Chemotherapy for Colorectal Cancer
Chemotherapy (chemo) is often used to treat colorectal cancer. It’s the use of drugs to kill cancer cells.
How is chemotherapy given?
You can get chemotherapy in different ways.
- Systemic chemotherapy: Drugs are put right into your blood through a vein or you take them by mouth. The drugs enter your bloodstream and reach all areas of your body. This can help reduce the risk of colorectal cancer spreading to other parts of the body.
- Regional chemotherapy: Drugs are put right into an artery that leads to the part of the body with the tumor. This focuses the chemo on the cancer cells in that area. It reduces side effects by limiting the amount of drug reaching the rest of your body. Hepatic artery infusion, or chemo given directly into the hepatic artery, is an example of regional chemotherapy sometimes used for cancer that has spread to the liver.
Doctors give chemo in cycles, with each treatment followed by a rest period to give the body time to recover. Chemotherapy cycles generally last about 2 to 4 weeks. People usually get at least several cycles of treatment.
When is chemotherapy used for colorectal cancer?
Chemo may be used at different times during treatment for colorectal cancer:
- Adjuvant chemo is given after surgery. The goal is to kill any cancer cells that might have been left behind at surgery because they were too small to see, as well as cancer cells that might have escaped from the main tumor and settled in other parts of the body but are too small to see on imaging tests. This helps lower the chance that the cancer will come back.
- Neoadjuvant chemo is given (sometimes with radiation) before surgery to try to shrink the cancer and make it easier to remove. This is often done for rectal cancer.
- Foradvancedcancers that have spread to other organs like the liver, chemo can be used to help shrink tumors and ease problems they’re causing. While it’s not likely to cure the cancer, this often helps people feel better and live longer.
Drugs used to treat colorectal cancer
Some drugs commonly used for colorectal cancer include:
- Capecitabine (Xeloda), which is in pill form. Once in the body, it is changed to 5-FU when it gets to the tumor site.
- Irinotecan (Camptosar)
- Oxaliplatin (Eloxatin)
- Trifluridine and tipiracil (Lonsurf), a combination drug in pill form
In most cases, 2 or more of these drugs are combined, which makes them work better. Sometimes, chemo drugs are given along with a targeted therapy drug.
Side effects of chemo
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, are also dividing quickly. These cells can be affected by chemo too, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and how long you take them. Common side effects of chemo can include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Increased chance of infections (from having too few white blood cells)
- Easy bruising or bleeding (from having too few blood platelets)
- Fatigue (from having too few red blood cells)
Along with these, some side effects are specific to certain drugs. For example:
- Hand-foot syndrome can develop during treatment with capecitabine or 5-FU (when given as an infusion). It can start out as redness in the hands and feet, and then progress to pain and sensitivity in the palms and soles. If it worsens, the skin may blister or peel, sometimes leading to painful sores. It’s important to tell your doctor right away about any early symptoms, such as redness or sensitivity, so that steps can be taken to keep things from getting worse.
- Neuropathy (nerve damage) is a common side effect of oxaliplatin. Symptoms include numbness, tingling, and even pain in the hands and feet. It can also cause intense sensitivity to hot and cold in your throat, esophagus (the tube connecting the throat to the stomach), and the palms of your hands. This can cause pain when swallowing liquids or holding a cold glass. If you’ll be getting oxaliplatin, talk with your doctor about side effects beforehand, and let him or her know right away if you develop numbness and tingling or other side effects.
- Allergic or sensitivity reactions can happen in some people while getting the drug oxaliplatin. Symptoms can include skin rash; chest tightness and trouble breathing; back pain; or feeling dizzy, lightheaded, or weak. Be sure to tell your nurse right away if you notice any of these symptoms while you’re getting chemo.
- Diarrhea is a common side effect with many of these drugs, but can be particularly bad with irinotecan. It needs to be treated right away — at the first loose stool — to prevent severe dehydration. This often means taking a drug like loperamide (Imodium). If you’re getting a chemo drug that will likely cause diarrhea, your doctor will give you instructions on what drugs to take and how often to take them to control this problem.
Most of these side effects tend to go away over time after treatment ends. Some, such as hand and foot numbness from oxaliplatin, may last for a long time. There are often ways to ease these side effects. For example, you can be given drugs to help prevent or reduce nausea and vomiting.
Be sure to discuss any questions about side effects with your cancer care team. Also report any side effects or changes you notice while getting chemo so that they can be treated right away. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to help keep the problem from getting worse.
Older people seem to be able to tolerate some types of chemo for colorectal cancer fairly well. Age is no reason to withhold treatment in otherwise healthy people.
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Hi friends! Happy to report that we had a great visit with my oncologist in Dallas last week. I’m scheduled to have another liver MRI and PET scan in the next couple of weeks, so we’ll be praying for good results!! I don’t want to get ahead of myself…..but there is a possibility I may be able to go on a chemo maintenance pill after I finish this “block” of chemo (16 treatments total). I know it’s still chemotherapy, but it sounds a little easier than what I’m doing right now. During my Dallas visit we discussed a lumpectomy (removing the main breast tumor) or possibly a mastectomy (removing the entire breast) if a lumpectomy isn’t feasible. The doctor also brought up possibly doing focused radiation (on my liver, sternum, and breast) after I complete this chemo block. I realize things can change from day to day…..so I’m trying to just take it one day at a time and trust that God’s plan is in place.
