma may be temporary or permanent depending on which the part of the bowel has been removed. You can expect your surgeon to discuss with you whether a temporary or permanent stoma may be required before your operation. If a stoma is fitted, a stomal therapist will show you how to clean and take care of the stoma.
Click here to view a diagram of the surgery | Pāwhirihia ki kōnei kia tirohia te hoahoa o te poka tinana
Radiation therapy | Haumanu iraruke
Radiation therapy may be used in conjunction with surgery and/or chemotherapy. Radiation therapy uses x-rays to kill cancer cells and stop the cancer growing. It can be given for all stages of cancer.
Getting radiation therapy is similar to getting an X-Ray but the radiation is stronger. It is a painless procedure which involves lying on a table and a large machine rotating around you. It is directed at the tumour to try to kill the tumour or stop the cancer cells growing without damaging the healthy tissue nearby. Radiotherapy is usually performed in an outpatient clinic. It usually takes place everyday Monday to Friday and lasts for about 10-20 minutes. Your treatment team will be able to tell you how many weeks you will need radiotherapy for.
Click here to view an example of radiation therapy.
Chemotherapy | Haumanu matū
Chemotherapy is sometimes required as an additional treatment depending on the stage of the cancer. Chemotherapy uses drugs to kill cancer cells and stop the cancer growing and dividing.
Chemotherapy is a drug which is administered either by swallowing tablets; through an injection; or through infusion which is a small tube that is inserted into a vein. The drug works by moving through the blood stream to kill the cancer cells. Unfortunately, some healthy cells can also be harmed leading to side effects. Chemotherapy can be given alone or in combination with other therapies such as targeted therapy, surgery, or radiation. It is usually administered in an outpatient clinic and sometimes a hospital stay is needed if the doctor wants to monitor you following treatment.
Click here to view an example of chemotherapy infusion | Pāwhirihia ki kōnei kia tirohia te hoahoa whāuru haumanu matū.
Targeted therapy | Haumanu heipū
Targeted therapy uses drugs to attack specific features of cancer cells and stop the cancer growing. It may be used if surgery is not an option, or the cancer has spread.
Targeted therapy involves blocking the processes that change normal cells into cancer cells. As the therapy treats only the cancer cells, healthy cells are not affected, and fewer side effects occur. Targeted therapies can be delivered intravenously, injected directly into tumors or via oral tablets.
A targeted therapy called ERBITUX® (cetuximab) will be publicly funded in New Zealand from 1 November 2024 for patients diagnosed with a very specific type of advanced bowel cancer known as left-sided RAS wild type and BRAF wild-type metastatic colorectal cancer.
Talk with your health care team about whether targeted therapy is recommended for you.
Click here to view a diagram of targeted therapy | Pāwhirihia ki kōnei kia tirohia te hoahoa haumanu heipū
Immunotherapy | Haumanu awhikiri
Immunotherapy is designed to boost the body’s natural defences to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. One common type of immunotherapy is called an immune checkpoint inhibitor. Immune checkpoint inhibitors work by blocking the pathways that would otherwise allow the cancer to hide from the immune system.
The immunotherapy, Pembrolizumab (Keytruda) is funded in New Zealand for microsatellite instability high or deficient mismatch repair (MSI-H/dMMR) colorectal cancer (CRC) patients.
Talk with your health care team about whether immunotherapy is recommended for you.
Clinical trials | Whakamātau haumanu
You may be eligible to take part in a clinical trial, which is a type of research study that investigates new or specialised therapies or treatments. While you are discussing therapy options with your care team, it is a good idea to ask about clinical trials that may be suitable for your condition and discuss whether participating may be right for you.
Being involved in a clinical trial may be beneficial in that you may access the latest treatments before they become generally available. Additionally, clinical trial participation is often associated with closer monitoring of your care and condition and potentially improved outcomes.
Clinical trials are free, and travel and accommodation (if needed) are provided.
