Advanced bowel cancer

When bowel cancer has spread to the liver, lung or lining of the abdomen and pelvis (omentum and peritoneum), this is known as advanced or metastatic (stage 4) bowel cancer. To control the cancer, slow its growth and manage symptoms such as pain, you may have a combination of chemotherapy, targeted therapy, radiation therapy and surgery.

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Systemic treatment

Advanced bowel cancer is commonly treated with drugs that reach cancer cells throughout the body. This is called systemic treatment, and includes chemotherapy and targeted therapy.

Targeted therapy drugs work differently from chemotherapy drugs. While chemotherapy drugs affect all rapidly dividing cells and kill cancerous cells, targeted therapy drugs affect specific molecules within cells to block cell growth.

Monoclonal antibodies are the main type of targeted therapy drug used in Australia for advanced bowel cancer. They include:

Bevacizumab – This drug stops the cancer developing new blood cells and growing. It is given as a drip into a vein (intravenous infusion) every two to three weeks, with chemotherapy.

Cetuximab and panitumumab – These drugs target specific features of cancer cells known as epidermal growth factor receptors (EGFR). They only work for people who have a normal RAS gene (known as RAS wild-type). The tumour will be tested for changes (mutations) in these genes before you are offered these drugs. These drugs are usually given as a drip into a vein (intravenous infusion). They may be given with chemotherapy or on their own after other chemotherapy drugs have stopped working.

Other types of targeted therapy drugs may be available on a clinical trial. Talk with your doctor about the latest developments and whether you are a suitable candidate.

Scans and blood tests will be used to monitor your response to systemic treatments. If results show that the cancer is shrinking or is under control, chemotherapy and/or targeted therapy will continue. If the cancer is growing, that treatment will stop and alternative treatments will be discussed.

Side effects of targeted therapy

The side effects of targeted therapy vary depending on the drugs used. Common side effects of bevacizumab include high blood pressure, tiredness, bleeding and headaches. The most common side effects of cetuximab and panitumumab are skin problems (redness, swelling, an acne-like rash or dry, flaky skin), tiredness and diarrhoea.

For more on this, see Targeted therapy.

Radiation therapy

Radiation therapy can also be used as a palliative treatment for both advanced colon and advanced rectal cancer. It can be used to stop bleeding and, if the cancer has spread to the bone or formed a mass in the pelvis, it can reduce pain. For further details, see Radiation therapy.


If the cancer has spread to other parts of the body, you may still be offered surgery. This can help remove some secondary cancers (e.g. in the liver or lungs) or relieve a bowel obstruction.

You may have surgery to remove parts of the bowel along with all or part of other affected organs. This may be called an en-bloc resection or, if the cancer is in your pelvis, an exenteration.

If the cancer has spread to the lining of the abdomen (peritoneum), you may have surgery to remove as many tumours as possible. This is known as a peritonectomy or cytoreductive surgery. Sometimes, a heated chemotherapy solution is inserted into the abdomen during a peritonectomy. This is called hyperthermic intraperitoneal chemotherapy (HIPEC). Recent studies suggest that surgery alone may be as effective as surgery followed by HIPEC, and ongoing research continues to test the best approach to treatment.

The type of operation used for advanced bowel cancer will depend on your situation, so talk to your surgeon about what to expect. Your medical team will advise what kind of follow-up and treatment is recommended after surgery. Regular check-ups have been found to improve survival for people after surgery for bowel cancer, so you should have check-ups for several years.

Many treatments for advanced bowel cancer are best performed in a specialised centre. Call 13 11 20 for more information or to ask about assistance that may be available if you have to travel a long way.

Other treatments

If the cancer cannot be removed with surgery, but has only spread to a small number of places in a single area, your doctor may recommend another type of treatment to destroy or control the cancer. These treatments, including thermal ablation, selective internal radiation therapy (SIRT) and stereotactic body radiation therapy (SBRT), are only suitable for some people. They are best performed in a specialised centre or may be offered as part of a clinical trial.

Palliative treatment

Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease. It is best thought of as supportive care.

Many people think that palliative treatment is for people at the end of their life, but it may help at any stage of advanced bowel cancer. It is about living for as long as possible in the most satisfying way you can.

Sometimes treatments such as surgery, chemotherapy, radiation therapy or targeted therapy are given palliatively. The aim is to help relieve symptoms such as pain or bleeding by shrinking or slowing the growth of the cancer.

Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical, social and spiritual needs.

For more on this, see Palliative care and Living with advanced cancer.

Video: What is palliative care?

This short video explains how palliative treatment aims to manage symptoms and improve people’s quality of life without trying to cure the disease.

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Different ways to download an EPUB file to your Apple device:

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To download an EPUB to your Kobo from a Mac:

  • download and save the EPUB directly onto your desktop.
  • connect your Kobo to your computer using the USB cable and tap “Connect” on your eReader.
  • open your “Finder” application.
  • select “Kobo eReader” from the listed devices to view the contents of your Kobo.
  • navigate to where you have stored your EPUB file in “Finder”, probably in documents or downloads, and drag and drop it into the Kobo window. You can now disconnect your Kobo to read the eBook.

Turn on your Kobo and your EPUB will be located in “eBooks”, while a PDF will be located in “Documents”.
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To download an EPUB file on your Sony Reader™:

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  • select the eBook you want from our website and click the link to download it.
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Amazon Kindle 2nd Generation devices

EPUB files can’t be read on the Amazon Kindle™. However, like most eReaders, Kindle™ 2nd Generation devices are able to display PDFs. We recommend that you download the PDF version of this booklet if you would like to read it on a Kindle™.
To transfer a PDF to your Kindle™ via USB cable from your computer or Mac:

  • download the PDF directly onto your computer.
  • connect the USB cable to your computer’s USB port, and the micro USB end of the cable to your Kindle™. Note: the Kindle™ won’t be available as a reading device while it is connected to your computer until it has been disconnected.
  • open the Kindle™ drive and several folders will appear inside. The “Documents” folder is where you will need to copy or drag the PDF to.
  • safely eject your Kindle™ from your computer and unplug the USB cable. Your content will appear on the Home Screen.

Kindle also provides a Kindle Personal Documents Service that allows users to send documents as an attachment directly to your eReader. For more information on this service, visit
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You can also download and open eBooks on Android devices and PCs with appropriate apps or software installed. Suitable eReader apps for Android include Google Play Books, FBReader and Moon+ Reader. Suitable software for PCs include Calibre and Adobe Digital Editions.

This information was last reviewed in February 2019
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