Back to the chemo pill- I believe my eyelashes and brows would grow back while I’m taking the pill which sounds glorious! (…it’s the little things…..and eyelashes and brows are actually quite useful believe it or not). But I digress. I’m willing to do whatever it takes to be here. Period. (Pic below from our Dallas visit). We were able to have lunch with some family and friends…..and it made the day that much better⭐️
Moving on, I was able to receive my 12th chemo treatment yesterday! If things go according to plan, I only have 4 more in this block! Praise. The. Lord. I found out recently that I have to stick to my cold cap “hair care” regimen for 1-3 months post chemo until all the shedding stops…..but at least there might be a break, or end in sight! I can’t tell you how much I miss wearing my hair in a messy bun, a ponytail….or washing my hair in the shower like a normal person! But, I am grateful that the cold caps have helped me keep a lot of my hair during this process. So that’s a win 🙂 I’m working on another blog piece for Woman’s Hospital on what goes into the cold cap process….so I’ll share that in the next couple of weeks once it is finished. (I’ve had a lot of people wanting more information on what the cold caps entail, so hopefully the blog will be helpful.) 💜
Chemo itself yesterday went smoothly….I had my amazing husband and cold cap crew with me….and a few of surprise visitors which really lifted my spirits🖤 (Thank you Julie Clark, Christy Thomas and Channin!) I was also able to see my friend Stacie and her sweet mom (pic below). Stacie is almost finished with chemo and I’m so excited to see her move on to the next chapter of her life.
Anyway, after I finished chemo and cold capping yesterday things went downhill a little. I’m not sure why, but I felt exceptionally awful last night starting around 9pm and today hasn’t been much better unfortunately. I’m really trying to remember that “joy is not dependent on my circumstances”…..but I’m human…..and the truth is it hasn’t been a great day. However. when things seem really hard…..I try to remind myself that God has this under control…and that I am so blessed to have the love and support from so many amazing people. Just because today wasn’t the best, doesn’t mean I can’t try again tomorrow 🙂
P.S. My husband made an excellent point that I might be the only qualified person in Baton Rouge to wear the jeans I had on yesterday…..besides him I suppose! I’m not trendy, but I am loving my new last name, and everything that comes with it⭐️
Keep those prayers coming, I appreciate it more than you know.
Cooling Caps (Scalp Hypothermia) to Reduce Hair Loss
What is it?
Scalp hypothermia is cooling the scalp with ice packs or cooling caps (cold caps) for a period of time before, during, and after each chemotherapy (chemo) treatment to try to prevent or reduce hair loss.
Newer versions of these devices use a two-piece cooling cap system that is controlled by a computer, which helps circulate a cooled liquid through a cap a person wears during each chemotherapy treatment. A second cap, made from neoprene (a type of artificial rubber), covers the cooling cap to hold it in place and keep the cold from escaping.
How might it work?
The theory behind scalp hypothermia is that the cooling tightens up or constricts blood vessels in the scalp. This constriction is thought to reduce the amount of chemo that reaches the cells of the hair follicles. The cold also decreases the activity of the hair follicles and makes them less attractive to chemo, which targets rapidly dividing cells. This could reduce the effect of chemo on the follicle cells and, as a result, prevent or reduce hair loss from the scalp.
What does the research show?
Controlled studies of older forms of scalp hypothermia (such as using ice packs) have had conflicting results. However, some studies of newer, computer-controlled cooling cap systems have shown benefits. Recent studies of women getting chemo for early-stage breast cancer have found that at least half of the women using one of these newer devices lost less than half of their hair. The most common side effects have been headaches, neck and shoulder discomfort, chills, and scalp pain.
The success of scalp hypothermia may be related to the type of chemo drugs used, the chemo dosage, and how well the person tolerates the coldness.
Some research has also suggested that people with a thicker hair layer might be more likely to lose hair than those with a thinner layer of hair. This might be because the scalp doesn’t cool down enough due to the insulating effect of the hair.
Cooling caps that are not fitted tightly have also been linked with more hair loss, often in patches where contact with the scalp is poor.
There remain some unanswered questions about the safety of scalp hypothermia. Some doctors are concerned that the cold could keep chemo from reaching any stray cancer cells lurking in the scalp. Some believe that the scalp cooling might protect cancer cells there and allow them to survive the chemo and keep growing. But in people who have used scalp hypothermia, reports of cancer in the scalp have been rare. More studies are needed to answer questions about long-term safety.
What should I do?
Some newer cooling cap systems, such as the DigniCap and Paxman cooling systems, have been cleared for use by the US Food and Drug Administration (FDA). Some older types of scalp hypothermia devices can be rented or purchased online, and some cancer treatment facilities in the US allow patients to use them.
If you are considering whether to use scalp hypothermia, it’s important to carefully weigh the potential benefits, discomforts, and risks . Discuss the pros and cons of this option with your cancer treatment doctor. You might also want to ask if the treatment center has experience in using cooling caps and how successful they have been.
Another consideration might be cost. Older types of caps are generally not covered by insurance, and it’s not yet clear if the use of newer, computer-controlled systems will be covered, either. It’s important to check with your insurance company to see what might be covered before starting your treatment.