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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.
Chemotherapy may be given 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.
Chemotherapy is sometimes given before an operation. This is known as neo-adjuvant chemotherapy. The aim of the treatment is to reduce the size of the cancer, to make it easier to remove during surgery. This may make it possible to avoid having a permanent colostomy.
Sometimes the chemotherapy is given in combination with radiotherapy – this is known as chemoradiotherapy.
If the cancer is advanced (stage 4), chemotherapy may be used to reduce symptoms.
Chemotherapy usually isn’t needed for stage 1 rectal 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 rectal 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 rectal cancer.
People with stage 3 rectal cancer (Dukes C) are usually offered chemotherapy. The chemotherapy can be used in combination with radiotherapy or on its own. You may be offered chemotherapy as part of a clinical trial.
The main drugs used to treat early-stage rectal cancer are:
Your specialist will discuss your particular course of treatment.
There are several research trials in the UK looking at different chemotherapy drugs, or combinations of drugs, to treat rectal cancer. Some of these may be given as tablets. You may be asked if you’d like to take part in a research 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 and increase your chance of being cured, but it 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 risk 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 cancer of the rectum, 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 rectum. The most common place for it to spread to is the liver. The next most common place is the lungs.
Although secondary cancer of the rectum can’t usually be cured, treatment with chemotherapy may be recommended by your doctor. The aim of the chemotherapy is to shrink the cancer and reduce symptoms. This can sometimes help to prolong life.
Chemotherapy may 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.
In recent years, improvements in surgical techniques and drug treatment have meant that an increasing number of people with liver secondaries are able to have surgery to remove their cancers – this can sometimes lead to a permanent cure.
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 rectal cancer are:
Several research trials are being carried out to test new drugs for advanced rectal cancer, and to help find the best way of using the current drugs (those mentioned above). 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 (known as second-line treatment). Sometimes a third course of chemotherapy (third-line treatment) is also given.
There are various benefits and disadvantages of chemotherapy for advanced rectal cancer, and it’s important to discuss these with your cancer specialist.
It isn’t possible to predict whether the 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 treatment.
You don’t have to have chemotherapy treatment unless you want it. If you choose not to, you’ll still be given treatment to help control any symptoms that the cancer causes. 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 where the secondary cancer is, 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 and you may find it helpful to read our section on coping with advanced cancer|.
Our sections on controlling cancer pain| and controlling the symptoms of cancer| explain ways that pain and symptoms can be relieved. They also give information on the support that is available from health professionals and other sources.
Many people having chemotherapy for rectal cancer will be given capsules or tablets. These are swallowed with water. Some people are given their chemotherapy drugs by injection into a vein (intravenously).
The drugs may be given through a fine tube in the back of your hand or arm (cannula), a plastic line, called a central line| in your chest; or through 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 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 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 depends 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 rectal 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 discusses 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.