Chemotherapy uses drugs to kill cancer cells. You may have chemotherapy to treat bowel cancer, either alone or together with other treatments.
This page describes how chemotherapy treats bowel cancer and which drugs are available.
All treatments carry the risk of side effects, and the most common ones are listed here. During treatment, you will need to use contraception to prevent pregnancy and to protect any sexual partners from the chemotherapy.
Timing of chemotherapy
Doctors give chemotherapy as a course of treatment, made up of several treatment cycles. Treatment usually lasts for up to six months. Ask your healthcare team how long each treatment cycle will last and how many cycles you will have.
You may have chemotherapy a few weeks after surgery if the cancer has spread to the lymph nodes or if there is a high risk of it coming back. This is called adjuvant chemotherapy.
If you have rectal cancer that has spread to the lymph nodes, you may have chemotherapy together with radiotherapy (chemoradiation) to shrink the cancer before surgery. This is called neo adjuvant chemotherapy.
If your cancer has spread to other parts of your body, you may have chemotherapy to keep the cancer under control or ease symptoms. In this case, chemotherapy is unlikely to cure the cancer but it can improve quality of life and survival. This is called palliative chemotherapy.
You may have surgery to remove the cancer if it has only spread to a few small areas of your liver or lungs. You may have chemotherapy before and after this surgery to shrink the cancer and make it easier to remove.
Some chemotherapy drugs are taken as an injection or drip into a vein. Others are tablets that you take by mouth.
The most common chemotherapy drugs are:
5FU is one of the most common chemotherapy drugs used in the UK and worldwide. You usually have 5FU together with a drug called folinic acid (leucovorin), which makes the chemotherapy work better. You take this drug as an injection or drip into a vein (intravenously). Doctors use 5FU before or after surgery and to treat bowel cancer that has spread to other parts of the body.
Capecitabine is taken as a tablet twice a day. The body absorbs the drug and converts it to 5FU. You may take capecitabine before or after surgery or to treat bowel cancer that has spread to other parts of the body.
Doctors use oxaliplatin together with 5FU and folinic acid. This combination is called FOLFOX. Or you may have oxaliplatin together with capecitabine (XELOX). You take this drug as an injection or drip into a vein (intravenously). You may have oxaliplatin after surgery or to treat bowel cancer that has spread to other parts of the body.
Irinotecan is taken as an injection or drip into a vein (intravenously). Doctors usually use it together with 5FU and folinic acid. This combination is called FOLFIRI. This drug treats bowel cancer that has spread to other parts of the body.
Each chemotherapy drug or combination has its own side effects. Your healthcare team will give you information about the side effects that are most likely to affect you. Common side effects of chemotherapy include:
- loose bowel movements (diarrhoea)
- an increased risk of infection.
- a sore mouth
- feeling and being sick
Chemotherapy can cause temporary or permanent infertility, depending on the drugs and doses used.
If you have bowel problems or sickness, you may find our information on diet helpful.
Oxaliplatin can damage the nerves in your hands or feet. This is called neuropathy. Symptoms usually improve a few weeks or months after treatment ends but they may get worse before they get better. Some people have long-term problems with nerve pain. You may become very sensitive to the cold and get pins and needles, weakness or numbness in your hands or feet. This can make it hard to do everyday things like writing, picking up small items and walking. Some people wear gloves to protect their hands from the cold, sheepskin boots to help with nerve damage in their feet and heat packs to help with pain in their veins.
You should use a condom if you have sex in the first few days after having chemotherapy. This will protect your partner from any chemotherapy that may be in the semen or vaginal fluid.
Both men and women should use contraception during chemotherapy and for about a year after treatment ends. This is because these treatments can damage sperm and eggs or harm a developing baby.
Cancer Research UK provides Information on chemotherapy to treat bowel cancer.
Macmillan Cancer Support provides information on chemotherapy and its side effects.
Updated March 2016. Due for review March 2019
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