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Introduction

Bowel cancer refers to cancer of the colon or rectum, two organs which together form the large bowel or large intestine. This section of the bowel starts on your right side, near your appendix, and ends at your anus, or back passage. Bowel cancer is very common, with over 2,000 cases diagnosed every year in Ireland. The number of cases per year is increasing because of a variety of factors, including an ageing population and the new bowel screening programme, which will be rolled out over the next few years.

As one of the eight national cancer centres, St James’s Hospital is a specialist in the management of large bowel cancer, providing 10% of all colorectal cancer care in the country. The unit has three colorectal surgeons who specialise in keyhole surgery for bowel cancer and two colorectal surgeons. They work alongside specialist nursing units in colorectal cancer care, stoma management and colorectal inpatient care and are supported by a specialist dietetic service. Chemotherapy is provided by the Colorectal Oncology Department, led by Professor John Kennedy, and colorectal radiotherapy is provided in the St Luke’s Centre on campus, led by Dr Charles Gilham. All colorectal cancer cases are discussed at a weekly multidisciplinary team meeting attended by these specialists. As St James’s Hospital is a national cancer centre, patients may be referred from another hospital for surgery.

Colorectal cancer treatment is often successful. The outcome is much better the earlier the patient is diagnosed, so anyone with a concern should attend their doctor immediately.

  • There are different treatments that may be available once you have been diagnosed with bowel cancer. The main treatment is surgery, with chemotherapy and radiotherapy used quite regularly, either before or after surgery, depending on each patient’s situation. Surgery usually involves removing a section of bowel and then rejoining the two pieces. Sometimes it is not possible to join the pieces back together and the patient may be given a stoma or bag. This means that a small opening is made on the patient’s stomach wall, through which their bowel empties into a bag. Patients can function perfectly normally with a stoma.

    The type of surgery you receive will depend on where in the bowel the cancer is found.

    • Right Hemicolectomy:  Cancer from the right side of your colon is removed.
    • High Anterior Resection: Cancer in the sigmoid colon (the part of the large intestine closest to the rectum and anus is removed.
    • Low Anterior Resection: Cancer in the rectum is removed.
    • Abdoperineal Resection: This involves removing the entire rectum and anus.
    • Subtotal or Total Colectomy: Most or the entire bowel is removed. 

    Cancer in the rectum may require a temporary or permanent stoma, an opening created when the healthy part of the bowel is brought out onto the surface of the abdomen. Your stool will be passed through this opening into a bag.

    Radiotherapy is used to direct X-ray beams at your cancer in order to damage cancer cells and stop them dividing and growing. Radiotherapy can be given before surgery (neoadjuvant) or after surgery (adjuvant). It is used mainly in the treatment of cancer in the rectum and anus.

    Chemotherapy refers to treatment with anti-cancer drugs, which are given to destroy or control cancer cells by damaging them so that they cannot divide and grow. Chemotherapy can be given before surgery (neoadjuvant), alongside radiotherapy, or after surgery (adjuvant).

  • Patients with colorectal cancer will be cared for by a team of people in the hospital who are experts in different parts of their treatment. This multidisciplinary team can include:

    Surgeons, who specialise in bowel surgery:

    • Mr Brian J. Mehigan (Colorectal Consultant)
    • Mr Paul H. McCormick (Colorectal Consultant)
    • Mr John O. Larkin (Colorectal Consultant)
    • Mr James O’ Riordan (Colorectal Consultant)
    • Mr Dara Kavanagh (Colorectal Consultant)

    Both Mr O Riordan and Mr Kavanagh are based between St James Hospital and Tallaght University Hospital.

    Radiation Oncologist, who is responsible for radiotherapy:

    • Dr Charles Gilham

    Oncologists, who are responsible for chemotherapy:

    The Psychological Oncologist, who is responsible for providing psychological support to you and your family:

    • Dr Annemarie O’Dwyer

    Cancer Nurse Coordinators, who help to facilitate your care while supporting you and your family throughout your treatment:

    • Ms Delia Flannery
    • Ms Katrina O’Connor

    Stoma Nurses, who provide information about stoma care and adjusting to life with a stoma:

    • Ms Annemarie Stuart
    • Ms Catherine Dowling
    • Ms Siobhan McGovern
    • Ms Laura Duffy

    Dietitian, who supports and educates patients about nutrition and diet:

    • Ms Elaine Leahy

    You may also meet other members of our team, including senior and junior doctors, physiotherapists, social workers and occupational therapists who will help you get back to your normal activities and lifestyle.

  • The Irish Cancer Society has a Daffodil Centre located on the ground floor of the hospital, providing practical, psychological and financial support and information for anyone who has been affected by cancer. 

    Telephone: (01) 616 5604.
    Email: daffodilcentrestjames@irishcancer.ie

    Arc House is located near the hospital, on the South Circular Road. It provides support, information and holistic therapies for men and women with cancer.

    Telephone: (01) 7078880.
    Email: linda@arccancersupport.ie

    Other Resources

    The following are websites of organisations offering information relating to the treatment and management of cancer:

    Association of Coloproctocolgy of Great Britain and Ireland: www.acpgbi.org.uk

    Irish Cancer Society: www.cancer.ie 

    Macmillan Support & Information Centre: www.macmillan.org.uk

    Royal Marsden Hospital Foundation NHS Trust: www.royalmarsden.org

    Memorial Sloan-Kettering Cancer Center: www.mskcc.org

    National Cancer Institute: www.nci.nih.gov

    (Local service links can be found through the Irish Cancer Society website).

  • Peter's journey with bowel cancer; "Once you hear the 'C' word you think I'm finished, I'm gone, but I'm still here."

  • This Passport is the patient’s personal document.  Patients are encouraged to bring it with them to each hospital visit so that they can update their information at that time.  They can use it as a place to store their information during their treatment and as a place to refer back to for treatment details, advice post operatively or on the side effects of treatment and when treatment ends.

    We hope that it will encourage the patients to take ownership of their follow up care and surveillance: Patient Passport.