Advanced (metastatic) bowel cancer

• Fatigue.
• Abdominal pain or bloating.
• Changes in bowel habit.
• Blood in the stool, and anaemia.
• Weight loss or reduced appetite.
• Symptoms from liver or lung involvement (e.g. jaundice, breathlessness).

• CT and MRI scans – to map the extent of disease in the liver, lungs, and abdomen.
• PET scans – sometimes used to look for a metastasis not visible on other scans.
• Biopsy – confirming spread if not already clear.
• Blood tests – including CEA tumour marker.
• Molecular sequencing – crucial to identify mutations (e.g. RAS, BRAF, MSI status) that help guide treatment, including potential referral to targeted therapy clinical trials when standard options are exhausted.

By arranging tests quickly, we minimise treatment delays.

Treatment is rarely one-dimensional. Most patients will receive a sequence of drug therapy such as chemotherapy or immunotherapy, often with different treatments like stereotactic radiotherapy integrated along the way.

This means treatments such as chemotherapy, targeted drugs, or immunotherapy that travel through the bloodstream to reach and act on cancer cells throughout the whole body, not just at the original tumour site. They control cancer cells throughout the body and often shrink tumours to allow surgery or radiotherapy.

• First-line treatment: typically FOLFOX (oxaliplatin-based) or FOLFIRI (irinotecan-based), often combined with targeted drugs such as bevacizumab (anti-VEGF) or cetuximab/panitumumab (anti-EGFR, if RAS and BRAF wild-type).
• Second-line treatment: usually a switch of oxaliplatin / irinotecan or a change to targeted agents depending on molecular profile, response and side effects.
• Third-line and beyond: newer drugs such as trifluridine-tipiracil, regorafenib and fruqitinib. In certain molecular subtypes (e.g. HER2-positive, NTRK translocations), novel targeted therapies can be effective.

Most patients now move through two, three or more lines of systemic therapy, each providing additional months or years of control. Treatment breaks are possible if the cancer is stable to balance quality of life with tumour control.

Stereotactic radiotherapy (SABR/SBRT) delivers very high doses of radiation with millimetre accuracy over just a few sessions. It is ideal for treating:

• A small number of secondaries (oligometastatic disease) in any organ.
• Cancer regrowth in areas not suitable for surgery.
• Symptom relief from painful or obstructive metastases.

SABR is painless, non-invasive, and delivered as an outpatient treatment. It integrates seamlessly with systemic therapy, either as a holding technique during chemotherapy breaks or as a consolidation treatment after good treatment response. I have a huge body of experience in delivering this treatment safely and effectively, including MRI-guided radiotherapy for more complex situations.

Lower dose palliative radiotherapy can also be used to relieve pain, bleeding, or obstruction, greatly improving quality of life.

For patients whose disease is limited to the liver, surgery to remove metastases (hepatic resection) offers the best chance of cure. Advances in surgical technique mean that even when the disease appears extensive, surgery may still be possible, often after chemotherapy has shrunk the tumours. Liver transplant is being explored for people whose cancer remains stable for several years on chemotherapy. Liver resection can often be combined with surgery to remove the colon / large bowel primary tumour, whereas tumours in the rectum are removed at a separate operation.

The liver surgeons I work with are among the most experienced in Europe. Working as a group, we assess every patient carefully, and use advanced techniques (two-stage resections, portal vein embolisation, combined ablation) to maximise safety and outcomes. Patients who undergo successful liver surgery can live many years, and some are cured.

For selected patients with spread to the peritoneum, cytoreductive surgery (CRS) combined with HIPEC (heated chemotherapy delivered directly into the abdomen during the operation) can be offered. The goal is to remove all visible disease and then use heated chemotherapy to kill microscopic cancer cells. When performed in expert centres, CRS/HIPEC can lead to long-term survival in a group of patients once thought untreatable. Our team at HCA Harborne Hospital has a huge body of experience in this technique. Because it is a complex and major procedure, careful selection is essential. We only recommend it when the likely benefits clearly outweigh the risks.

Our real strength lies not just in each treatment, but in how we combine them. The private MDTs I work within hold themselves to the highest standard of clinical care and ethical decision-making, bringing international best practice to our patients. We’ve learned that thorough case review, innovative thinking, joined-up working, and the timing and sequencing of different treatments, are all critical. By coordinating this, we ensure you get the right treatment at the right time. This approach is what allows many patients with advanced bowel cancer to live well for years.

For people living with metastatic colon cancer, how the body is supported during chemotherapy can make a real difference to outcomes and quality of life. Integrating diet, exercise, and metabolic health into care isn’t an optional extra — it helps the treatment work better and reduces complications. A balanced diet provides the protein, vitamins, and calories needed to tolerate chemotherapy and repair tissues, while also helping to prevent weight loss and frailty. Regular physical activity, even something as simple as walking, improves strength, mood, and immunity, and reduces the risk of blood clots and infections. Paying attention to metabolic health — keeping blood sugar, weight, and cardiovascular fitness in check — lowers inflammation and improves how the body handles both cancer and its treatment. Put together, these lifestyle measures act as a foundation on which systemic therapies can do their job, giving you the best possible chance to live longer and feel stronger.

The team I work with will help you with:

• Nutrition: comprehensive dietary advice, iron and vitamin support, and enzyme replacement if needed.
• Symptom control: management of anaemia, bowel function, nausea, pain relief.
• Psychological support: this is available from a specialist nurse or psychologist for patients and families coping with anger, fear and uncertainty.
• Lifestyle: evidence-based guidance on exercise, sleep, and supplements to support wellbeing.

Our aim is to keep you as strong and independent as possible during treatment.