Advanced & metastatic bowel cancer
A diagnosis of advanced bowel cancer is difficult news. There are still treatment options, and we're here to help you understand them.
What does advanced or metastatic mean?
Advanced bowel cancer means the cancer has grown into or through the bowel wall, or has spread to nearby lymph nodes. Metastatic bowel cancer (sometimes called stage IV) means the cancer has spread to other parts of the body, most commonly the liver or lungs.
A diagnosis of advanced cancer doesn't mean there are no options. Treatment can often control the cancer, reduce symptoms, and maintain quality of life. In some cases, especially when cancer has spread only to the liver or lungs, treatment can still be curative.
Treatment options
Treatment for advanced bowel cancer depends on where the cancer has spread, your overall health, and your goals. Your oncologist will work with you to find the right approach.
Palliative chemotherapy
Chemotherapy for advanced cancer aims to control the disease, slow its growth, and relieve symptoms. It's not about giving up – palliative treatment is active treatment that helps you live well for as long as possible. Common regimens include FOLFOX, CAPOX, and FOLFIRI, often combined with targeted therapies.
Surgery for liver or lung metastases
If cancer has spread to the liver or lungs in a limited way, surgery to remove those secondary tumours (metastasectomy) may be possible – and can sometimes be curative. This is assessed on a case-by-case basis by a specialist team.
Radiation therapy
Radiation can be used to shrink tumours, relieve pain, or treat specific areas where the cancer has spread. Stereotactic body radiation therapy (SBRT) can precisely target small areas of cancer in the liver or lungs.
Targeted therapy and immunotherapy
Drugs like bevacizumab, cetuximab, and panitumumab may be added to chemotherapy. If your tumour is MSI-high or dMMR, immunotherapy (such as pembrolizumab) may be an option. Biomarker testing of your tumour helps guide these decisions.
Ablation and other local treatments
Techniques like radiofrequency ablation (RFA) or microwave ablation can destroy small tumours in the liver without open surgery. These are considered when surgery isn't suitable.
Clinical trials
Clinical trials test new treatments or new combinations of existing treatments. They can give you access to therapies that aren't yet widely available. New Zealand participates in international trials for bowel cancer, and new ones open regularly.
- •Ask your oncologist if there are any trials you might be eligible for
- •Trials are voluntary – you can withdraw at any time
- •Being in a trial doesn't mean you're a "guinea pig" – trials have strict safety oversight and you'll be closely monitored
- •The Australian New Zealand Clinical Trials Registry (ANZCTR) lists current trials
PHARMAC funded treatments
PHARMAC is the government agency that decides which medicines are publicly funded in New Zealand. Some treatments for advanced bowel cancer are funded, while others are not.
Currently funded treatments include:
- • Standard chemotherapy regimens (FOLFOX, CAPOX, FOLFIRI, 5-FU/capecitabine)
- • Bevacizumab (Avastin) for some situations
- • Pembrolizumab for MSI-high/dMMR cancers (criteria apply)
Funding criteria can change – your oncologist will know the current status.
Unfunded treatments
Some effective treatments are not funded by PHARMAC. This can be frustrating and stressful. If your oncologist recommends an unfunded treatment, here are some options:
- •Named patient pharmaceutical assessment (NPPA) – your oncologist can apply to PHARMAC for funding on a case-by-case basis
- •Compassionate access – some pharmaceutical companies provide their drugs free of charge in certain circumstances
- •Self-funding – some people choose to pay privately, though costs can be significant
- •Clinical trials – trial drugs are provided at no cost to participants
Bowel Cancer NZ advocacy: We actively advocate to PHARMAC for better access to bowel cancer treatments. If you're struggling with access to unfunded treatments, contact our team – we may be able to help you navigate the system.
Honest conversations
Living with advanced cancer means dealing with uncertainty. It's important to have honest conversations with your care team about your prognosis, your treatment goals, and what matters most to you. These conversations can be hard, but they help you make informed decisions about your care.
You might want to ask your oncologist: "What is the goal of this treatment?" and "What would happen if I chose not to have this treatment?" There are no wrong questions.
You don't have to navigate this alone
Our nurse support line is here to help you understand your options, connect with services, and provide a listening ear. Call 0800 226 968.