Chemotherapy after surgery for bowel cancer

• A quick guide to what's on this page
• What adjuvant chemotherapy is
• Chemotherapy drugs used after surgery
• More information about chemotherapy

Adjuvant chemotherapy is chemotherapy given after surgery. Your specialist may recommend you have chemotherapy as soon as you have recovered from your surgery

• To help stop the cancer from coming back
• If you had cancer in any of the lymph glands that were removed

If cancer cells were found in any of your lymph nodes, there is a chance that your cancer could have spread. Cancer cells could have travelled away from the primary cancer in the bowel through the bloodstream or lymphatic system. These cells are too small to be seen on X-rays or scans. They can start to grow into secondary cancer at some time in the future.

Your doctor cannot say for certain whether any cancer cells have escaped or not. If there is a risk that this could have happened, you will probably be offered adjuvant chemotherapy. This can reduce the risk of your cancer coming back by killing off escaped cancer cells. We know that chemotherapy works best on very small groups of cancer cells rather than larger tumours.

Chemotherapy drugs commonly used after bowel cancer surgery include

• FOLFOX - a combination of folinic acid (leucovorin), fluorouracil and oxaliplatin given into a vein
• Capecitabine (Xeloda) - as tablets
• Tegafur and uracil (Uftoral) - as capsules
• Fluorouracil (5FU) into a vein

The links above take you to detailed information about these treatments and their side effects. There is also detailed information about the side effects of bowel cancer chemotherapy in this section of CancerHelp UK.

You may have treatment for about 6 to 7 months as tablets to take at home. Or you may have treatment as fluids given into a vein. If you have treatment into a vein, you can have the drugs through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

Your doctor will take into account various factors when deciding which chemotherapy treatment is best for you. They will discuss this with you.

In April 2006, the National Institute for Health and Clinical Excellence (NICE) issued guidance on both capecitabine and oxaliplatin as treatments after surgery for Dukes C bowel cancer. They say that using capecitabine on its own, or oxaliplatin with 5FU and folinic acid are both possible adjuvant treatments for this stage of bowel cancer. They add that the choice of treatment should be decided between you and your doctor, taking into account the stage of the cancer, your physical condition, side effects of the drugs and your personal preferences.

NICE are also looking at the drug irinotecan on its own as adjuvant chemotherapy treatment.

For more about having chemotherapy injections look at the main chemotherapy section in CancerHelp UK. It explains the treatment in more detail including

• What chemotherapy involves
• How chemo is planned
• How you have the treatment
• General chemo side effects
• Side effects of specific drugs
• Living with chemotherapy

Our bowel cancer organisations page has details of information services you can contact for more information about bowel cancer and its treatment. Books and booklets are also available, some of which are free.