Colorectal Cancer Chemotherapy

Chemotherapy is a type of cancer treatment that uses powerful drugs to kill cancerous cells. It is a systemic treatment, meaning that the drugs affect cancerous cells throughout the body and prevents them from spreading. There are many different types of chemotherapy drugs that are used to treat specific types of cancer, can be prescribed at different stages of treatment, and can be administered in a variety of ways.

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, or infusion, or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy, or targeted therapy.

Download our 3-part book, Your Guide in the Fight, for more in-depth information on your colorectal cancer chemotherapy options.

For colon cancer, most often, your physician will first perform surgery to remove all or most of a tumor originating in the colon before you undergo chemotherapy. If the cancer has spread to the lymph nodes or to other areas of the body, chemotherapy drugs may be prescribed after surgery to kill the remaining cancer cells after surgery. This is called adjuvant chemotherapy.

For rectal cancer, your doctor may suggest you complete chemotherapy first before undergoing surgery. This is called neoadjuvant chemotherapy. In some cases, neoadjuvant chemotherapy is used concurrently with radiation therapy, as the drugs might increase the radiation’s effectiveness.

The rectum resides near several other organs, like the bladder, the uterus and vagina in women, and the prostate in men. Since this area is more densely packed, shrinking a rectal tumor before surgery helps ease removal. Chemotherapy can also be used after rectal cancer surgery to kill remaining cancer cells after surgery. 

Palliative chemotherapy is used when colorectal cancer has spread to other parts of the body and surgery will not be enough to eliminate the cancer. Palliative colorectal cancer chemotherapy might help shrink tumors and reduce symptoms.

In addition to chemotherapy, there are other treatment options for colorectal cancer:

• Surgery
• Targeted Therapy
• Immunotherapy
• Radiation Therapy

Your medical team will review your medical records and perform tests to plan your cancer treatment. Whether the team decides on administering chemotherapy for your type of colorectal cancer will depend on:

• Size and location of the cancer
• Age
• General health
• Other medications you are taking, including vitamins and supplements
• Other individual factors such as comorbid diseases or conditions

Depending on your exact chemotherapy treatment, the team may advise you on food and drink that you should or should not consume on the days that you receive treatment. Ingesting certain substances can negatively interact with your chemotherapy, so be sure to follow your medical team’s directions.

Colorectal cancer chemotherapy treatment is typically administered in cycles that range from 2 to 6 weeks. Your treatment cycle, schedule, and dosage will depend on the exact drug being given. Most patients will go through several cycles of chemotherapy, as long as they respond well to the treatment.

Chemotherapy treatment comes with side effects. Learn more about what side effects you may experience and how to manage them.

When you get a long list of names of drugs and treatments, it can be overwhelming. Take your time and learn about each drug to help you manage your care and prepare for potential side effects. 

Your doctor may recommend one or more of them at different times during treatment. Sometimes these are combined with targeted therapy drugs. You may know someone who had the same cancer type and stage that you have, but your treatment differed. It’s important to keep in mind that everyone is different, and your doctor is providing the treatment option, which he believes will save your life. 

• Capecitabine (Xeloda^®)
• Fluorouracil (5-FU)
• Irinotecan (Camptosar^®)
• Oxaliplatin (Eloxatin^®)
• Trifluridine/tipiracil (Lonsurf^®)
  

Some common treatment regimens using these drugs include:

• 5-FU alone
• 5-FU with leucovorin (folinic acid), a vitamin that improves the effectiveness of 5-FU
• Capecitabine, an oral form of 5-FU
• FOLFOX: 5-FU with leucovorin and oxaliplatin
• FOLFIRI: 5-FU with leucovorin and irinotecan
• Irinotecan alone
• XELIRI/CAPIRI: Capecitabine with irinotecan
• XELOX/CAPEOX: Capecitabine with oxaliplatin
• Any of the above with one of the following targeted therapies: cetuximab (Erbitux^®), bevacizumab (Avastin^®), or panitumumab (Vectibix^®). In addition, FOLFIRI may be combined with either of these targeted therapies: ziv-aflibercept (Zaltrap^®) or ramucirumab (Cyramza^®).

The term “standard of care” means the treatment you are receiving is accepted by medical experts as a proper treatment for colon or rectal cancer. You might hear them refer to it as best practice, standard medical care, and standard therapy.

Fight CRC works hand in hand with National Comprehensive Care Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) to make sure patients have accurate information. Download the following guidelines to help you manage your care. These guidelines inform “standard of care” for all colon and rectal cancer patients. 

• Colon Guidelines (PDFs in English, Russian, Ukrainian)
• Rectal Guidelines (PDFs  in English, Russian)

If you need printed resources, visit our store to receive a free Resource Champion Kit.

Medline Plus Drug Information

A service of the U.S. National Library of Medicine and the National Institutes of Health, this database includes information on the precautions, side effects, and proper use of thousands of prescription drugs, over-the-counter medications, herbs, and supplements.

National Cancer Institute (NCI) Drug Information Summaries

The NCI has compiled consumer-friendly overviews for more than 250 common cancer drugs and drug combinations. Each summary includes information on appropriate drug usage, side effects, drug interactions, and links to current clinical trials in which the drug is being used.

WebMD Drugs and Medications Database

This listing summarizes the uses, precautions, side effects, interactions, and overdose information for more than 60,000 medications, herbs, and supplements.

Fight CRC’s Clinical Trial Finder

Our Clinical Trial Finder can help patients with microsatelite stability (MSS) colorectal cancer (CRC) get a potential list of clinical trials to discuss with their medical teams. Originally created by the late Dr. Tom Marsilje as a curated spreadsheet of clinical trials, the FightCRC’s Trial Finder is a resource to search for clinical trials that are open in your geography, and for which you may be eligible. The current data are limited to MSS (microsatellite-stable) and stage IV CRC patients. The curated list of trials is sourced from the ClinicalTrials.gov website, and reviewed and posted to this finder by Fight CRC research advocates. The tool is not a comprehensive list of all CRC clinical trials – only those that would be most interesting to a patient with MSS-CRC, such as Dr. Tom himself. 

The trials that display in the search results are based on Tom's review criteria:

1. Trials with a “reduced” chance of potential failure
2. Trials with the biggest “potential” long-term benefit

Clinical Trials Mini Magazine

Colorectal Cancer Clinical Trial Finder

Fight CRC’s Provider Finder

Fight Colorectal Cancer (Fight CRC) and Komodo Health’s Provider Finder combines provider experience and knowledge of colorectal cancer with innovation and technology to deliver important information directly to patients’ fingertips. The Provider Finder gives patients easy access to healthcare providers using searchable fields to narrow choices and options of providers in an otherwise overwhelming world. No single organization can cure colorectal cancer alone. We’re building and growing a patient community that’s well-informed, fearless, and devoted to improving outcomes for all. We are constantly inspired by our community’s resilience, strength, and heart.

Fight CRC's Resource Library

Our resource library contains webinars, podcasts, videos, and free informative materials about genetics, biomarker testing, side effect management and more!