Cisplatin and fluorouracil (5FU) chemotherapy
Cisplatin and fluorouracil (5fU) chemotherapy is a treatment used to treat cancers of the gullet (oesophagus), the head and neck area, and anal cancers. Fluorouracil is usually called by its more common name 5FU.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
How cisplatin and 5FU is given
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You will have cisplatin and 5FU in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness drugs as an injection into a vein or as tablets. They give you the drugs and chemotherapy through one of the following (depending if you have a line in or not):
a short thin tube (cannula) that the nurse puts into a vein in your arm or hand
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
You’ll have extra fluids through a drip before and after the cisplatin. This is to protect your kidneys. Your nurse will give you cisplatin as a drip. They usually run the drip through a pump, which gives you the treatment over a set time. This takes at least one hour, but can take up to eight hours. You will then have an infusion of 5FU into your cannula or line.
When the chemotherapy is being given - allergic reaction
Rarely, some people might experience an allergic reaction while they're having cisplatin. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
Your course of cisplatin and 5FU
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Cisplatin and 5FU are given in different ways depending on the type of cancer you have. Your doctor or nurse will explain more about this. They might use one of the following schedules.
On the first day, your nurse gives you cisplatin with extra fluids through a drip. You will then have an infusion of 5FU, which takes four days. If you have a cannula, you need to stay in hospital for this part of the treatment. If you have a line, you can have 5FU through a small portable pump, which you carry on a belt or in a holster. You can go home once the pump is connected to your line and the infusion has started.
A nurse will disconnect the pump when your treatment is finished on day five. You may need to go back to the hospital to have this done. Sometimes, a district nurse can do this at home. If you have your treatment in hospital, you can go home when your treatment is finished. After this, you have a rest period with no chemotherapy. You start the next cycle three weeks after you began your treatment.
This treatment can be given along with radiotherapy (called chemoradiation) to treat anal cancer.
On the first day, your nurse gives you cisplatin with extra fluids through a drip. You will then have an infusion of 5FU, which takes 22 hours. If you have a cannula, you need to stay in hospital for this part of the treatment. If you have a line, you can have 5FU through a small portable pump which you carry on a belt or in a holster. You can go home once the pump is connected to your line and the infusion has started.
On days two, three and four, you have another infusion of 5FU. This also takes 22 hours. If you take the pump home, you will need to come back to the hospital each day for your pump to be renewed.
A nurse will disconnect the pump when your treatment is finished on day five. You may need to come back to the hospital to have this done. Sometimes, a district nurse can do this at home. If you have your treatment in hospital, you can go home when your treatment is finished. After this, you have a rest period with no chemotherapy. You start the next cycle three weeks after you began your treatment.
On the first day, your nurse gives you cisplatin with extra fluids through a drip. You will then have an infusion of 5FU, which you have for the next 21 days. You will need to have a central line or a PICC line for this. You will have 5FU through a small portable pump, which you carry on a belt or in a holster. You can go home once the pump is connected to your line and the infusion has started.
You will need to come back to the hospital on days eight and 15 to have your pump renewed.
A nurse will disconnect the pump when your treatment is finished on day 21. You will need to come back to the hospital to have the pump disconnected. This completes the first cycle of your treatment.
On the same day, you will start your next cycle. This is the same as the first cycle. Each cycle takes three weeks. Usually 2-6 cycles of chemotherapy are given.
Before you go home, the nurse or pharmacist will give you anti-sickness drugs to take. Take all your tablets exactly as explained.
Possible side effects of cisplatin and 5FU
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We explain the most common side effects of cisplatin and 5FU here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention, but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these. It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you.
Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
Chemotherapy can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen in the first few days after cisplatin. The 5FU in the pump is unlikely to make you feel sick. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Your hair may thin but you’re unlikely to lose all the hair from your head. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. Your nurse can give you advice about coping with hair loss.
Changes in the way the kidneys work
This treatment can affect how your kidneys work. You will have blood tests before and during treatment to check this. Your nurse will ask you to drink plenty of fluid. Tell them if there are any changes in how much urine you are producing. You’ll have extra fluids through a drip before and after cisplatin. This is to protect your kidneys.
Numb or tingling hands or feet
These symptoms are caused by the effect of cisplatin and 5FU on nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but in some people they may never go away. Talk to your doctor if you are worried about this.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Changes in hearing
Cisplatin can affect your hearing. You may have a hearing test before you start treatment. During treatment, you may get ringing in your ears (tinnitus) and lose the ability to hear some high-pitched sounds. Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. 5FU can cause a rash, which may be itchy.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat. Your skin may darken. It will return to its normal colour after you finish treatment.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Your nails may become brittle and break easily. They may get darker or discoloured, and/or you may get lines or ridges on them. These changes grow out after treatment finishes. Wearing gloves when washing dishes or using detergents will help protect your nails during treatment.
Your eyes may become watery and feel sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops. 5FU may also cause blurry vision and/or eye pain. Always tell your doctor or nurse if you have eye pain or notice any change in your vision.
Changes in the way the liver works
Treatment may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.
Less common side effects of cisplatin and 5FU
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Changes in the way your heart works
5FU can affect the way the heart works. You may have tests to see how well your heart is working before, during and sometimes after treatment.
If you have pain or tightness in your chest, feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions, but it’s important to get them checked by a doctor.
Effects on the lungs
Cisplatin can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, a fever or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Other information about cisplatin and 5FU
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Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious, but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This treatment interacts with the drugs phenytoin (epanutin ®), allopurinol and interferon. It may also affect the way drugs that thin the blood work, such as warfarin. Let your doctor know if you are taking any of these drugs. You should also tell your doctor if you’re taking folic acid because it might increase the side effects of 5FU.
Medicines you can buy in a shop or chemist may also be harmful when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Treatment may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using a number of reliable sources including:
electronic Medicines Compendium (eMC). medicines.org.uk (accessed July 2013).
Perry MC. The Chemotherapy Source Book. 5th edition. Lippincott Williams and Wilkins. 2012.
With thanks to: Bruce Burnett, Teacher Practitioner in Clinical Pharmacy Practice who reviewed this edition.
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