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Common questions

Bowel cancer

This fact sheet is to help MBF members and their families be better prepared for the healthcare experience after a diagnosis of bowel cancer.

Not all of the information here will be applicable to everyone, so it is important to discuss your individual circumstances with your doctor and perhaps with other healthcare professionals in the team caring for you. Please, never hesitate to ask 'why' or to have something explained to you until you understand it. If, after you have been given an answer, you still feel as though there are unanswered questions, ask again or ask someone else. You can help the healthcare team to help you if you feel free to communicate your needs to them. Further research and reading (see 'Learn more about bowel cancer and its treatment') will also help you make more informed decisions about your treatment.

About bowel cancer  

In most cases, the broad term 'bowel cancer' refers to cancer in either the colon or the rectum. The colon is the large tube at the end of your digestive tract that absorbs water and some nutrients from food. The rectum is a section of the colon just before the anus, where the waste products of digestion are stored as faeces. For this reason, you may also hear bowel cancer referred to as colon cancer.

Although treatment for cancers in both the colon and the rectum are broadly similar, the type of treatment you can expect will to some extent depend on where the cancer is, as well as other factors such as the size of the cancer and whether it has spread, as we outline below.

It is also important to know that:

  • Survival rates for bowel cancer continue to improve. Most cancer treatments are measured by looking at how many people with the disease are still alive after 5 years. For bowel cancer, well over half of those who have the cancer successfully removed are still alive five years after diagnosis - and this percentage is much higher - close to 90% - in cases where the cancer is detected early and has not spread beyond the bowel wall.
  • Aftercare and help with recovery -- both physical and emotional -- is also improving, with a range of services available to help with both the practicalities and to offer you and your family counselling and other support that you may need.

Bowel cancer is the second most common form of cancer in Australians after skin cancer. It affects one in eighteen men and one in twenty-six women aged under 75. Australia also has one of the highest rates of bowel cancer in the world, along with the United States and New Zealand.

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Your treatment options 

If you have been diagnosed with bowel cancer, you will probably have to undergo some further testing to determine more exactly the size and location of the cancer, whether it has spread, and if so, where to. This is likely to include blood testing and medical imaging such as x-rays, CT (computer tomography) scanning, ultrasound or MRI (magnetic resonance imaging). If you have not already had one, it may also involve having a procedure that enables the doctor to get a better view of your bowel, usually a colonoscopy or sometimes a sigmoidoscopy.

As such, you may have heard that generally bowel cancer is categorised according to 'stages', as follows:

Stage A: where the cancer is confined to the bowel wall;

Stage B: where the cancer has spread to the outer surface of the bowel wall, but not beyond;

Stage C: where lymph nodes (glands) outside the bowel wall are affected but not beyond;

Stage D: where the cancer has spread to other parts of the body (medically known as 'metastasised')

If you already know the 'stage' of your condition, try to keep this in mind when you talk to your doctor and/or conduct your own research regarding treatment options. This will help you focus on the information that's most relevant to you.

The recommended treatment for the cancer will then be determined depending on several factors, including:

  • where the cancer is: what part of the colon; or, if in the rectum, for example, how close it is to the anus;
  • its stage;
  • if it has spread and if it has, to what other parts of the body;
  • your general health and age; and
  • how you feel about the different options available.

Treatment for bowel cancer commonly includes a combination of some or all of the following:

  • surgery;
  • radiotherapy (radiation therapy);
  • chemotherapy;
  • further corrective surgery, for example, if your original treatment involved a temporary stoma;
  • psychological and emotional support where required; and/or
  • follow-up care.

Because the decisions regarding your treatment may be complex, you should discuss with your doctor as to whether or not you should be referred for treatment to a centre that offers and coordinates the full range of these options. Radiotherapy may not be available in all hospitals, but check that your doctor is associated with and can coordinate care with a centre where it is.

Be sure to consider the need for counselling. This diagnosis can be worrying for you and your family, and if working through the issues can help, then take advantage of the help that you can access.

What is a stoma?

Often, surgery for bowel cancer involves creation of a 'stoma' or 'ostomy' (and, in the case where it is made to the colon, a 'colostomy'). This is a surgically-made opening in your abdomen through which the elimination of waste from your bowel can take place, bypassing the area that has been affected by cancer and/or the surgery. A stoma can be temporary - enabling the affected area to heal effectively - or permanent, most often when the rectum is affected and removed. Once again, this will depend on the type and location of your cancer and the type of surgery you have had. Specialised stomal therapists are available to help you understand and manage your care. See below for more about stomas and stoma therapy.