Click here to learn more about clinical trials | Pāwhirihia ki kōnei kia tirohia tētahi tauira o te whāuru haumanu matū.
Palliative care | Pairuri
A specialist may refer a patient to palliative care services, but this doesn’t always mean end-of-life care. Today people can be referred to these services much earlier if they’re living with cancer. Palliative care can help one to live as well as possible including managing pain and symptoms. This care may be at home, in a hospital or at another location one prefers. Additional supportive care (treatment or services that support you through a cancer experience) are also available.
Traditional Māori Healing | Rongoā Māori
Rongoā Māori is a body of knowledge that takes a holistic view to wellbeing and treatment. In particular, it focuses on hinengaro (mind), wairua (soul), mauri (life essence), ngā atua (Gods) and te taiao (the environment).
There are many providers who are able to provide rongoā services. Your Māori Health team at the hospital will be able to connect you with one nearest to where you live.
See the below websites for more information on rongoā Māori
Other complementary therapies
Complementary therapies are treatments that are used alongside standard treatments. They are often used to boost the immune system, relieve symptoms, and enhance the effectiveness of standard treatments.
Speak to your doctor if you intend to use complementary therapies to ensure that they will work well alongside your treatment.
Some examples of complementary therapies are:
Acupuncture
Meditation and mindfulness
Music therapy
Massage
Aromatherapy
Naturopathy
Tai chi
Pilates
Visualisation or Guided Imagery
Spirituality
Click here to find out more about complementary therapies
Side Effects from Treatment
Ngā mate āpiti
Side effects of bowel cancer treatment | Ngā mate āpiti o te rongoā mate pukupuku kōpiro
As with any medical treatment, you may experience side effects from your cancer treatment. This is perfectly normal and can be a sign that the treatment is working, although it may feel unpleasant. Side effects vary from person to person and depend on the type of treatment, the part of the body treated, and the length and dose of treatment. Most side effects are temporary and go away after treatment ends. Below you can find information on some common side effects of treatments and how you can manage them to improve your daily well-being.
You may experience side effects other than those discussed here.
If you experience side effects, let your healthcare team know when you next see them. If the symptoms feel extreme or are worrying you, get in contact with your oncology team sooner.
Common side effects of bowel cancer treatments | Ngā mate āpiti tōkau o te rongoā mate pukupuku kōpiro
Click on each treatment to learn more about the side effects of that treatment | Pāwhirihia i ia momo rongoā kia tirohia i ngā mate āpiti e hāngai ana
Surgery | Poka tinana
The side effects of surgery depend on the type of surgery you have had and your level of health before the operation. Your surgeon will discuss the risks associated with your cancer surgery. Feel free to ask questions to make sure that you have all the information you need.
Some side effects of surgery are due to the anaesthesia and should fade shortly after the surgery. These include:
Nausea | Whakapairuaki
Vomiting | Whakaruaki
Dizziness | Takaānini
Agitation | Pōkeka
Other side effects are due to the surgical procedure itself which should subside shortly after surgery. These include:
Fatigue | ruha
Pain at the site of the surgery | Mamae wāhi poka
Some additional side effects may present due to the disruption to your digestive system as a result of the surgery and could take weeks or months to recover from.
These include:
Diarrhoea and malabsorption | Kotere me whākapi miti
Weight loss | Heke taumaha
Loss of appetite | Minangaro
Feeling full quickly | Pūnaunau wawe
Slow return of bowel function (ileus)
Specific risks of bowel cancer surgery include:
Damage to other structures for example the ureter
Scar tissue around the bowel (adhesions)
Hernia
Chemotherapy and biological therapies | Haumanu matū, koiora
Chemotherapy treatment kills cancer cells, but in the process, damages normal healthy cells which causes side effects. These side effects vary from person to person and depend on the type of treatment, the part of the body treated, and the length and dose of treatment. Below are some common side effects of this.
