Chemotherapy For Colorectal Cancer

Cancer treatment and survival rates are continuously improving, but a cancer diagnosis remains extremely frightening. Chemotherapy is often an integral part of the treatment of colorectal cancer, along with surgery and sometimes radiotherapy. This article discusses the chemotherapy drugs that are most frequently used for colorectal cancer, and their side effects.

Colorectal Cancer Treatment Varies Per Stage

Stage 0 colorectal cancer patients generally have their polyps removed surgically, by colonoscopy. Unless the whole polyp was not removed, no further treatment is needed. For stage I patients, having the tumor and lymph nodes removed is usually the only required treatment. 

Stage II patients sometimes receive chemotherapy after their surgery to remove any stray cancer cells. Rectal cancer patients may receive radiotherapy as well. Cure rates are generally very good for this stage of colorectal cancer. 

Stage III patients face a similar treatment course as stage I patients, with the difference that chemotherapy is administered most of the time rather than sometimes. Radiotherapy is, again, common for rectal cancer patients.

Stage IV colorectal cancer is metastatic, meaning that it has spread to other parts of the body as well. It can affect the liver, lungs, abdomen, ovaries and other organs. These patients may receive a combination of surgery, chemotherapy, and radiotherapy. Doctors who are experienced in dealing with this stage of cancer are essential. Clinical trials may be a viable option for stage IV colorectal cancer patients. 

Chemotherapy — Adjuvant, Neoadjuvant, And Advanced Cancer Support

Adjuvant chemotherapy is the term for chemotherapy administered after all visible cancer is surgically removed. This type of chemotherapy serves to destroy the small number of cancer cells that may not have been caught by surgery, and that may be left around the main tumor's location or could have spread to other parts of the body. It reduces the risk that the cancer will return later. Patients with stage II and III colon cancer or colon cancer have been shown to live longer when they receive adjuvant chemotherapy. 

Neoadjuvant chemotherapy refers to chemotherapy before surgery, to shrink the tumor and make an operation easier. This is frequently used for patients who have rectal cancer. 

See Also: Colorectal (Colon) Cancer: Causes, Symptoms and Treatment

In patients with advanced cancer, chemotherapy may be used to reduce the size of the tumor and relieve the symptoms of cancer that has spread. While this treatment is not expected to destroy the cancer completely, it does add to the comfort of those with advanced cancer, and often increases their life expectancy.

Systemic chemotherapy enters the blood stream and reach the whole body. Useful for patients whose cancer has spread to various parts of the body, it can be given intravenously or orally. Regional chemo is, meanwhile, more targeted. In this case, the chemotherapy is injected in an artery that leads directly to the tumor. If the cancer is localized, this method can increase effectiveness while reducing the side effects a patient will experience. 

Chemotherapy Drugs Used For Colorectal Cancer

Four drugs are dominantly used in the treatment of colorectal cancer, often in combination. 

5-Fluorouracil is more commonly referred to simply as 5-FU, and is a frequently used chemotherapy drug for colorectal cancer patients. Often given together with leucovorin, a vitamin-like drug, 5-FU has been used for around 40 years now. Its side effects include an increased chance of getting infections, heart problems, tiredness and breathlessness, easy bruising, nausea and vomiting, diarrhea, mouth sores and ulcers, soreness, and high uric acid levels. 

Patients who experience chest pain or have diarrhea for longer than three days should always inform their doctors. If you receive 5-FU, you may not experience the hair loss often associated with chemo. You may lose your appetite, are at a slightly increased risk of heat attack, and become (temporarily) infertile.

Capecitabine, also available under the brand name Xeloda, is a pill. It is associated with a risk of infection, fatigue and breathlessness, and bruising more easily. Nausea and vomiting, diarrhea, and mouth ulcers are also relatively common side effects of this drug. Rarer side effects are much like those of 5-FU, though Capecitabine is not linked to heart problems. 

Irinotecan, also known as Campto, is a drug specifically used for bowel cancer and is administered intravenously. Its side effects can include increased sweating, saliva production, and tears. Since severe diarrhea is not uncommon, patients may also receive anti-diarrheal drugs. Liver changes, menstrual irregularities, and infertility are less common side effects that are usually temporary. The other side effects — like nausea and hair thinning — are common to most chemotherapy treatments.

Oxaliplatin (Eloxatin) is based on platinum and, again, given by IV drip. Besides your usual chemotherapy side effects, patients might experience tingling, numbness, back pain and taste changes. It is not safe for use during pregnancy or breastfeeding. Mood changes, inflammation of the pancreas, and kidney damage are rare side effects, and some patients are allergic to the drug. 

Chemotherapy is given in cycles. After a period of treatment, a rest period allows the patient's body to recover. A cycle usually lasts between two and four weeks, and patients can expect multiple cycles.

Self-Care During Chemotherapy Treatment

How well do patients cope with chemotherapy? That largely depends on the individual. All chemo patients can expect to experience some side effects, and most will need to take it easy during their treatment and the rest period. Those who are feeling relatively well can generally work, as long as their schedule allows them to take time out when they do feel ill.

It is important that a patient's medical team is consulted before the use of medications. Medication taken for the use of chronic conditions should be reviewed with the team prior to chemo, while a doctor should always be asked before a chemo patient uses over-the-counter drugs. Medication that specifically addresses chemo side effects, including anti-nausea and anti-diarrheal medications, may be prescribed. 

While sex is OK during chemotherapy treatment, careful use of condoms is essential during and after the treatment. The drugs can affect a patient's infertility adversely, but careful condom use is essential for patients of both sexes. This is because chemotherapy treatment makes pregnancy unsafe, and can alter a male patient's sperm. In addition, traces of the drugs found in a patient's bodily fluids could harm their partners. Some people find that chemo sends their libido packing altogether, while men sometimes experience erectile problems during and after the treatment. 

See Also: Colon (Colorectal) Cancer: Risks and Prevention Tips

Permanent infertility is not very common after colorectal cancer, but patients may wish to consider freezing their gametes prior to the treatment just in case. Those who have young children will want to arrange for additional childcare, particularly during and right after chemotherapy sessions. 

Cancer is always nerve-wrecking, and patients as well as their loved ones may benefit from counseling to help them cope.