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Questions to ask your doctors 

Your treatment and ongoing care for bowel cancer will involve a number of different doctors, including your GP, who will refer you to specialists and help coordinate your care; a specialist colorectal surgeon or general surgeon who specialises in bowel cancer care to perform your surgery; possibly a gastroenterologist; a radiation and/or medical oncologist if required to take care of radiation therapy or chemotherapy; and counselling or community help if needed. Ideally, try to find doctors who work as a coordinated team, usually out of one major hospital or centre to improve the coordination of your care, reduce your travelling time and make effective communication between doctors about your ongoing treatment and care easier.

Every person and every case of bowel cancer is different, so the treatment options that are right for you differ, too. Your treatment decisions may depend on the answers to many questions. Here are a few to get you started.

To the GP/Referring Doctor:

  • Why have you chosen to refer me to this doctor?
  • Do you know if this doctor has used the type of procedures I am likely to need? How many do they do each year?
  • Is this doctor associated with a comprehensive cancer care centre?
  • Do you know anything about the radiotherapists and oncologists that may be involved if I go to this doctor?
  • Do you know if they charge a gap that Medicare or my health fund won't cover for my inpatient procedures? Or is there someone just as suitable that is more likely not to charge a 'gap' over the medical fee? Even so, choose your doctor first on the outcomes you can expect and their experience and expertise.

To the Specialist Doctor:

  • Will you explain the treatment I am going to have, starting in simple terms, please?
  • Why do you think this is the best treatment option for me? What other options are there?
  • What are the likely outcomes of my treatment?
    • What are the chances that the outcomes will be good, with this treatment or with the alternative options?

Preparing for hospital, if applicable:

  • Should I stop taking any of my medications prior to going to hospital? If so, how long before?
  • What are the possible complications and/or side effects associated with my surgery?
  • What can I do, prior to hospital, to reduce my risk for complications?
  • Do you think I will need a stoma?
    • Is it likely to be temporary or permanent?
    • Is there anything else you can tell me about this aspect of my treatment, or any other support agencies that I could refer to help me adjust to this?
  • How many of these procedures have you done?
  • Are you associated with a comprehensive cancer care centre?
  • Are you and your team the right ones to be seeing at this stage or should I be thinking of seeing someone who may be even more specialised in this area? Is there any time when we should reconsider that?
  • Do you charge a gap that Medicare or my health fund won't cover for inpatient services? Even so, choose your doctor first on the outcomes you can expect and their experience and expertise.
  • Does the anaesthetist who usually works with you charge a gap? If so, how much should I expect that to be?
  • How long do you expect me to be in hospital?
  • After I am discharged from hospital, whom do I call if anything happens?

Preparing for going home:

  • How long after the operation will you be able to tell me the result and how will I be able to contact you?
  • What restrictions will I have regarding my everyday activities when I go home (ie. driving, lifting heavy objects)? If so, how long will I need assistance?
  • If I need radiotherapy or chemotherapy drugs, where would I be going for that treatment? Are the outcomes of treatment at that centre as good or better than those at other large centres near here?
  • Do you know anything about the outcomes for the radiotherapists and oncologists that may be involved?
  • If I am to have chemotherapy or radiotherapy or hormone therapy, can you tell me:
    • How long will the treatment last?
    • How will I expect to feel?
    • What are the possible side effects and complications of these treatments?
    • Is there any way I can reduce these?
  • Are there any clinical trials or new treatments I should know about?
  • What sort of monitoring and follow-up treatment should I expect once my initial treatment is over?

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What MBF pays toward your treatment  

Understanding how the healthcare system works can be confusing. This brief summary outlines what you can expect during bowel cancer treatment. Always check with MBF before you go to hospital.

Your hospital costs 

All levels of MBF hospital cover help pay for in-patient treatments provided that:

  • you receive the services while you are formally admitted in a hospital;
  • it is a treatment for which Medicare pays a benefit;
  • it is not an Excluded Service on your level of cover; and
  • you've met all the standard conditions of your membership (like serving the relevant waiting periods).

