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Chemotherapy might be necessary following colorectal cancer surgery if there is local spread to lymph nodes. This is typically given over 6 months.
Aim of chemotherapy
If you have been diagnosed with a cancer, your colorectal surgeon may refer you to a Medical Oncologist for chemotherapy. Chemotherapy can be given before surgery (neo-adjuvant chemotherapy) or after surgery (adjuvant chemotherapy). Chemotherapy can be given for early cancer that has spread to 1 or more lymph nodes (curative chemotherapy) or for advanced disease where cure is unlikely (palliative chemotherapy). Chemotherapy in most cases is given in addition to surgery. Occasionally, chemotherapy is given with or without radiotherapy instead of surgery.
Side effects of chemotherapy
5-Fluorouracil (5-FU) is generally well tolerated, with hair loss (alopecia) and bone marrow suppression (neutropenia), much less common than chemotherapy for other cancers. However, fatigue, nausea, diarrhoea and cracking around the lips (stomatitis) can occur.
Chemotherapeutic agents
5-fluorouracil (5-FU) is the main chemotherapeutic agent used for colorectal cancer. 5-FU may be given as an intravenous infusion or taken orally (Xeloda®). For colon cancer it may be used on its own, or in combination with oxaliplatin and/or leucovorin (Folfox®). For anal cancer it is commonly used in combination with Mitomycin-C.
Duration of chemotherapy
Whether oral or intravenous, the standard duration of chemotherapy is 6 months following your surgery.
Oral Xeloda
Xeloda® is usually taken twice daily for 14 days. This is usually followed by a 7-day rest period, for a total cycle of 21 days.
Infusional 5-Fluorouracil
5-fluorouracil (5-FU) can be given as a weekly 24-hour bolus infusion (Mayo clinic regimen), which is sometimes associated with severe nausea and toxicity, or it can be given as a gentler continuous infusion (de Gramont regimen) over 48 hours once a fortnight.