Nausea and vomiting | Whakapairuaki & Whakaruaki
Loss of appetite | Minangaro
Feeling full quickly | Pūnaunau wawe
Diarrhoea and constipation | Kotere me te Kōroke
Fatigue | Ruha
Weight loss | Heke taumaha
Sore mouth or throat | Mamae o te Waha/ Korokoro
Taste changes | Panonitana rongo tawara
Hair loss | Whakahewa
Dry or itchy skin | Kiri mangeo
Foggy brain
Some chemotherapy side effects can be life threatening therefore it is important to go to contact your oncology team or go to your nearest emergency department immediately if you experience any of the following and let them know that you are undergoing chemotherapy treatment. These include:
Fever or chills
Pain in your chest or difficulty breathing
Diarrhoea
Vomiting that is not eased with anti-sickness medication
Bleeding from the gums or nose that doesn’t stop
Pain or blood present when passing urine
Radiation therapy | Haumanu iraruke
Radiation therapy is used to kill cancer cells, but it can also kill some healthy cells near to the cancer site too. Although radiation therapy itself does not hurt, you may experience some symptoms afterwards due to the affect the radiation has on the healthy cells. These symptoms may include:
Nausea and vomiting | Whakapairuaki & Ruaki
Loss of appetite | Minangaro
Feeling full quickly | Pūnaunau wawe
Diarrhoea and constipation | Kotere & Kōreke
Fatigue | Ruha
Similar to a sunburn - at the radiation site | Mamae Tīkākā
Weight loss | Heke taumaha
Managing symptoms and side effects | Whakahaere tohumate me ngā mate āpiti
Click on the symptoms below to find information on how to manage symptoms and side effects | Pāwhirihia i ia momo tohumate mō ngā mōhiohio kia whakahaere ai ngā tohumate me ngā mate āpiti
Fatigue | Ruha
A common side effect of treatment is feeling constant tiredness (fatigue). Treatment or the cancer itself can reduce the number of red blood cells in your body, resulting in anaemia, which can make you feel very tired.
Tips to manage fatigue | Ngā kupu āwhina mō te whakahaere i te ruha:
Use your energy wisely
Plan ahead for when you feel too tired to cook
Shop online for groceries
Bulk cook meals you can store in the freezer
Cook when you have more energy
Ask and accept offers of help with shopping and cooking from whānau and friends
Use home delivery services such as Meals on Wheels or other companies that bring pre-prepared food to you. You can ask for help to access these via your social worker
Keep snacks handy in your bag or car
Activity can help with fatigue
Regular, gentle exercise can help improve fatigue and your appetite
Activity can mean many things – walking, stretching, even vacuuming!
Set small goals. Set a timer for five minutes and see what you can manage in this time
Eat with others.
Loss of appetite | Kore hiakai
It can be discouraging to lose your appetite. You may lose your appetite because of the effects of cancer itself, the treatment, or other side effects, such as feeling sick, not enjoying the smell of food, or feeling upset. To help you can:
Eat small amounts often, e.g., every 2–3 hours. Keeping to a regular eating pattern rather than waiting until you are hungry will mean your body gets the nourishment it needs to
Use a smaller plate – a big plate of food may put you off
Eat what you feel like when you feel like it. Have cereal for dinner or a main meal at lunch
Include a variety of foods in your diet
Sip fluids throughout the day
Replace water, tea and coffee with drinks or soups that add energy (kilojoules/calories), such as milk, milkshake, smoothies, replacement drinks or soup
Relax dietary restrictions – maintaining your weight or regaining weight you have lost is more important than avoiding full-fat and other high-energy foods
Gentle physical activity can stimulate appetite – take a short walk around the block
Eat with others
Keep snacks handy e.g., in your bag or car so you can eat on the go
Talk to your dietitian about liquid meal replacements that might be easier to digest.
