Chemotherapy for advanced bowel cancer
This page tells you how you can have chemotherapy for bowel cancer that has come back, or has spread when it is diagnosed. You can find information about
Chemotherapy for advanced bowel cancer
Treatment with chemotherapy for advanced bowel cancer is unlikely to cure your cancer. But it can help you live longer and may shrink the tumour. Other aims of the treatment are to slow the cancer down and control symptoms such as pain, loss of appetite and losing weight.
You may have treatment as tablets or capsules to take at home. Or you may have treatment as liquids given into a vein. Your doctor will take into account various factors when deciding which chemotherapy treatment is best for you. They will look at which treatments you have already had, and how long it took for the cancer to come back. They will also discuss the treatment with you.
Sometimes, surgery is used to remove bowel cancer cells that have spread to the liver. You may have chemotherapy to shrink the tumour before the operation. Some people have chemotherapy before and after surgery.
Treatment with chemotherapy at this stage is unlikely to cure your cancer. But it can help you live longer and may shrink the cancer. Other aims of the treatment are to slow the cancer down and control symptoms such as pain, loss of appetite and losing weight. For advanced cancer, the aim of chemotherapy is to help you feel better. If you are unhappy about the side effects, you don't have to carry on with the treatment.
The drugs used for bowel cancer that has come back after treatment or has spread are
- 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
- FOLFIRI - a combination of folinic acid (leucovorin), fluorouracil and irinotecan
- Irinotecan - 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 as tablets or capsules to take at home. Or you may have treatment as liquids given into a vein. Your doctor will take into account various factors when deciding which chemotherapy treatment is best for you. They will look at which treatments you have already had, and how long it took for the cancer to come back. They will also discuss the treatment with you.
Treatment given when the cancer first comes back is called first line treatment. If the cancer comes back after first line treatment, or if the first line treatment does not control the cancer, then you may be able to have a different chemotherapy treatment. This is called second line treatment.
If you have treatment into a vein, you usually have it in the outpatient department or chemotherapy day unit. You can have the chemotherapy through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line or a PICC line. These are long, plastic tubes that give the chemotherapy 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.
If you have treatment with capecitabine tablets or tegafur and uracil capsules (Uftoral), you will be given the treatment to take at home. You usually take capecitabine tablets twice a day for a few months. You usually take Uftoral with folinic acid (a vitamin) which makes it work better. You take the treatment daily for a few weeks and then have a break, before starting the treatment again.
Some people prefer to have treatment with tablets or capsules because they can be taken at home. So you don't have to go to the hospital so often. These drugs are a type of fluorouracil, but they cause different side effects to fluorouracil given into a vein. The tablets or capsules are less likely to cause diarrhoea or a sore mouth. But they are more likely to cause hand and foot syndrome, which makes the skin on your palms and soles become sore, red and sometimes peel. There is more about the specific side effects of capecitabine and tegafur with uracil in the chemotherapy section of CancerHelp UK.
Your doctor will arrange a scan before you start treatment and again about 3 months later. Your doctor can measure the tumour on the scan and so will be able to see how well the treatment is working. The tumour may have
- Got smaller
- Got bigger
- Stayed the same
If it has stayed the same size, your doctor will want to talk to you about whether or not it is worth carrying on with the treatment.
If it has got bigger, despite your treatment, your doctor will stop the chemotherapy and may suggest trying a different treatment.
If it has got smaller, you may have a break and then have more treatment. According to a recent study, it may be just as helpful to have chemotherapy for 3 months for advanced bowel cancer as it is to have it for longer. You may benefit from a break. Your doctor will talk through the pros and cons with you.
Trials are continually being carried out to try and improve the treatments for advanced bowel cancer by finding new drugs or trying different combinations of drugs. A newer drug, raltitrexed (Tomudex), can be used for advanced bowel cancer. But NICE says that you should only have it as part of a clinical trial at the moment as there is not enough evidence that it works.
Sometimes, surgery is used to remove bowel cancer cells that have spread to the liver (liver metastases). This can only be done if there is no sign of any cancer anywhere else in the body. You will have a PET-CT scan to check whether there are cancer cells outside the liver.
If the liver tumour is too large to operate on, you may have FOLFOX or FOLFIRI chemotherapy to try to shrink the tumour so it can be removed.
If the liver tumours are small, you may have 3 FOLFOX chemotherapy treatments before and after the surgery. A recent trial showed that the chemotherapy helps people to live longer after the operation.
If your doctor believes that standard chemotherapy for advanced bowel cancer is unlikely to help you, you may be offered treatment as part of early clinical trials. These trials test new, experimental drugs being developed. If you are offered experimental treatment
- You should always be offered it as a part of a clinical trial
- All the risks and possible benefits will be explained to you
- Previous research will have suggested that the drug will help bowel cancer
- Your doctors will find out how much it is likely to help people in the future
- Your doctors will find out more about the side effects of the drug from the trial results
- You can pull out of the trial at any time
Some organisations can give information about new treatments for colorectal cancer. Or they can put you in touch with cancer support groups where you can talk to other people who have been through similar experiences to your own.
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 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.
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