Side effects of bowel cancer chemotherapy

Chemotherapy has some general side effects. Chemotherapy drugs kill cells that divide quickly, as cancer cells do. Blood cells also divide rapidly, so chemotherapy can lower the number of healthy white blood cells, red blood cells and platelets you have. This can mean that you

• May be more tired than usual
• Are more likely to get infections
• Can be prone to nosebleeds and other bleeding problems

If you develop a temperature above 38°C or think you have an infection, it is very important to contact the hospital immediately. You may need urgent treatment with antibiotics. Your doctor or chemotherapy nurse will give you an emergency number to phone if you need to. There is information about the effect of chemotherapy on your blood cells in our section on side effects of cancer drugs.

Tiredness or fatigue is the most common side effect for people having chemotherapy. Tiredness can reduce how much you are able to do. You may also feel weak and as though you have no energy. Tiredness may carry on for some months after your treatment ends. How quickly you get back to normal will depend on your general health, on the amount of treatment you've had and whether you have also had other treatments. 

There is information about how to cope with tiredness in the cancer fatigue section of CancerHelp UK.

Other side effects of bowel cancer chemotherapy can include

• Sickness
• Diarrhoea
• A sore mouth
• Hair loss or thinning
• Changes to your periods (menstrual cycle)
• Sore eyes – they may feel as if they have grit in them - ask your doctor or nurse for eye drops

You can use the links above to go to pages in the cancer drugs section that tell you about coping with the side effects.

Side effects may seem hard to bear at the time. But most disappear when your treatment ends.

The drugs most often used for bowel cancer treatment are

• Fluorouracil (also called 5FU) – often given with a vitamin called folinic acid
• Capecitabine
• Uftoral (also called tegafur with uracil)
• Irinotecan (Campto)
• Oxaliplatin

The links above take you to detailed information about the individual drugs and their side effects.

Most people cope well with 5FU and have few side effects. But it can cause

• Sickness
• Diarrhoea
• Tiredness
• Drop in blood cell counts
• A sore mouth or mouth ulcers

When you have 5FU continuously through a pump, it can cause reddening and soreness of the hands and feet. This is called hand and foot syndrome or palmar-plantar erythema. It happens to about 1 in 3 people having this treatment. The skin can begin to peel on the palms of the hands and soles of the feet. For most people, this is reasonably mild and you can just carry on with the treatment. But if it gets bad, your doctor may lower your chemotherapy dose or suggest that you have a break from treatment until you have recovered.

The effects of capecitabine are very similar to 5FU and may also include reddening and soreness of the hands and feet. This is called hand and foot syndrome or palmar-plantar erythema. The skin can begin to peel on the palms of the hands and soles of the feet. For most people, this is reasonably mild and you can just carry on with the treatment. But if it gets bad, your doctor may lower the capecitabine dose or suggest you have a break from treatment until you recover.

The effects of Uftoral are very similar to 5FU and include skin rashes and sensitivity of the skin to sunlight.

This drug may cause

• Sweating
• Tiredness
• Watery eyes
• Feeling or being sick
• Hair loss or hair thinning
• A drop in blood cell counts
• Increased production of saliva
• Cramping pain in the abdomen
• Diarrhoea starting the day after treatment

Some people have sweating, abdominal pain and diarrhoea while they are having the drug infusion. Diarrhoea after irinotecan infusion can be a serious side effect. If you get diarrhoea a day or so after you have had your treatment, you should tell your doctor or chemotherapy nurse. You can become dehydrated very quickly.

This drug may cause

• Sickness
• Numb lips
• Sensitivity to cold
• Numbness and tingling of hands or feet

You get numbness and tingling because oxaliplatin affects your nerves. It can make it very difficult to do fiddly things such as doing up buttons. Some people find it hard to walk because the soles of their feet are numb. You should tell your doctor or specialist nurse if you have this side effect. You may need to have a lower dose of oxaliplatin or stop the treatment for a time. For some people, this side effect may be permanent.

There is information about chemotherapy affecting the nerves in our cancer drugs side effects section.