Although giving radiation before rectal cancer surgery reduces the risk that cancer will return in the rectum and nearby tissues, it does so at a cost. Quality-of-life studies that accompanied a trial of a short course of radiation therapy before surgery found more sexual and bowel problems with presurgical radiation.
During the Medical Research Council CR07 clinical trial, patients with rectal cancer were randomized to receive a short, five-day course of radiation before their surgery or surgery with chemoradiation afterwards only for those with cancer cells remaining in tissues outside the tumor . Three years later only 4 percent of the presurgical radiation group had cancer return locally compared to 11 percent of those treated with surgery and selective postsurgical chemoradiation. Presurgical radiation patients were also more likely to be alive five years later — 78 percent of them survived compared to 72 percent of the patients who didn’t have radiotherapy before their surgery.
Three months after surgery both groups of men had issues with sexual functioning, which researchers attributed to the surgery. Those difficulties returned to normal as patients recovered. However, additional problems with sexual function developed later for men who had presurgical radiation. They declined over time, but some men still reported difficulties three years later.
Men had no less interest or enjoyment in sexual activities, but did have problems with function. For both groups, men who had colostomies had worse function three months after surgery than men who had surgery that preserved anal sphincters.
Overall, bowel problems weren’t different between the two groups, but in one area radiation made a difference. Eighteen months after surgery, patients who had radiation were more than twice as likely to have stool leakage and bowel incontinence (16.4 percent versus 6.5 percent).
Results of local recurrence at three and five years during the trial were first presented at ASCO in 2006.That report found that with the best surgery, which removed the rectum and its entire surrounding tissue, along with short-course preoperative radiotherapy, almost completely eliminated local recurrence. Only one percent of the 1,350 patients in the study had cancer return in the rectum or local area around it when they received excellent surgery and presurgical radiation.
Without preoperative radiotherapy, 6 percent of patients had local recurrence. When surgery was not optimal, 9 percent of patients with preoperative radiation and 19 percent of those who did not have radiotherapy had local recurrence three years later.
Discussing the results of the quality of life analysis at ASTRO, David Sebag-Montefiore, MD, a leader of the study and a radiation oncologist in Leeds, UK, said,
We know that this and other trials have consistently shown that radiation before surgery reduces the risk of local cancer returning. However, this has to be balanced against any negative side effects. The results of our quality of life study should help doctors and patients to discuss both the benefits and risks of pre-operative radiation before surgical removal of rectal cancer.
You can hear an interview with Dr. Sebag-Montefiore recorded at ASTRO on Medpage Today.
September 27, 2008 at 9:53 pm, Mike Jackson said:
Had 90% of rectum removed, wore an iliostomy for seven months and was reversed in Feb. Still having bowel problems constipation followed by diareah, lasting maybe for the entire day. I cant plan to do anything at all. Im forty six and single. I have problems with sexual activities and I poop my pants. If there is any humor in the whole thing, is that Im about to loose my mind with all of the hospital bills to give me this wonderfull life they title, At Least Your Alive. I have nothing to offer a woman, and I live in fear of having accidents. Sincerly: Mike Jackson
October 12, 2008 at 3:02 pm, Anthony M said:
i have the same exact problem. i just cant plan a dam thing cause there are days i have this pressure on my rectum all day and when i finally move my bowels its like a complete emptiness. than im fine for a few days and back to constipation followed by the runs. i hate this and i just want to fix it.
October 24, 2008 at 1:14 am, Laurie said:
I am a 48 yr old woman, but I understand the negative feelings. I had the same, rectal cancer, preop chemo-rad., temp.ileostomy, reversal 4 months ago. It does feel cruel sometimes to be told we should be glad to be alive. I am struggling with being overwhelmed by the debt and need to earn money when I am limited and tired (though I have a husband who works at a pretty decent job). The answer to me is in Jesus Christ my Savior. He gives eternal life, real life and says He came to give us life and life more abundant. “I am the Way, the Truth, and the Life. No man cometh unto the Father but by Me.” John 14:6 There really is hope and joy and lack of problems beyond this life, and help through each moment here. Please consider turning to the Lord and His Word, the Bible, for Light in your darkness. It’s still hard, but you will be okay.
