Chemotherapy

When chemotherapy is used

Chemotherapy uses drugs to kill or slow the growth of cancer cells while doing the least possible damage to healthy cells. If the cancer has spread to lymph nodes or to other organs, you may have chemotherapy:

Before surgery (neoadjuvant) – Some people with rectal cancer have chemotherapy before surgery to shrink it so it’s easier to remove. You may have only chemotherapy or with radiation therapy (chemoradiation).

After surgery (adjuvant) – Chemotherapy after surgery for colon or rectal cancer aims to destroy any remaining cancer cells and reduce the chance of the cancer coming back. If your doctor recommends chemotherapy, you usually start treatment within 6–8 weeks, when your wounds have healed and you’ve recovered your strength.

On its own – If the cancer has spread to other organs, such as the liver or lungs, chemotherapy may be used either to shrink the tumours or to reduce symptoms and make you more comfortable.

Having chemotherapy

Chemotherapy is usually given through a drip into a vein (intravenously). To avoid repeated needles, you may have it through a device inserted beneath your skin, such as a port-a-cath or peripherally inserted central catheter (PICC). Sometimes chemotherapy is taken as tablets (orally).

Chemotherapy is commonly given as a period of treatment followed by a break. This is called a cycle. Adjuvant chemotherapy is usually given for 3–6 months, in cycles that last for 2–3 weeks each. Your medical oncologist will explain your treatment schedule. Usually, you have chemotherapy during day visits to a hospital or treatment centre. Some people have chemotherapy at home through a portable pump.

Side effects of chemotherapy

The side effects of chemotherapy vary, depending on the drugs used and the dose. Your medical oncologist or nurse will talk to you about the likely side effects, including how they can be prevented or controlled. If side effects are hard to manage, the chemotherapy treatment can be adjusted to reduce the side effects while still giving you a good result.

Side effects may include:

• tiredness
• neutropenia (low white blood cells)
• feeling sick (nausea and vomiting)
• diarrhoea
• lip and mouth sores
• changes in appetite, taste and smell
• sore hands and feet (peripheral neuropathy)
• and hair loss or thinning.

The chemotherapy drug oxaliplatin may make your hands, feet, mouth and throat sensitive to cold items (e.g. cold food and drinks, air conditioning), causing pins and needles and numbness. Skin rash and increased sensitivity to sunburn are more common if using the chemotherapy drug fluorouracil or capecitabine.

Keep a record of the doses and names of your chemotherapy drugs handy. This will save time if you get an infection and need to visit the emergency department (see below). You may also find it helpful to keep a symptom diary when you start chemotherapy, so you can monitor side effects as they occur.