Chemotherapy for Colorectal Cancer

Richard Binder, MD Oncology, Hematology

Q: What is chemotherapy?
Chemotherapy is the use of medicines to treat your cancer. Sometimes these drugs are also referred to by the shorter term, "chemo."

Q: Is chemotherapy used in the treatment of colorectal cancer?
Yes, chemotherapy is used after surgery to kill cancer cells that have spread locally or to other parts of the body. Chemotherapy is also used to decrease the risk of disease recurrence (coming back or reappearing) and as treatment when cancer does reoccur.

Q: What is adjuvant therapy?
Adjuvant therapy is treatment given in addition to the primary therapy/treatment to improve the chances of curing the disease. In the case of colon and rectal cancer, the primary therapy/treatment is surgery. Chemotherapy is given as adjuvant therapy after surgery when the cancer is also in the lymph nodes.

Q: What is neo-adjuvant therapy?
Neo-adjuvant chemotherapy is chemotherapy given prior to the primary therapy (surgery).

Q: Why would a physician use adjuvant therapy and neo-adjuvant therapy for the treatment of colorectal cancer, and does this work?
Both adjuvant and neo-adjuvant therapy are used to reduce the risk of the cancer recurring. Adjuvant and neo-adjuvant chemotherapy are not always effective, but the risk of recurring disease can be reduced by about 50%.

Q: What is recommended if the disease has already spread?
The therapy/treatment is dependent on where the cancer has spread and how much it has spread. Therapy/treatment would include chemotherapy, radiation therapy, surgery, chemoembolization, radiofrequency therapy or cryosurgery, or a combination of these therapies.

Q: Who decides if I will get chemo?
You and your doctor will decide if chemo is the next step in treatment for you.

Q: How often will I receive chemotherapy treatments?
The frequency of your treatments may be daily or weekly, but they are usually given in cycles as an outpatient procedure. These breaks allow your body a chance to rest and build healthy new cells in preparation for the next cycle.

Q: How will the chemotherapy be given to me?
Most chemotherapy drugs are given through a tiny plastic tube called a "catheter." This is inserted into a vein in your arm or hand.

Sometimes the chemo is given "IV push," meaning that is given over a few minutes directly from a syringe into the infusion tubing. At other times, the chemo may be added to a plastic bag filled with solution. This is called an "IV infusion" and may last from 20 minutes to a few hours.

Some chemotherapy is given by mouth.

Q: What happens if the veins in my arms are too small or get too sore with the treatments?
An alternative is the central venous access device (CVAD). This is a catheter that can be placed by a surgeon, radiologist or a specially trained nurse. Its tip remains in a large vessel above your heart where it is safe to infuse any types of intravenous medications or fluids.

Q: What are possible side effects of the chemotherapy?

• a sore mouth, gums, throat and tongue
• nausea and/or vomiting
• diarrhea
• dry skin
• hair loss or thinning of your hair
• lowered blood counts
• fatigue

It is important to remember, however, that not every person experiences every side effect and the severity of side effects varies from person to person. These side effects can be avoided and/or treated through use of other medications and treatments.

Q: What should I do if I have side effects?
First, it is important to report any side effects to your doctor. Often the doctor will prescribe medications to prevent side effects such as nausea before they appear.

Q: How long do side effects last?
Most side effects gradually disappear after treatment ends. Your overall health and the specific drugs that you are receiving will influence the time it takes to get over some of the side effects.

Resources
American Cancer Society (ACS) booklet - "Understanding Chemotherapy: A Guide for Patients and Families." To receive additional information, you may call 1-800-ACS-2345. Or access the ACS website.