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Chemotherapy treatment

You might have chemotherapy if you have advanced bowel cancer. Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells.  The drugs circulate throughout your body in the bloodstream. 

What is advanced cancer?

Advanced bowel cancer is cancer that started in either the back passage (rectum) or large bowel (colon) and has spread to another part of the body.

Bowel cancer can spread to the:

  • liver
  • lungs
  • lymph nodes
  • bones
Diagram showing the most common sites for bowel cancer to spread to

When you have chemotherapy

You might have chemotherapy on its own, or combined with other treatments.

Chemotherapy for advanced bowel cancer can relieve symptoms. It can also control the cancer and improve your quality of life for a time. But the treatment on its own can’t cure the disease.

You might have chemotherapy before surgery to remove cancer that has spread to your liver. This is to try to shrink it so it is easier to remove. You usually have chemotherapy both before and after surgery.

You usually have chemotherapy every 2 to 3 weeks depending on what drugs you have. Each 2 to 3 week period is called a cycle. You may have up to 8 cycles of chemotherapy.

Types of chemotherapy

Usually you have a combination of 2 or 3 drugs.

The most common chemotherapy drugs for advanced bowel cancer are:

  • capecitabine (Xeloda)
  • fluorouracil (5FU)
  • oxaliplatin (Eloxatin)
  • irinotecan (Campto)
  • raltitrexed (Tomudex) if you can't have 5FU or capecitabine
  • trifluridine (Lonsurf )

Combinations of these drugs may include:

  • folinic acid (leucovorin or calcium folinate), fluorouracil and oxaliplatin (FOLFOX)
  • folinic acid (leucovorin or calcium folinate), fluorouracil and irinotecan (FOLFIRI)
  • oxaliplatin and capecitabine (XELOX)

How you have chemotherapy

You have most of these drugs into your bloodstream through a drip into your arm. A nurse puts a small tube into one of your veins and connects the drip to it.

Or you might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

You have capecitabine as tablets.

You must take your tablets according to the instructions your doctor or pharmacist gives you.

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, no more, no less. Never stop taking a cancer drug without talking to your specialist first.

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.

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 newspapers, books or electronic devices to 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.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your advice line or your doctor or nurse immediately if you have signs of infection, such as a temperature above 37.5C, or if you develop a severe skin reaction. Signs of a severe skin reaction include peeling or blistering of the skin.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called 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.

Low DPD levels don’t cause symptoms so you won’t know if you have a deficiency. Talk to your doctor if you are worried and about whether you need to have a test to check for it. 

Some people have severe side effects from capecitabine or fluorouracil even if they don't have low DPD levels. Contact your doctor or nurse if your side effects are severe.

When you go home

Chemotherapy for bowel cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

Last reviewed: 
05 Nov 2018
  • Metastatic Colorectal Cancer: ESMO Clinical Practice Guidelines 
    E Cutsem and others
    Annals of Oncology, 2014. Volume 25, Pages ii1-iii9

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