Chemotherapy for Colon Cancer

"WHY DO I NEED chemotherapy if the surgery remove my colon cancer?" This is a common question that colon cancer patients have.

Colorectal cancer is the third most common cancer in men and women in the United States. More than 130,000 cases will be diagnosed this year, and, thankfully, more than half will live to tell the tale. For many the prospect of receiving chemotherapy is as scary as the cancer itself.

Why Do I Need Chemotherapy?

After cancer is removed by surgery, patients have many concerns about their future. Often additional steps are needed to kill cells that surgery may have missed, and that can not be detected by x-rays or blood tests. Without chemotherapy, the small cancer cells that surgery may have missed can survive and grow into a new, possibly incurable, tumor. Chemotherapy decreases the chance of cancer returning, and increases the likelihood of cure.

What is Chemotherapy?

Chemotherapy is a term used to describe the drugs that kill rapidly dividing (growing) cancer cells One of the most commonly used chemotherapy combinations for colon cancer is called "FOLFOX." FOLFOX is a combination of three different agents: 5-fluorouracil (five flor oh YER uh sil, also called 5-FU), leucovorin (luke oh VOR in, a vitamin which makes 5-FU more effective) and oxaliplatin (ox all uh PLAT in).

FOLFOX is given by IV in the arm, or through a special port that is placed under the skin in the upper chest. Like most chemotherapies, FOLFOX is given in cycles, usually every two weeks for 12 weeks, or six cycles. Usually FOLFOX is started in an infusion clinic and then completed at home through a pump.

While FOLFOX kills cancer cells, it may also injure healthy cells in our body (mostly normal cells that grow rapidly, like cancer cells) leading to adverse side effects.

Side Effects and How to Manage Them

Side effects of chemotherapy are common, but most are manageable with changes in diet, adjustment of daily routines and/or with medication prescribed by your doctor.

• Nausea, vomiting or diarrhea: Eating small meals frequently throughout the day can help the digestive process. Avoid hot or spicy foods and drink plenty of liquids.
• Mouth sores: Regular brushing of teeth and gums, and frequent use of mouthwash, are important for prevention.
• Hand-foot syndrome: Redness, swelling or tingling of the hands and/or feet can prevent normal activity. Wear gloves when doing household chores. Use moisturizers, and avoid perfumes.
• Neuropathy and Cold Sensitivity: Numbness and tingling in the hands and feet can cause difficulty picking up small objects or buttoning a shirt. Cold-sensitivity neuropathy may start soon after, and sometimes during, the first oxaliplatin infusion. Eat warm food and avoid cold environments.
• Infection: White blood cell count will often dip after receiving FOLFOX, leaving you at risk for infection. Avoid large crowds and wash hands to decrease risk of contracting disease.
  
  Report the following to your doctor or nurse immediately
• Fever above 100.5 degrees
• Chills
• Bruising or a wound that won't heal
• Chest pain, shortness of breath or rapid heart beat
• Blood in urine or stool

It's important to remember that most side effects are temporary, and that the chemotherapy may save your life.

Dr. Wang practices oncology at the Contra Costa Regional Medical Center.

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