Chemotherapy is the use of ‘anti-cancer’ (also known as cytotoxic) drugs to destroy cancer cells in the body.
If you have stage 0 or 1 bowel cancer, it should be possible to remove the cancer by surgery and chemotherapy will not be required.
In stage 2 bowel cancer, where there is no evidence that the cancer has grown through the bowel wall into the pelvis or lymph nodes, chemotherapy may not be needed. The tissue removed during surgery is examined under the microscope, and the findings discussed at the multi-disciplinary team meeting. Where the tumour is large or invading deeper within the bowel wall, chemotherapy may be offered to mop up any cancer cells that may be left in the body, which the surgeon could not see. One large study has shown that having chemotherapy for stage 2 bowel cancer could reduce the risk of the cancer returning by 4%. There is no strong evidence to suggest that this is beneficial for everyone and it should be considered carefully on an individual basis if your tumour has any “high-risk” features. Please ask your oncologist about this.
If you have stage 3 bowel cancer, surgery to remove the cancer and nearby lymph nodes is usually followed by a course of chemotherapy to help prevent the cancer returning.
If you have stage 4 (advanced) cancer, symptoms can be controlled and the spread of the cancer can be slowed using a combination of surgery, chemotherapy, radiotherapy and targeted therapies as appropriate.
Chemotherapy is used at different stages of treatment, and can be used in combination to make other treatments more effective:
- Neo-adjuvant – to shrink the tumour(s) before surgery to reduce the risk of the cancer recurring in the future.
- Adjuvant – to destroy any microscopic cancer cells that may remain after the cancer is removed by surgery and reduce the possibility of the cancer returning.
- Palliative – to relieve symptoms and slow the spread of the cancer, if a cure is not possible. it can be given first-line, second-line, third-line or subsequent lines as follows:
– First-line – chemotherapy that has been shown, through extensive clinical trials and research, to be the best option for the type of cancer being treated.
– Second-line – chemotherapy that has been shown, through extensive clinical trials and research, to be the best option if the disease has not responded to first-line chemotherapy or has recurred.
– Third-line – treatment that is given when both initial treatment (first-line therapy) and subsequent treatment (second-line therapy) don’t work, or stop working.
How will I receive chemotherapy?
In order for the chemotherapy to destroy cancer cells in the body, the drugs must be absorbed into your blood and carried throughout your body. The chemotherapy drugs can be given in different ways:
Oral chemotherapy: If your chemotherapy drug is available as a tablet you can swallow, this can be taken at home. You only go to the hospital for routine outpatients’ appointments, which include a blood test. As oral chemotherapies can cause side-effects it is important to keep a diary of how you are feeling and possible side-effects to ensure that you are able to identify and report them to your medical team immediately.
Intravenous (IV) injection: The treatment is given directly into a vein. This could be a small injection over a few minutes, a short infusion of up to 30 minutes, or longer infusions over the course of a couple of hours or even a couple of days.
Methods of intravenous chemotherapy
Intravenous chemotherapy can be given via four different methods:
- Cannula: A small tube inserted at each chemotherapy session into a vein in the back of your hand, or your arm.
- Central line: A thin, flexible tube inserted though the skin of the chest into a vein near the heart, which can stay in place for many months. Hickman® or Groshong® lines are common types.
- PICC line: A thin, flexible tube passed into a vein in the bend or upper part of your arm and threaded through until the end of the tube lies in a vein near the heart. PICC lines can stay in place for many months.
- Portacath: This is a small chamber which lies completely under the skin with a thin, flexible tube that goes into a vein in your chest or arm.
You can find more information on chemotherapy drugs here.
Chemotherapy can affect your sense of taste and smell, dull your appetite and make you feel sick. It may also make your mouth and throat sore or sensitive to hot and cold food and drink. For advice on ways to manage these side-effects through diet, please download our booklet ‘Living with Bowel Cancer – Eating Well‘.