Taste or smell changes | Rongo kakara me te hā
Some treatments such as chemotherapy can change the way food and/or drink taste or smell. It may taste bland or metallic.
Tips on managing changes in taste include:
Add extra flavour to food if it tastes bland – like fresh herbs, lemon, lime, ginger, garlic, soy sauce, honey, chilli, or pepper
Experiment with different food, as your tastes may change
If meat tastes bad during treatment, replace it with other protein sources like cheese, eggs, nuts, dairy foods, baked beans, lentils, or chickpeas
Add small amounts of sugar to food if it tastes bitter or salty
Use a straw when drinking
Change from using metal cutlery to plastic or bamboo cutlery
Tips on managing changes in smell include | Ngā kupu āwhina mō te whakahaere i ngā panoni rongo kakara:
Eat cold food or food at room temperature (hot food smells more)
Reheat pre-prepared meals in the microwave so the cooking smell doesn’t put you off
Stay out of the kitchen, if possible, when food is being prepared
Ask family or friends to cook
Use the exhaust fan, open the kitchen window, or cook outside to help reduce cooking smells
Nausea and vomiting | Whakapairuaki me te ruaki
Feeling sick and vomiting are often side effects of cancer, its treatment, or some medicines. They often occur together, but not always.
Nausea | Whakapairuaki
Nausea is stomach discomfort and the sensation of wanting to vomit. Nausea can be a precursor to vomiting the contents of the stomach and may be caused by treatment, stress, food odours, gas in the gastrointestinal tract, motion sickness or even the thought of having treatment.
Tips on how to cope with nausea | Ngā kupu āwhina ki te morimori i te whakapairuaki:
Have a light snack before treatment and wait a few hours before eating again
Eat small meals 5–6 times during the day. Going without food for long periods can make nausea worse
Snack on dry or bland foods, e.g., crackers, toast, dry cereals, bread sticks or pretzels
Choose cold foods or foods at room temperature instead of hot, fried, greasy, or spicy foods
Eat and drink slowly and chew your food well
Try foods with ginger, e.g., ginger biscuits, or ginger beer
Avoid foods that are overly sweet, fatty, fried, spicy, or oily, or that have strong smells
Brush teeth regularly to help reduce unpleasant tastes that may make you feel nauseated
Do not eat your favourite food when feeling nauseated to avoid developing a permanent dislike
Suck on hard lollies – flavoured with ginger, peppermint, or lemon
Try ginger food and drink items, such as candied ginger, ginger beer, ginger ale, or ginger tea. Talk to your dietitian doctor or pharmacist about ginger supplements
Take anti-nausea medicines as prescribed. Let the doctor know if the medicines don’t seem to be working.
Vomiting | Ruaki
Vomiting is the forcible emptying (“throwing up”) of stomach contents through the mouth. Vomiting can follow nausea and may be caused by treatment, stress, food odours, gas in the gastrointestinal tract, motion sickness or even the thought of having treatment.
Vomiting is more serious than nausea. Vomiting can cause dehydration and increase the risk of malnutrition. See a doctor if you are vomiting for more than one day, especially if you cannot keep water down as you may become dehydrated.
Tips on how to cope with vomiting | Ngā kupu āwhina ki te morimori i te ruaki:
Take small sips of water or clear liquids, such as ginger ale, soda water or sports drinks like Gatorade or Hydrolyte. Dilute sweet drinks. If you feel like a fizzy drink, open it, and let it sit for 10 minutes or so, and drink it when it’s a bit flat
Sucking on crushed ice cubes or an ice block can be soothing
Once you can keep clear liquids down try some different drinks, such as consommé and clear broths, weak tea, herbal tea, fruit drinks, beef, and chicken stocks
Have small, frequent meals and snacks throughout the day
Introduce bland, starchy foods, such as plain biscuits, bread or toast with honey or jam, peanut butter, rice, yoghurt, or fruit. Attempt small, frequent servings at first
Consume a little bit more each time until you are eating a well-balanced diet.
