Chemotherapy for bowel cancer
What is chemotherapy?
Chemotherapy is a term used to refer to medicines that can destroy cancer cells. Chemotherapy medications can be given in a variety of ways, including into a vein (intravenously) by injection, intravenously with a pump, or in tablet form taken by mouth. Each medication is usually targeted at a specific type of cancer, and each medicine has specific doses and schedules for its use. Chemotherapy can be given in a variety of situations.
Primary chemotherapy is used when bowel cancer is advanced and has already spread to different parts of the body. In this situation, surgery cannot be used to eliminate the cancer, so the best option is to be treated with chemotherapy. This may shrink tumours, alleviate symptoms, and prolong life.
Adjuvant chemotherapy is when chemotherapy is given after the cancer is surgically removed. The surgery may not eliminate all the cancer, so the adjuvant chemotherapy treatment is used to kill any cancer cells that may have been missed, such as cells that may have spread to the liver or elsewhere.
Neoadjuvant chemotherapy is chemotherapy given before surgery. Chemotherapy medications may be given before surgery in order to shrink the tumour so that the surgeon can completely remove it with fewer complications. Chemotherapy is also sometimes given with radiotherapy, as it can make the radiotherapy more effective.
Your specialist will discuss with you the best treatment strategy for your situation.
Chemotherapy medicines used for bowel cancer
5- Fluorouracil (5-FU) is one of the most commonly used chemotherapy drugs used to treat bowel cancer. It is often used in combination with the vitamin folinic acid (leucovorin), which makes 5-FU more effective. 5-FU is given intravenously. A tablet form of chemotherapy called capecitabine (Xeloda) is converted by the body into 5-FU and is often used for bowel cancer. Capecitabine is also used as a neoadjuvant therapy with radiotherapy in patients with rectal cancers to enhance the effect of radiotherapy.
Several new chemotherapy medications also are used for the treatment of bowel cancer including oxaliplatin, irinotecan and uftoral.
Several clinical trials are under way and other treatments may become available in the future.
One area of interest is biological therapies (treatments that use medicines made from natural body substances). Currently in the UK cetuximab, bevacizumab, and panitumumab are licensed for use in the UK for the treatment of advanced bowel cancer. The National Institute for Health and Clinical Excellence (NICE) says that cetuximab should be available on the NHS, but that bevacizumab and panitumumab should not be available on the NHS. The Scottish Medicines Consortium (SMC) says that panitumumab should not be available on the NHS in Scotland.
What are the side-effects of chemotherapy for bowel cancer?
Because the mechanism of chemotherapy is to rapidly destroy dividing cancer cells, it also destroys or damages other rapidly dividing healthy non-cancerous cells in our bodies, such as those that make up the membranes lining the mouth, the lining of the gastrointestinal tract, the hair follicles, and the bone marrow. As a result, the side-effects of chemotherapy relate to the damage done to the cells in these areas.