Chemotherapy (pronounced kee-mo-ther-apee) agents are drugs that target and kill rapidly dividing cells, such as cancerous cells. Chemotherapy can be administered in conjunction with other colon cancer treatments (surgery, radiation) or by itself. The medical oncologist (cancer doctor) orders the chemotherapy. He or she will take several factors into consideration while choosing your best chemotherapy options, including the stage and grade of your cancer and your physical health.
How It Works
Chemotherapy drugs travel throughout your body and kill cells that are dividing (growing or duplicating) rapidly. There are many different types of cells that divide rapidly in your body aside from cancerous cells, including those in your gastrointestinal tract, hair, skin and nails. This is the main reason that the majority of chemotherapy side effects target hair, skin, and the gastrointestinal tract. The chemotherapy drugs cannot differentiate between healthy fast-dividing cells (hair) and the cancerous cells (tumor) in your body, so they kill them all by stopping the duplication cycle. However, healthy cells that are meant to rapidly divide (such as hair or nails)will be replaced upon completion of chemotherapy, unlike the cancerous cells that have been killed.
Why the Stage Matters
Your colon cancer’s stage and grade is an important part of your treatment consideration. Although each treatment regimen is constructed on an individual basis, the majority of people with stage 0 and stage I colon cancers will not require chemotherapy.
The doctor may order chemotherapy, along with other treatments (radiation, surgery), in stage II and stage III colon cancer. The timing of your chemotherapy (before or after surgery or radiation) depends upon your doctor.
In stage IV colon cancer, the doctor may order chemotherapy to help relieve your symptoms or to increase your quality and length of life.
Palliative, Adjuvant, or Primary?
There are many reasons why your doctor will order chemotherapy aside from the obvious (to treat colon cancer). He or she may order chemotherapy drugs to provide either an adjuvant (additional) form of treatment, as a palliative (comfort-seeking) or as a primary mode of treatment.
Palliative symptom relief in advanced and metastatic stage IV colon cancer can be obtained by shrinking the tumors with chemotherapy agents, and increasing your quality of life with cancer.
Adjuvant chemotherapy is given along with another type of treatment modality, such as surgery. Chemotherapy may be used prior to surgery, to shrink the tumor before surgical excision, or after surgery, to reduce your risk of recurrence.
Primary chemotherapy is given as your only treatment modality for colon cancer. Surgical excision and removal is the most common form of treatment for colon cancer, but occasionally a person is too ill or cannot withstand the surgery.
Most Commonly Used Chemotherapy Agents
Chemotherapy drugs come in two primary forms: oral and intravenous. Intravenous chemotherapy drugs are given by injection through a vein, whereas oral chemotherapy drugs are given by mouth with a pill.
Most intravenous chemotherapy drugs are given on cycles, which are followed by a period of rest. Your doctor will take your health, your cancer’s stage and grade, the chemotherapy drugs used, and the treatment goals into consideration while deciding how many treatments are right for you. After chemotherapy is started, your doctor will have a better idea of how long you will need the treatment based on your body’s response to the medications.
- 5-FU, Adrucil, Efudex, Fluoroplex (fluorouracil): Used for advanced cancer, recurrent cancer, and cancers that do not respond to other chemotherapy agents.
- Eloxatin (oxaliplatin): Used for advanced cancer, recurrent cancer, or in stage III cancer after surgery.
- Xeloda (capecitabine): Taken by mouth in pill form, used to treat stage III cancer.
- Camptosar (irinotecan, irinotecan hydrochloride): Used to treat metastastic colorectal cancers, especially those that do not respond to other forms of chemotherapy.
- Wellcovorin (Leucovorin Calcium): Taken by mouth, this drug helps mitigate harmful effects from potent chemotherapy agents, such as 5-FU, but it is not a chemotherapy agent.
Stage III and IV colon cancers are sometimes treated with a combination of chemotherapy agents, which may include FOLFIRI, FOLFIRI-B, XELOX, and FOLFOX. The names are a compilation of abbreviations for the chemotherapy drugs included in each combination.