Chewing and swallowing | Ngaungau me te horomi
After treatment chewing and swallowing may be difficult and painful. Surgery, radiotherapy, and chemotherapy can cause temporary problems. People with dentures who have lost weight may also find their teeth become loose, which can make eating difficult.
Signs that you are having problems with chewing and swallowing include taking longer to chew and swallow, coughing or choking while eating or drinking, or food sticking in your mouth or throat like a ball.
Tips on chewing and swallowing | Ngā kupu āwhina mō te ngaungau me te horomi:
Change how you prepare your food by chopping food up into smaller pieces or pureeing
Let your doctor know that you are having issues and get a referral to see a speech pathologist and dietitian
A speech pathologist can monitor your ability to swallow and suggest modifications to the texture of your food once your ability to swallow and chew begins to improve. A dietitian can ensure you are meeting your nutritional needs.
Mouth changes | Ngā panonitanga o te waha
Some chemotherapy drugs and some pain medicines can make your mouth dry, cause mouth ulcers, or change the amount of saliva in your mouth. A dry mouth can increase the risk of tooth decay and infections such as oral thrush, which will make eating harder.
Ulcers may also be present in your digestive tract, causing discomfort in the stomach or bowel and diarrhoea.
Tips to lessen discomfort with mouth sores | Ngā kupu āwhina ki te whakamauru i ngā harehare waha:
Suck on ice cubes
Eat soft foods – stews, soups, scrambled eggs, and smoothies
Cold foods and fluids may be more comfortable than hot ones
Avoid ‘coarse’ foods that can irritate your mouth, such as crackers, toast, nuts, and seeds
Avoid spicy or very hot foods
Use a straw and direct liquids away from the areas where mouth sores are most painful
Talk to your doctor about medication or mouth washes to help manage the pain and allow you to eat more comfortably.
Tips to relieve a dry mouth | Ngā kupu āwhina ki te whakamauru i te waha maroke:
Suck on ice cubes
Keep your mouth clean with regular mouthwashes to prevent infections
Gargle with 1⁄2 tsp salt or 1 tsp bicarbonate of soda in a glass of water
Choose an alcohol-free mouthwash to avoid irritating your mouth further
Use a soft toothbrush when cleaning your teeth
Ask your dentist or health care team about suitable mouth rinses or oral lubricants
Limit alcohol and coffee as these are dehydrating fluids and avoid smoking
Avoid ‘coarse’ foods that can irritate your mouth, such as crackers, toast, nuts, and seeds
Avoid spicy or very hot foods
Soften food by dipping it into milk, soup, tea, or coffee
Moisten with sauce, gravy, cream, custard
Sip fluids with meals and throughout the day
Chew sugar-free gum to stimulate the flow of saliva.
Changes in bowels- constipation and diarrhoea | Ngā panonitanga o ngā kōpiro
Living with cancer and its treatments can result in changes to your bowel habits. This could be differences in the appearance, consistency, and/or the smell of your stools.
Constipation | Kōroke
This is when your bowel motions are infrequent and difficult to pass. It can be caused by different factors including regularly taking opioid medicines; having a diet low in fibre; not getting enough exercise; not having enough fluids to drink (dehydration); or having a low overall food intake.
Tips on how to manage constipation | Ngā kupu āwhina mō te whakahaere kōroke:
Soften stools by drinking 8–10 glasses of fluid a day, e.g., water, herbal tea, milk-based drinks, soup, prune juice
Eat foods high in fibre, e.g., wholegrain breads, cereals, or pasta; raw and unpeeled fruits and vegetables; nuts and seeds; legumes and pulses
If you are increasing the amount of fibre in your diet, increase fluids to prevent the extra fibre making constipation worse
Ask your doctor about using a laxative, stool softener and/or fibre supplement
Exercise – check with your doctor, exercise physiologist or physiotherapist about the amount and type of exercise that is right for you.