Your MBF hospital cover will help pay for the following treatments and services so long as you are formally admitted to the hospital and the above conditions are met:

  • shared accommodation (or private room if available);
  • surgery related expenses including operating theatre, and intensive care if needed;
  • chemotherapy;
  • certain drugs supplied as part of your inpatient hospital treatment; and
  • certain therapies such as physiotherapy, occupational therapy and speech therapy when provided by the hospital and associated with your hospital treatment.

Please note that Medicare pays a Medicare benefit toward the cost of radiation therapy.

The costs of participating in clinical trials are paid by the sponsor of the trial and are not covered by private health insurance or by the patient.

Remember, if you are not in an MBF Network Hospital and/or public hospital, you may incur substantial out-of-pocket expenses for your hospital charges.

Please note that surgeon's and other doctors' charges will be part of your medical costs.

Your medical (doctors') costs  

Ask your surgeon to explain the costs of your surgery including their own fees, and any fees that other doctors involved in the surgery might charge and any other expenses involved. If there are any gaps for you to pay, ask for a written cost estimate. This is known as 'informed financial consent'. Obtaining this information is extremely important before any planned hospital admission.

It is likely that there will be many doctors involved in your treatment and care. These may include the oncologist (cancer specialist), the surgeon, assistant surgeon, anaesthetist, pathologist, radiation oncologist (who oversees radiotherapy) and so on. You may not meet all of them in person.

Each doctor will charge for his or her services. See Going to hospital and Gap and informed financial consent for a guide to these costs.

Key things for you to know about medical costs and your health cover are:

  • MBF will pay benefits toward your doctors' charges for the service you receive:
    • when formally admitted as an in-patient in hospital or day surgery, and
    • when the service relates to treatment included under your level of cover, and
    • when you are entitled to a Medicare benefit for the treatment.
  • The Medicare Benefits Schedule Fee ('MBS') is the amount determined by the Commonwealth Government for the purpose of paying Medicare Benefits. For eligible in-patient services, Medicare pays for 75% of the MBS; MBF pays the remaining 25%.
  • Many doctors charge above the MBS, creating a 'gap' - an amount the patient has to pay.
  • MBF does not pay any amount charged by your doctor above the MBS unless there is an agreement in place between your doctor and MBF. This agreement is known as the MBF Medical Gap Cover Scheme.
  • MBF has created the MBF Medical Gap Cover Scheme to help reduce gaps paid by members. Doctors who participate in this scheme have agreed to accept the MBF benefit as full payment for your treatment. If a doctor has agreed to treat you under the MBF Medical Gap Cover Scheme there will be no 'gap' to pay for that doctor's charge.
  • It may be that not all doctors involved in your hospital treatment are 'no gap' doctors. So you may have to pay a gap for some doctors' services, but not others.

Remember, doctors are independent of MBF and can decide whether or not to treat you under the MBF Medical Gap Cover Scheme.

Click here for a list of 'no gap' doctors or call MBF.

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Other costs relating to your treatment and recovery  

If you have MBF extras cover, MBF may also help with the cost of a number of other healthcare services that may assist with the treatment and recovery from bowel cancer.

Depending on your level of MBF extras cover, limits of your cover and waiting periods these may include:

  • occupational therapy, to help you re-establish your usual living or working routine;
  • psychology, such as counselling for you and family members included on your cover;
  • pharmacy (for drugs not listed on the Pharmaceutical Benefits Scheme);
  • physiotherapy, to help restore movement and function following surgery; and
  • health aids and appliances (i.e. colostomy appliances).

MBF extras benefits are only payable for services provided in Australia by an MBF Recognised Provider. MBF Recognised Providers are health service providers that meet MBF guidelines. Call 131 137 to confirm whether or not your provider is a MBF Recognised Provider.

You can enjoy higher benefits on all preventive and general dental services and selected physiotherapy, optical, pharmacy and gym membership services (restrictions on claiming apply) by using the growing MBF MemberCare network of service providers. With our MBF MemberCare network of providers, you are guaranteed of receiving at least 70%-90% of the charge back on selected services depending on your level of cover, up to the annual limit of your cover. Find an MBF MemberCare service provider.

Learn more about bowel cancer and its treatment  

More about going to hospital, MBF Network hospitals, no-gap doctors, and MBF MemberCare providers  

As well as calling MBF, you can find plenty of useful information about your health cover and what to expect when you go to hospital right here on this website.

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Last updated: 05-06-07

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