October 29, 2008 at 5:53 pm, Julie said:
My husband just finished pre-surgical radiation 28 rounds w/low-dose chemo and he is only 47 yrs old. He’ll have the procedure with colostomy mid-december, and they wont reverse until 2nd round of chemo is done 4 to 6 months post-surgery. Even though I’m just the wife-caregiver, and its not me its happening to, I’d so much rather have him here than the alternative. Leaky bowels, sexual dysfunction, we’ll deal with it all. Yes it does suck, but his life is still worth living. I love him for his mind, his heart, his kindness etc. If his butt is broken, I just dont care.
April 13, 2009 at 9:39 pm, Mauraid said:
I have just been diagnosed with either Stage II or III Rectal Cancer and the surgeon has been pushing me to have 3 months of pre-op chemo and radiation. I have absolutely nothing else wrong with me except the single rectal tumor. I worry that generalized lower abdominal radiation will create other problems in the long run. I do not understand why the chemo must be systemic and not targeted at the single tumor. Any replies to these questions would be appreciated.
Also, regarding leakage, etc, would an ostomy that you can control be better than the leakage and incontinence?
April 20, 2009 at 10:37 am, Kate Murphy said:
You have good questions to ask your radiation oncologist and surgeon.
The pre-operative chemotherapy sensitizes radiation and has been found to reduce risk of cancer returning in and around the rectum over radiation itself. There is currently no way to deliver chemotherapy to the rectal tumor other than systemically.
Pre-operative chemoradiation can also reduce risk of needing an ostomy.
Whether an ostomy is a better choice than bowel problems after radiation and rectal surgery is a good question to ask. Many people live very well with ostomies. It is also possible to have an ostomy created later on if you find rectal problems intolerable.
However, many folks live very well with few or no bowel problems after radiation and surgery for rectal cancer. It may take a while before the bowel activity returns to normal.
June 16, 2009 at 7:38 pm, Catherine said:
I had anal cancer and had chemo and radiation. It took me 3 years to get over the effects of the chemo and the radiation. Then the cancer came back. I had a complete rectum removal and I now have a ostomy bag. I don’t have to worry about the leakage or any orders, etc. I wish I had let the doctors do the surgery the first time around. After my surgery, I was back to work in 1 month and was riding my horses after 4 months. I can do just about anything I want to do. I am not as strong physicaly as I was before the chemo and the surgery but I am working on that. I am female, and 52 years old. I too am lonely sometimes because I am afraid to date because I will have to tell them i wear a ostomy bag. Most people that haven’t had any recent experience with them still think thay are like the old days when they were big smelly bags, but it is not like that any more. I can wear whatever I want (except a bikini) and you can not tell I am wearing a bag.
April 07, 2012 at 5:08 pm, Jan said:
I’ so happy to hear that I am not the only one experiencing these problems. I was diagnosed with rectal cancer ( almost stage 3) in Dec 2009. My team was very aggressive and started chemo (port a cath 24/7) and radiation 5 days a week, for 29 treatments. I had very little problems during this treatment. I had surgery where 12-13 inches of colon and most of the rectum plus 13 lymph nodes were removed. All came back cancer free. Then I started 6 months of chemo follow up, an IV at the drs then 48 hrs with a portable pump then 11 days off then the process began again. By about the 9th or 10th day I was starting to feel normal, other had to start over. Now 17 months after las Chemo I still have terrible days. I can seldom leave home without a pad on to protect from leakage, seem to spend hours in the bathroom at home, go days with eating white rice, bananas and Imodium like it is going out of style. It’s very hard to work, but I do and even harder to plan an event because I never know if it’s will be a good day (or week) or a bad one. My husband doesn’t understand what I am going through. My drs have said to tell him, and others, that we are asking a colon that has performed colon functions for 50 years+ to suddenly start performing like a rectum. Well mine is fighting me all the way. I can only hope that it does straighten out and this will not be something to be dealt with for the rest of my life. I know this is long but I am thankful to hear from the rest of you that I am not alone. Thanks and hope all works out for everyone.