Diarrhoea | Kotere
This means your bowel motions are watery, urgent, and frequent. You may also get abdominal cramping, wind, and pain. Frequent loose stools can occur because you are not digesting food or absorbing nutrients properly. Cancer treatment, medicines, infections, reactions to certain foods and anxiety can all cause diarrhoea.
Diarrhoea can result in dehydration, so it’s important to stay hydrated by drinking extra fluids. Every time you have a loose bowel movement you should drink an extra cup of non-caffeinated fluid. If you have diarrhoea for several days, see your doctor so he/she can determine the cause and help to manage your diarrhoea. Your doctor may decide to prescribe you anti-diarrhoea or over-the-counter medication.
Tips on how to manage diarrhoea | Ngā kupu āwhina mō te whakahaere kōtere:
Drink plenty of fluids to avoid becoming dehydrated. Water and diluted cordials are better than high-sugar drinks, alcohol, or caffeinated fluids – remember signs of dehydration are smaller amounts of dark urine
Choose low-fibre foods, e.g., bananas, mashed potato, rice, pasta, white bread, oats, steamed chicken without the skin, white fish
Avoid foods that increase bowel activity, e.g., spicy, fatty, or oily foods, caffeine, alcohol, or artificial sweeteners
Try soy milk or lactose-free milk if you develop a temporary intolerance to milk (lactose)
Don’t eat too many raw fruit and vegetable skins and wholegrain cereals as they may make diarrhoea worse
Avoid foods and drinks that are high in sugar, such as cordial, soft drinks and lollies
Avoid foods sweetened with artificial sweeteners such as sorbitol, mannitol, and xylitol. These are often marketed as ‘sugar-free’
It may also help to eat small, frequent meals throughout the day, rather than three large meals
Heartburn (Indigestion) | Tokopā
Some cancers and treatments can cause heartburn, which is a burning sensation in the upper chest, oesophagus and/or throat. It is caused by the contents of the stomach coming back up into the oesophagus (reflux).
Heartburn may make you feel too uncomfortable to eat much, which could lead to weight loss. If the tips below do not relieve heartburn, let your doctor know as medication may help to prevent or manage these side effects.
Tips to manage heartburn | Ngā kupu āwhina mō te whakahaere tokopā:
Avoid large meals; try to eat 3 small meals and 3 small snacks throughout the day
Eat slowly and take the time to enjoy your meal
Avoid wearing tight clothing while eating, especially belts
Sip fluids between meals, rather than drinking large amounts at mealtimes
Limit or avoid foods that may make heartburn worse, e.g., chocolate, highly seasoned spicy foods, high-fat foods (e.g., fried food, pastries, cream, butter, and oils), tomato and tomato products, citrus fruits, coffee (including decaf), strong tea, soft drinks, and alcohol
Straight after eating, sit upright for at least 30 minutes and avoid lying down or activities that involve bending over (e.g., gardening)
Peripheral neuropathy | Pūtau Iotaiaki mōwaho:
Peripheral neuropathy is caused by damage to the peripheral nerves. These are the nerves in the body outside the brain or spinal cord. Peripheral neuropathy may be caused by cancer, cancer treatments or other health problems. It most commonly affects the hands and feet. Peripheral neuropathy caused by cancer treatment will get better over time with proper treatment and care.
