Chemotherapy after surgery for bowel cancer

Adjuvant chemotherapy is chemotherapy that you have after surgery. The treatment aims to help stop the cancer coming back or spreading to other parts of the body. During the surgery your surgeon can see how deeply the cancer has grown into the wall of the bowel or surrounding tissue. They can also see how big the cancer is. They will send a sample of the tumour to the laboratory to be looked at under a microscope. 

Your doctors will recommend chemotherapy if there is a risk of the cancer coming back or spreading. Factors that make the cancer more likely to come back or spread include

• Cancer in any of the lymph glands removed during surgery
• Cancer cells that look very abnormal (high grade) under a microscope
• Cancer cells found to have spread into the tumour blood vessels (vascular invasion)
• Cancer that has grown deeply into the bowel wall or has spread into surrounding tissue

In these situations cancer cells are more likely to have travelled away from where the cancer started in the bowel (the primary cancer). The cells are carried away in the bloodstream or lymphatic system. They are too small to be seen on X-rays or scans. But they can grow into secondary cancer at some time in the future. 

We know that chemotherapy works best on very small groups of cancer cells rather than larger tumours. So your doctor will offer you chemotherapy after surgery to reduce the chance of the cancer coming back or spreading. The chemotherapy goes around the body in the bloodstream and can destroy cancer cells left behind in the area of the tumour. It can also destroy cancer cells that have spread to other parts of the body such as the liver.

You normally start chemotherapy as soon as you have recovered from surgery, usually within 6 weeks.

Chemotherapy drugs doctors commonly use after bowel cancer surgery include

• FOLFOX – a combination of folinic acid (leucovorin or calcium folinate), fluorouracil and oxaliplatin given into a vein
• Capecitabine (Xeloda) tablets
• Fluorouracil (5FU) into a vein
• Tegafur and uracil (Uftoral) capsules
• XELOX – a combination of oxaliplatin and capecitabine

The links above take you to detailed information about these treatments and their side effects. There is also detailed information about the side effects of bowel cancer chemotherapy in this section.

You may have treatment for about 6 to 7 months as tablets to take at home. Or you may have the chemotherapy as fluids given into a vein. If you have treatment into a vein, you can have the drugs through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

The National Institute for Health and Clinical Excellence (NICE) has guidelines on both capecitabine and oxaliplatin as treatments after surgery for Dukes C (advanced) bowel cancer. They say that using capecitabine on its own, or oxaliplatin with 5FU and folinic acid are both possible treatments after surgery for this stage of bowel cancer. They say the choice of treatment should be decided between you and your doctor, taking into account the stage of the cancer, your physical condition, the side effects of the drugs and your personal preferences. 

The Scottish Medicines Consortium (SMC) and the All Wales Medicines Strategy Group (AWMSG) also recommend that XELOX (capecitabine and oxaliplatin together) should be available as a treatment after surgery for people with stage 3 bowel cancer in Scotland and Wales. NICE have not looked at this particular combination for people in England yet.

For information about having chemotherapy look at our main chemotherapy section. It explains the treatment in detail including

• What chemotherapy involves
• How chemotherapy is planned
• How you have the treatment
• General chemotherapy side effects
• Side effects of specific drugs
• Living with chemotherapy

Our bowel cancer organisations page has details of information services you can contact for more information about bowel cancer and its treatment. There are also books and booklets available, some of which are free.