Chemotherapy uses anti cancer drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
You usually have chemotherapy combined with radiotherapy (chemoradiotherapy) as your main treatment for anal cancer that hasn't spread.
Or you might have chemotherapy on its own or with other treatments if your anal cancer has spread (advanced anal cancer).
When you have it
Doctors usually give chemotherapy and radiotherapy together (chemoradiotherapy) to try to cure anal cancer. Chemotherapy makes the cancer cells more sensitive to radiotherapy, so that the radiotherapy works better.
Some people have chemotherapy to control symptoms of advanced cancer. This is to shrink or slow down the cancer. It can also relieve your symptoms. The treatment you have depends on which treatment you've already had. You might have chemotherapy with radiotherapy or surgery.
Types of chemotherapy for anal cancer
There are many different chemotherapy drugs. The most common type of drugs for anal cancer are:
- fluorouracil (5FU)
- mitomycin C
You usually have these drugs together with radiotherapy (chemoradiotherapy).
Doctors might also use:
- lomustine (CCNU)
How you have chemotherapy
You might have chemotherapy into your bloodstream or as tablets.
Into your bloodstream
You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.
You might have your chemotherapy as tablets, instead of having chemotherapy into a vein. The tablets you have are called capecitabine. Taking tablets means that you can have most of your treatment at home.
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Talk to your specialist or advice line before you stop taking a cancer drug.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.
You might have side effects from chemoradiotherapy to the anus. These can be more severe than either radiotherapy or chemotherapy on their own.
Side effects can include:
- feeling tired
- opening your bowels more often (diarrhoea)
- sore skin around the anus and groin - which can make opening your bowels painful
Tell your nurse or doctor if this happens. They can give you painkillers and tell you about how to look after your skin.
Use only creams or dressings on your skin that your nurse or doctor recommends.
The side effects can be different when you have chemotherapy and radiotherapy together.
You have regular blood tests during your treatment to make sure your blood cells aren’t too low. A low white blood cell count means you are more at risk of picking up infections. A low red blood cell count causes anaemia, with tiredness and breathlessness.
Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.
Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.
Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you:
- take any supplements
- have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They could be harmful.