Diagnosis of bowel cancer: what treatments are available?

A tumour is detected and the diagnosis is bowel cancer. Mr Sauter, what is the best course of action for those affected in this situation?

Receiving such a diagnosis is usually unexpected and often a big shock. Nevertheless, it is important to remain calm. I often arrange a second consultation a day or two later, because a lot of questions only arise during the course of care. I offer patients the opportunity to bring a family member or friend to the appointment. It can also be helpful for those affected to take notes during the consultation. Important questions include further clarification steps, the stage of the disease and the type of therapy. Patients often want the tumour to be removed today or tomorrow. However, it is important to know that such tumours do not spread within a few days. This means that it usually makes no difference whether the tumour is operated on or treated the following day or two weeks later. Sufficient time should be allowed for thorough staging.

What steps follow such a diagnosis?

If a tumour is detected during a colonoscopy, very small samples, so-called "biopsies", are taken. These are examined by the pathology department under a microscope using various stains in order to classify the tumour more precisely, as this has a major influence on the type and intensity of therapy. At the same time, an imaging procedure is carried out, usually a computerised tomography scan, to look for metastases in lymph nodes and other organs such as the liver or lungs.

Let's talk briefly about the individual treatment strategy: To what extent does the stage of the disease play a role in this?

The stage plays a very important role, more precisely the questions of whether the cancer is superficial on the mucous membrane or growing in depth and whether lymph nodes or other organs are affected. The stage, the location (rectum or colon) and the characteristics of the tumour under the microscope determine whether surgery, chemotherapy, radiotherapy or a combination of different therapies are primarily used. Sometimes chemotherapy is given before surgery - for example, in the case of rectal cancer in combination with radiotherapy - and sometimes afterwards.

Colorectal cancer can be detected not only in the large intestine, but also in the small intestine: How do the possible therapies differ for patients?

That is correct. Tumours can also occur in the small intestine, but these are much rarer. In addition, they usually do not develop from precursors. For these reasons, good prevention is not possible. The treatment is similar to that for the large intestine - a combination of surgery, chemotherapy and radiotherapy.

Finally, let's take a brief look at the past: is bowel cancer still treated in the same way today as it was 20 years ago?

No, there has been enormous progress. Laparoscopy" is often used during surgery, i.e. keyhole surgery, in which a camera and instruments are inserted into the abdominal cavity via three to four small incisions in the abdomen to remove the tumour. Sometimes an artificial bowel outlet (stoma) has to be temporarily created, but in the majority of operations this is not necessary.

Enormous progress has been made in recent years, not only in surgery but also in drug therapies. Chemotherapy has become much better tolerated and more efficient. In the past, patients with metastases, for example in the liver, could not be cured, but today this is often possible. There are also a number of new therapies that use antibodies to kill cancer cells, for example, or therapies that enable the immune system to attack the tumour, so-called "checkpoint inhibitors", to name just a few examples.