Treatment of local rectal cancer

At HUS, rectal cancer is operated on at Meilahti Tower Hospital. In most cases, you will be admitted to the hospital on the day before the surgery, and you will then meet the anesthesiologist, the operating surgeon, the ward nurse, and a physiotherapist. You will need to cleanse your bowels as instructed by drinking a bowel-cleansing preparation on the day before the operation. If required, you will receive an epidural anesthetic for pain management on the day before the surgery.  

Depending on the location of the tumor, the operation involves removing part or all of the rectum, the rectal mesentery, and adjacent lymph nodes. The operation is performed as open surgery through a cut in the lower abdomen or as keyhole surgery. If we are able to preserve the lower part of the rectum, we join up the end of the colon to the lower part of the rectum. Often we make a temporary colostomy to protect the anastomosis. If we need to remove the entire rectum and anus, we make a permanent end stoma. 

From the operating room, you will be taken to the recovery room and then to an inpatient ward at Meilahti Tower Hospital. During your first days on the ward, you will receive intravenous fluids, pain medication, and possibly antibiotics. Recovery from surgery is accelerated by active mobilization with assistance from the nurses and physiotherapists, and the start of oral nutrition the day after the operation.

You can be discharged if you are getting enough nutrition, your bowel movements have become normal, and you are able to urinate. The adequacy of pain management with oral medication is important with regard to your discharge from hospital. You must also be able to inject the blood thinning medication yourself that is required to be initiated after surgery. Being able to manage the care of your stoma is also important when discharged. 

Radiation therapy reduces the risk of local recurrence of rectal cancer, and thus evaluating the need for radiation therapy is an essential element of treatment. In case of an elevated risk of local recurrence, you will receive radiation therapy on five consecutive days before the operation.

Sometimes the tumor needs to be reduced in size before surgery. In this case, you will receive a combination of chemotherapy and radiation therapy, i.e. chemoradiotherapy, and the duration of the treatment will then be approximately five weeks. 

If radiation therapy or a combination of radiation therapy and chemotherapy is indicated before your rectal cancer operation, we will book an initial appointment for you at the Radiation Therapy Unit of the Comprehensive Cancer Center. At the appointment, the radiation oncologist will evaluate your eligibility for radiation therapy or a combination of radiation therapy and chemotherapy, advise you of the benefits and potential disadvantages of the treatment, and explain how your radiation therapy will be delivered.  

After the appointment, the clinic nurse will book your appointments for the radiation therapy dosage planning session and for your first radiation therapy appointment. When necessary, we will also book an appointment for chemotherapy guidance with a nurse if the combination treatment is being administered. During the radiation therapy and chemotherapy period, we perform check-ups with blood tests and estimate the progress of the treatment at appointments with the radiation oncologist. 

A radiographer will give you instructions for the dosage planning examinations, or radiation simulation. To aid us in planning your radiation therapy, we will perform a computer-based simulation and also an MRI scan, if necessary. This examination is performed with you in the same position that you will have during the actual radiation therapy. At the end of the examination, we will mark your skin with three tattooed points that will help us align you in the exact same position on each radiation therapy session.  

The radiographer will show you around the radiation therapy unit and will explain the progress of the treatment and its adverse effects. The radiographer will book your first radiation therapy appointment and explain your laboratory visits and any other examinations that may be needed. At this appointment, you will also be advised of the travel cost reimbursement and social security system of Kela, and you will be given contact details for a social worker. 

At your first radiation therapy appointment, you will be given a timetable for your visits. We will also inform you of the adverse effects of radiation therapy and how you should care for yourself at home. You can talk to a nurse about things that are on your mind at each radiation therapy appointment. 

Adverse effects of radiation therapy include irritation of the skin and mucous membranes, and possibly diarrhea. In case of any problems, you can contact the radiographers working on your radiation therapy unit by phone.

We plan the number of radiation therapy sessions individually. Radiation therapy is carried out on consecutive weekdays. Although the radiation therapy itself only lasts about 15 minutes per session, you should allow plenty of time for each visit. At the last treatment session, we will go discuss your further treatment with you. If you have any questions after your radiation therapy is completed, you may contact the radiographers working on your radiation therapy unit for a period of one month thereafter. 

Before your first visit to the Comprehensive Cancer Center, we will answer any questions you may have about chemotherapy at the surgical unit. For chemotherapy, we will prepare an individual treatment plan based on the most recent research data as well as on international and national treatment recommendations.

Your treatment is always planned in cooperation with physicians from several specialties. If necessary, close cooperation between different specialties will continue throughout your treatment to ensure the best possible treatment outcome. 

At your first appointment with the oncologist, we will prepare the required statements for Kela to apply for long-term benefits, such as for special reimbursement for medicines and sick leave. Before your first treatment session, you will review your treatment plan and the adverse effects of chemotherapy with a nurse. You will also receive written instructions regarding your treatment. 

Chemotherapy for bowel cancer is administered in the Medical Treatment Unit at the Comprehensive Cancer Center. You will be treated by a nurse, generally your primary nurse. Your primary nurse’s contact details will be given to you at your first appointment. You can also contact your primary nurse using the Maisa portal or the Noona app, to which we will grant you credentials.  

Chemotherapy usually consists of a cytotoxic drug administered orally, sometimes with added intravenous medication.  

Before chemotherapy, you will be taking premedication one hour before each treatment session. The chemotherapy lasts for 1–4 hours each time, and the sessions take place every 2–3 weeks. 

The aim is that you should be able to live your life as normally as possible despite the chemotherapy. It takes 3–7 days to recover from an individual treatment session, after which your condition will improve. You can go outdoors and do light exercise in accordance with your condition.  

The most common adverse effects of chemotherapy are irritation of the mucous membranes in the mouth, diarrhea, fatigue, skin problems, and nausea. You must ensure that you drink enough fluids and have a diverse diet, that your bowel movements are regular, and that you maintain good oral hygiene. Alcohol should be avoided, and natural supplements are prohibited. 

After surgery, we assess the need for adjuvant therapy. The purpose of adjuvant therapy is to reduce the risk of your cancer recurring. The most important factors in the decision are the possible existence of lymph node metastases and how deep in the intestinal wall the tumor is located.

Adjuvant therapy lasts for 3–6 months, depending on the characteristics of your disease. The treatment is usually implemented with a cytotoxic drug administered orally, sometimes also with added intravenous medication.