- FOLFIRI = Leucovorin calcium + fluorouracil + Irinotecan hydrochloride
- FOLFIRI-B = Leucovorin calcium + fluorouracil + Irinotecan hydrochloride + Bevacizumab
- XELOX = Xeloda + oxaliplatin
- FOLFOX = Leucovorin calcium + fluorouracil + oxaliplatin
Will I Need a Port?
A port is a surgically implanted device that the doctors and nurses use to gain access to your veins repeatedly, which can help decrease the scarring and discomfort of your peripheral veins during long-term treatment. Ports and central lines are used when chemotherapy is given continuously, such as with an infusion pump.
A port or central line is not suggested for everyone, as it is a surgical procedure with risks, such as bleeding, infection and malfunction. Your doctor will decide (on a case-by-case basis) if you are a candidate for a central line or port insertion. If a central line device is put in, your doctors and nurses will use it to administer your chemotherapy drugs. If you do not have a central line or port, the nurse will insert an intravenous catheter prior to each chemotherapy session.
Where Will I Go for Treatment?
The majority of chemotherapy administration occurs right in your oncologist’s office or in an outpatient oncology center. Your doctor may have a couple different offices; try to find a location closest to your home to ease any travel concerns.
Side Effects and Risks
Perhaps the first thought that enters your mind after hearing the word chemotherapy is the plethora of side effects you will have to encounter. Chemotherapy drugs are potent and they do come with a long list of possible side effects. However, your doctor and nurses are trained to anticipate these side effects and can help you mitigate them throughout your treatment. Common chemotherapy side effects may include:
- Nausea, vomiting or diarrhea
- Loss of appetite
- Peeling skin, blisters or sun sensitivity
- Low blood counts (neutropenia)
- Lethargy and exhaustion
- Mouth sores
- Numbness or tingling in the hands and feet
- Swelling in the hands and feet
- Susceptibility to colds and infections
Mitigating Side Effects
Your doctor and nurses will help you through any side effects you suffer from chemotherapy. There are plenty of things you can do for yourself -– you have a big role in maintaining your health and well-being during chemotherapy through rest, nutrition and good hygiene. Remember to:
- Suck on ice chips during chemotherapy (decrease mouth sores after)
- Use proper hand washing techniques at all times
- Stay away from sources of infection (crowded malls, schools) if possible
- Eat small, nutritious meals frequently
- Stay hydrated with plenty of water
- Rest when needed -– conserve your energy
- Talk to your doctor about ways to control nausea and diarrhea
- Watch for signs of infection and report them to your doctor
Talking to Your Doctor
It is normal to have many questions about your impending colon cancer treatments. Many oncology practices offer an educational session about chemotherapy guided by an oncology nurse before you start treatment. Ponder these questions before your next doctor’s appointment:
- What is the goal of my treatment with chemotherapy? (palliative, curative, shrinking tumors before surgery)
- Will the chemotherapy be the primary form of treatment?
- What chemotherapy agent will I get? Oral or intravenous?
- What is the risk of my cancer coming back after chemotherapy?
- How long will I be on chemotherapy?
- How many times a week will I need chemotherapy?
- Will I be able to work?
- Will I need someone to drive me to and from treatments?
- What are the most common side effects with this type of chemotherapy?
- How do you plan to mitigate these side effects? (medications, education)
- What should I expect during treatment?
- When should I call you? (fever, lethargy)
- Will my insurance cover all costs?
Write down your questions and any new concerns that develop. Talk to your doctor and nurses frequently throughout your treatment -- they are your allies in this fight.
American Cancer Society. (n.d.). Chemotherapy Principles: An In-Depth Discussion. Accessed February 3, 2012.
American Cancer Society. (2006). American Cancer Society’s Complete Guide to Colorectal Cancer. Clifton Fields, NE: American Cancer Society.
National Cancer Institute. (December 2011). Drugs Approved for Colon and Rectal Cancer. Accessed February 1, 2012.
Lange, V. (2009). Be a Survivor. Colorectal Cancer Treatment Guide. (4th ed.). Los Angeles: Lange Productions.