Chemotherapy for metastatic bowel cancer

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

What is metastatic bowel cancer?

Metastatic 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. It is also called advanced cancer.

Bowel cancer can spread to the:

liver
lungs
lymph nodes
bones

Diagram showing the most common sites for bowel cancer to spread to

Aim of chemotherapy

Chemotherapy for metastatic 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.

How often do you have chemotherapy?

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 usually have treatment as long as it is working and the side effects are not too bad.

You usually have a scan Open a glossary item every 2 to 3 months to see if treatment is helping.

What type of chemotherapy do you have?

Usually you have a combination of 2 or 3 drugs.

The most common chemotherapy drugs for metastatic bowel cancer are:

capecitabine (Xeloda)
fluorouracil (5FU)
oxaliplatin (Eloxatin)
irinotecan (Campto)
raltitrexed (Tomudex) if you can't have 5FU or capecitabine
trifluridine and tipiracil (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)
folinic acid, fluorouracil, oxaliplatin and irinotecan (FOLFOXIRI)
oxaliplatin and capecitabine (XELOX)
irinotecan and capecitabine (IrCap, XELIRI, CAPIRI)

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 usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test.

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.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.

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Transcript

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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, such as 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.

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 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.

Surgery combined with chemotherapy into the tummy (abdomen)

You might have surgery combined with chemotherapy if you have bowel cancer that has only spread to the peritoneum Open a glossary item . This is also called stage 4c bowel cancer.

Surgery combined with chemotherapy is also called cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC).

It involves:

the surgeon removing any tissue affected by the bowel cancer
having heated chemotherapy drugs put directly into your abdomen during the surgery (HIPEC)

You have to be well enough to have this intensive surgery.

This treatment is only available in specialist centres. This means that you might have to travel for treatment.

We have more information about CRS with HIPEC in our information about pseudomyxoma peritonei. Pseudomyxoma peritonei is a rare cancer that starts in the appendix.

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.