The most common symptoms of peripheral neuropathy can include | Ngā kōrero tōkau mō te Pūtau Iotaiaki Mōwaho:
Tingling, burning, numbness or pain in the hands or feet
Difficulty doing up buttons and picking up small items
Loss of feeling especially in the hands and feet
Problems with balance or walking, and clumsiness
Be safe. If you notice changes in your walking, stance, fine and gross motor skills, or balance speak to your doctor as soon as possible and ask for a referral to an occupational therapist, exercise physiologist or physiotherapist
Tips to manage peripheral neuropathy | Ngā kupu āwhina mō te whakahaere Pūtau Iotaiaki Mōwaho:
Use a night light so that you don’t trip or bang into anything if you need to go to the toilet at night
Keep clutter and rugs off the floors
Have clear paths to the toilet and bedroom
Use handrails where possible
Use nonslip mats in the shower and bathroom
Be careful on slippery and wet floors
Do not walk around bare footed as you may not notice if you stand on something that could damage your feet
Wear shoes and slippers that fit well
Use a walking stick if you need to
Wear gloves when washing up, cleaning and gardening
Test water temperature with your elbow
Take care when cutting food and opening cans or jars
Keep your skin moisturised to prevent cracking
Check your hands and feet daily for signs of injury, rubbing, redness or infection
Ask for help if you need it, e.g., to do up buttons and shoes
Find clothes and shoes that are easy to put on and take off
Avoid driving if symptoms are severe
Alerting your healthcare team of side effects | Whakaohititia tō rōpu tiaki hauora ki ngā mate āpiti
Your health care team wants to hear about your side effects. Your questions and concerns are important. Do not be afraid to share them. Ask your health care team who you should contact if you feel that your side effects need assessing right away.
Treatment changes | Ngā pānonitanga maimoa
Occasionally, if you have severe side effects, your doctor may discuss delaying or changing your treatment to prevent further discomfort.
Start a symptom diary | Tīmatahia he rātaka tohumate
Keeping track of your symptoms can help you and your cancer care team to manage them better.
Know who to contact if you have a problem | Me mōhio hoki ki te whakapā atu ki a wai mēnā he raru tāu
Ask your doctor or nurse:
when you should call for help or advice
who you should contact
how to contact them (including at night or weekends)
Keep this information where you can easily find it.
Our partners at the Pancare Foundation have created a webinar to help patients manage these side effects and help you navigate each day and experience greater quality of life. Pancare's experts share their knowledge surrounding common side effects such as nausea, peripheral neuropathy, fatigue, mouth sores, abdominal discomfort and more. Practical ways to manage these side effects are explored along with information regarding the support and care available for you and your family.
*NB - The PanSupport service mentioned is not available to patients in New Zealand
Diet & Nutrition
Whiringa kai me te taioranga
Why is diet and nutrition important? | He aha e whaitikanga ai te whiringa kai me te taioranga?
You may be feeling that some things are out of your control, however there are a number of actions that you can take to make sure your body is in the best condition to cope with, and heal from, the symptoms and side effects of the cancer and cancer treatments.
Below you will find detail about why diet and nutrition can make a big difference to the healing process and how you feel.
Why does bowel cancer affect nutrition | He aha e pāngia ai te mate pukupuku kōpiro i te taioranga?
Bowel cancer, and cancer treatments place extra demands on your body. They can also cause you to lose your appetite and energy, putting you at an increased risk of malnutrition. It is important to ensure that your body is receiving the right nutrition before, during and after treatment to be able to cope with these extra demands.
Your food choices when you have cancer and are undergoing treatment may be very different from what you are used to eating.
The main goal is to try to keep your weight constant, maintain muscle strength, maintain a healthy weight, and have more energy, all of which help your body to heal properly, improve your quality of life and give you the energy to cope with all the new challenges treatment may bring.
Bowel cancer and the treatments for bowel cancer may impact | Mō te tūpono noa e pāngia ai koe e te mate pukupuku kōpiro me ngā maimoatanga o te mate pukupuku Kōpiro:
Your nutritional requirements and what you need to eat
How much you eat
Your appetite
Your ability to digest food
Your ability to maintain your weight and muscle mass
Your energy levels and general wellbeing.
