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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
Find out how we produce our information|
Chemotherapy| is the use of special anti-cancer (cytotoxic) drugs to destroy cancer cells. In colon cancer, it's mainly used after surgery. Its aim is to get rid of any remaining cancer cells and reduce the chance of the cancer coming back in the future. This is called adjuvant chemotherapy.
If the cancer is advanced (stage 4), chemotherapy may be used to reduce symptoms.
Chemotherapy usually isn’t needed for stage 1 colon cancers that haven’t begun to grow through the muscle wall and aren’t affecting the lymph nodes (Dukes A).
In the treatment of stage 2 colon cancer (Dukes B), the risk of the cancer coming back is low, so chemotherapy may not be needed. However, after surgery the cancer will be examined carefully under the microscope, and your doctor may recommend that you have chemotherapy if cancer cells are found in the blood or lymph vessels very close to the cancer. You may also be offered chemotherapy as part of a clinical trial.| Your cancer specialist will discuss whether chemotherapy will be of any benefit to you if you have stage 2 colon cancer.
People with stage 3 colon cancer (Dukes C) are usually offered chemotherapy. They may also be offered chemotherapy as part of a clinical trial|.
The main drugs used are:
Your specialist will discuss your particular course of treatment with you.
There are several research trials in the UK looking at different chemotherapy drugs, or combinations of drugs, to treat colon cancer. Some of these may be given as tablets. You may be asked if you’d like to take part in a clinical trial| to test one of these treatments.
There are various benefits and risks of having chemotherapy and your doctor can discuss these with you.
Chemotherapy can reduce the chance of the cancer coming back, but doesn’t guarantee this. It can also sometimes cause side effects| that may be unpleasant. To help decide whether adjuvant chemotherapy may be appropriate in your case, your specialist will take into account the risk of any cancer cells being left behind, the likelihood that the chemotherapy will get rid of them, and the possible side effects of the treatment.
If the chance of the cancer coming back is low, the chemotherapy may only slightly reduce the chance of the cancer returning. However, if the risk of the cancer coming back is high, the benefit of chemotherapy may be greater. It’s important to discuss with your doctor the possible risks and benefits of chemotherapy in your particular situation.
Chemotherapy may also be given when the cancer has spread to another part of the body. Many people have no further problems after their original treatment for colon cancer, but unfortunately, in some people the cancer comes back or spreads to other parts of the body. This is called secondary, advanced or metastatic cancer.
Sometimes, when the cancer is first diagnosed, it may already have spread beyond the bowel. The most common place for it to spread to is the liver. We can send you a booklet about secondary cancer in the liver. The next most common place is the lungs.
Although secondary cancer of the colon can’t usually be cured, treatment with chemotherapy may be recommended by your doctor. The aim of the chemotherapy is to shrink the cancers and reduce symptoms. This can sometimes help to prolong life. Chemotherapy may also be given to shrink cancers before they are removed from the liver or, more rarely, the lungs. Sometimes drugs called monoclonal antibodies| are given in combination with chemotherapy.
Improvements in surgical techniques combined with drug treatment have meant that some people who have had liver secondaries removed, often combined with drug treatment, appear to be cured as a result of their treatment. Your doctor or specialist nurse can discuss this with you further.
We have further information about secondary cancer in the liver| and secondary cancer in the lungs|.
The most commonly used chemotherapy drugs for advanced colon cancer are:
Several research trials are being carried out to test new drugs for advanced colon cancer, and to help find the best way of using the current drugs. You may be asked if you’d like to take part in a research trial using new chemotherapy drugs or new types of treatments.
If the cancer starts to grow again, during or after the chemotherapy, you may be given a different type of chemotherapy (this is known as second-line treatment). Sometimes a third course of chemotherapy (third-line treatment) may also be given.
There are various benefits and disadvantages of chemotherapy for advanced colon cancer, and it’s important to discuss these with your cancer specialist.
It isn’t possible to predict whether chemotherapy will work for a particular person, but if they are fairly fit the treatment is more likely to be effective. It’s also less likely to have side effects| than in someone who is unwell when they start the treatment.
You don’t have to have chemotherapy unless you want to. If you choose not to, you’ll still be given treatment to help control any symptoms caused by the cancer. This is known as supportive, or palliative, care. Palliative care can also be given alongside chemotherapy if needed.
Your doctor will consider a number of things before asking you to make a decision about particular treatments. This will include the position of the secondary cancer, your general health and any chemotherapy treatment you’ve had in the past.
If you have advanced cancer, there are many difficult issues to deal with. You may find it helpful to read our section on coping with advanced cancer|.
Our sections on controlling cancer pain| and controlling cancer symptoms |explain ways that pain and symptoms can be treated. They also give information on the support that is available from health professionals and other sources.
Many people having chemotherapy for colon cancer are given capsules or tablets, which are swallowed with water.
Some people with colon cancer will have their chemotherapy drugs given by injection into a vein (intravenously). The drugs may be given through a vein in the back of your hand; a plastic line called a central line|, in your chest; or a thin tube inserted into a vein in the crook of your arm (a PICC line|).
Position of a central line
View a large copy of the diagram showing the position of a central line|
Position of a PICC line
View a large copy of the diagram showing the position of a PICC line|
Sometimes chemotherapy can be given to you continuously through a small portable pump which is attached to your central or PICC line. A controlled amount of the drug can be given into the bloodstream over a period of time. This means that you can go home with the pump, and spend less time in hospital. Some people whose cancer has spread to the liver may be given chemotherapy into an artery that goes directly into the liver.
Intravenous chemotherapy (see above) is usually given as a session of treatment. A session may last from a few hours to several days. If you have treatment for a few hours, this may be repeated each week for several months. This chemotherapy is usually given as an outpatient.
If your treatment lasts a few days you’ll usually have a rest period of a few weeks before the next session. This allows your body to recover from the side effects of the treatment. The chemotherapy session and the rest period make up a cycle of treatment. You may need to stay in hospital for your treatment, but it can also often be given to you as an outpatient. Your specialist will discuss this with you.
The number of cycles you have will depend on the stage of the cancer and how well it’s responding to the drugs.
It is not advisable to become pregnant or father a child while taking any of the chemotherapy drugs used to treat colon cancer, as they may harm the developing baby. It’s important to use effective contraception during your treatment and for a year afterwards. You can discuss this with your doctor or specialist nurse.
Condoms should be used during sex within the first 48 hours after chemotherapy to protect your partner from any of the drug that may be present in semen or vaginal fluid.
Our chemotherapy| section describes the treatment in more detail.
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.