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Expectations – Cancer What Now
What Now?

Your Colorectal Cancer Treatment & Recovery Online Resource in Alberta

Answers, insights & inspiration

Step 3: What to Expect During Treatment

What is going to happen next?

Once you have decided with your Cancer specialist that you are going to have Radiation and / or Chemotherapy you begin your cancer treatment journey. Patients will be on one of 3 pathways. 

Path A - Most Common

Radiation and Chemo –> Surgery –> Chemotherapy

  1. Medical Consultation
  2. Additional Tests
  3. Radiation Simulation and Planning
  4. PICC Line or Central Line (only patients getting IV chemo) 
  5. First Day of Radiation and Chemo
  6. 6 Weeks of Radiation and Chemo
  7. 6-8 weeks recovery after Radiation
  8. MRI or CT scans to assess response
  9. Surgery
  10. Hospitalization 10 days average post Op
  11. 4-6 weeks recovery at home after Surgery
  12. Chemotherapy for 4 months afterwards
  13. Reversal of Temporary Ostomy (3 mo later)
  14. Ongoing checkups – Labs CEA and Annual Colonoscopy and CT scans

Path B - Less Common

Surgery –> Radiation and Chemotherapy

  1. Surgery
  2. Hospitalization 10 days average post Op
  3. 4-6 weeks recovery at home after Surgery
  4. Medical Consultation
  5. Additional Tests
  6. Radiation Simulation and Planning
  7. PICC Line or Central Line (only patients getting IV chemo) 
  8. Chemo and Radiation Booking
  9. First Day of Radiation and Chemo
  10. 6 Weeks of Radiation and Chemo
  11. Chemotherapy for 4 months afterwards
  12. Reversal of Temporary Ostomy (3 mo later)
  13. Ongoing checkups – Labs CEA and Annual Colonoscopy and CT scans

Path C - Rarely used

Radiation alone –> Surgery –> Chemotherapy

  1. Medical Consultation
  2. Additional Tests
  3. Radiation Simulation and Planning
  4. First Day of Radiation
  5. 1 week of Radiation
  6. Surgery (within 1 week of Radiation)
  7. Hospitalization 10 days average post Op
  8. 4-6 weeks recovery at home after Surgery
  9. PICC Line or Central Line (only patients getting IV chemo) 
  10. Chemotherapy for 4 months afterwards
  11. Reversal of Temporary Ostomy (3 mo later)
  12. Ongoing checkups – Labs CEA and Annual Colonoscopy and CT scans

What are the side effects of Radiation and Chemo?

  • Side effects will begin 3 weeks after the first day of Radiation Chemo
  • The side effects listed below may last 6 or more weeks after radiation
  • The list below includes some of the “possible” side effects
  • You may have SOME – ALL – or NONE of these
  • You will be monitored for side effects by Radiation therapists, Nurses and Doctors

Learn more:

  • To learn more about many treatment related side effects click here 
  • To learn more about Radiation related side effects click here or to download a booklet here

 

Side Effects in MOST Patients (>50%)

  • Diarrhea – VERY Urgent, Frequent, Watery bowel movements
  • Nausea
  • Heartburn – Difficulties chewing and swallowing
  • Fatigue      
  • Burning of your urine

Side effects in SOME patients (<30%)

  • Vomiting
  • Mouth sores / infections
  • Irritation of the eyes, lips
  • Abdominal pain and cramps
  • Rectal bleeding, burning and itching and irritation of hemorrhoids / Skin
  • Back pain

RARE but important side effects (<5%)

  • Fevers or infections
  • You may develop irritation redness of your hands and feet
  • Allergic or Unusual reaction to Drugs (DPD Deficiency)
  • Injury to the kidneys and nerves
  • Chest pain
  • Severe life threatening illness or death

What are the long term side effects of Radiation?

Long Term Side Effects

  • These side effects occur 6 month or later AFTER radiation treatment
  • The risk of these serious permanent side effects is less than 5%

Skin     

  • Permanent change in the skin color and hair loss
  • The skin will be thinner and more susceptible to infection and irritation

Rectum

  • Radiation Proctitis
  • Permanent change in bowel function
  • More frequent, urgent bowel movements
  • Occasional rectal bleeding
  • Rectal incontinence – RARE
  • Small bowel obstruction – RARE < 15%

Bladder

  • Permanent change in bladder function,
  • You may need to urinate more often or urgently

Female

  • Vaginal dryness / spotting / discharge / sensitivity during intercourse

Male

  • Erectile dysfunction

Bones

  • We can see these effects 10-15 years later
  • Osteoporosis in the sacrum
  • Osteoporosis in the Hips
  • We recommend that you use Vitamin D and Calcium to help prevent Osteoporosis

Secondary Malignancy

  • Any exposure to radiation can cause a very small risk of causing cancers 5+ years afterwards
  • Your risk of developing a cancer as a result of your radiation treatment is 0.5 % in 5 years

How will I manage?

Most patients do not realize that it takes nearly a year to complete a full course of therapy and fully recover

  • 3.5 Months  Radiation and chemo combined 
  • 1.5 Months Surgery (and recovery)
  • 4 Months Chemo
  • 3-4 Months recovery and reversal of Ostomy

Most people can manage radiation and chemotherapy side effects as an out patient. They can live independently in their own homes and can come to treatment daily. Most patients do not need to be admitted to hospital.

  • Radiation treatments are done daily Monday – Friday
  • You will be given an appointment schedule on the first day of radiation
  • Speak to the Radiation unit to reschedule or change your appointment times
  • Each appointment takes less than 20 minutes
  • You can drive yourself and back from each appointment
  • Parking is expensive. If you do not want to drive Volunteer drivers are available and will pick up patients anywhere in the city limits and drive you to and from your appointment. For patients who live near the city but outside the city limits you may drive into the city and meet them at a convenient location
  • If you live far away from the city and driving is not feasible / possible you may stay at the Hostel

Learn More

  • To learn more about Volunteer drivers call 1-800-263-6750
  • To learn more about Hostel Services click here
  • Downloadable patient guide click here

Will I be able to work?

For most patients it takes nearly 1 year to complete therapy and recover. Although the side effects are manageable and are not debilitating most patients cannot work during this time. 

Patients who may be able to work:

  • Young and healthy to begin with
  • Part time workers
  • Flexible work hours
  • Ability to work from home
  • Light office work or computer work

Patients who find it difficult to work:

  • Older or other medical problems
  • Physically demanding work
  • Inflexible work hours – must start and end shift same time each day
  • Direct contact with customers or clients
  • Limited access to bathroom facilities

Learn More

  • To learn more about working during cancer treatments click here or here