Good nutrition can help to | He mea āwhina te taioranga pai ki te:
Manage the side effects of treatment
Speed up recovery after treatment
Heal wounds and rebuild damaged tissues after surgery, radiotherapy, chemotherapy, or other treatment
Improve the body’s immune system and ability to fight infections
Overall, try to make food choices that provide you with enough | Nā reira, me ngana ki te whiriwhiri i ngā kai ka whakaratoa ki a koe:
Calories (to maintain your weight)
Protein (to help rebuild tissues that cancer treatment may harm)
Nutrients such as vitamins and minerals
Fluids (essential for your body’s functioning)
Exercise can also help with appetite and digestion issues related to treatment.
Nutritional tips during treatment | He kupu āwhina taioranga e koke ai te maimoatanga
To maintain good nutrition | Kia mau roa ki te taioranga pai:
You may need more energy (kilojoules/calories).
Eat small, frequent meals or snacks, rather than three large meals a day.
Ask for a referral to a dietitian – discuss eating issues, weight issues, muscle loss.
Do some light physical activity, such as walking, to improve appetite and mood, reduce fatigue, help digestion, and prevent constipation.
Check with your doctor or dietitian before taking vitamin or mineral supplements or making other changes to your diet.
Relax dietary restrictions, e.g., choose full-cream rather than low-fat milk.
Consider using nutritional supplements if you cannot eat enough – discuss options with your doctor, palliative care specialist or dietitian.
Nutritional tips following surgery | Ngā kōrero āwhina taioranga whai muri i te pokanga
Click here to learn more about nutritional tips following surgery | Pāwhirihia ki kōnei mō ētahi atu kupu āwhina taioranga
Surgeries used to treat cancer may result in a variety of side effects, including weight loss. The side effects usually only last for a short period of time, but you may have to make some changes to your diet to ensure that you are getting enough nutrition and maintaining your weight.
Your body needs good nutrition after surgery, and it is an important part of your recovery process. If you are struggling to eat or drink, the hospital may prescribe nutrition supplements, or recommend tube feeding, to help you to maintain weight and provide you with the nutrients you need for speedy recovery.
Tips on maintaining weight after surgery | Ngā kupu āwhina ki te whakataki taumaha whai muri i te pokanga:
Monitor your weight – weigh yourself once or twice a week to monitor for any weight loss
If you are losing weight, tell your doctor and get a referral to see a dietitian
Eat small, frequent meals after surgery so your digestive system only has to deal with a small amount of food at a time
We recognise that dietary changes have a huge impact on everyone with cancer. It can take a while to get used to changes to your diet and lifestyle but finding ways to manage your diet and symptoms can help you feel more in control. It can also be helpful to speak to your dietitian, doctor or nurse.
Living well with cancer
Kia ora pai ai
Learn more about living with cancer.
Read about other people’s cancer journeys see our personal journeys page.
Useful websites and patient support | Ngā pae tukutuku whai take me ngā wāhi āwhina tūroro
Bowel Cancer NZ - Working to Beat Bower Cancer / Colon Cancer
Our friends at Bowel Cancer NZ provide a comprehensive set of resources for patients and families affected by bowel cancer. They also have a registered nurse available by phone on 0800 BCNZ NURSE (0800 226 968) or through their website chatbot Monday to Thursday 10am – 4pm and also by email. The BCNZ nurse will be able to answer questions about the effects of various treatments, explain bowel cancer terminology, and provide support, information, and contacts for other services.
National Bowel Cancer Screening Programme (NBSP) - Bowel screening | Time to Screen - National Screening Unit
Bowel screening will be offered every two years to men and women aged 60-74 who are eligible for publicly funded healthcare. When it is your turn to be screened, you will receive an invitation letter, a consent form, and a free bowel screening kit. Invitations are sent within two years of the programme starting in your area. Visit the NBSP website - Time to Screen NZ - for more information about the screening programme in your area or visit the Bowel Cancer NZ website for more information.
Bowel Cancer Foundation Trust
Bowel Cancer Foundation Trust provides screening, rehabilitation and helps with treatment for those who do not qualify in the public system to detect bowel cancer early and help save lives.