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:
- lymph nodes
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.
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
COVID swab test
Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.
To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.
At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.
This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.
Check with your team about when you’ll have the test as there are some differences between hospitals.
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 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.
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
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.
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. You should have a test before you start this treatment to check if you have a DPD deficiency.
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.