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.

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

Chemotherapy for Colon Cancer 

Most often, your physician will perform surgery to remove all or most of a tumor originating in the colon. If the cancer has spread to the lymph nodes or to other areas of the body, chemotherapy drugs may be prescribed to kill the remaining cancer cells.

Chemotherapy for Rectal Cancer

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, a doctor may prescribe chemotherapy treatment to shrink a rectal tumor before surgery to ease removal. Chemotherapy can also be used after rectal cancer surgery to kill remaining cancer cells after surgery.

Neoadjuvant Chemotherapy

Neoadjuvant chemotherapy may be given before surgery. Treating colorectal cancer with chemotherapy drugs can shrink the target tumor, so a surgeon will be able to remove it more easily with fewer complications. In some cases, neoadjuvant chemotherapy is used concurrently with radiation therapy, as the drugs might increase the radiation’s effectiveness.

Adjuvant Chemotherapy

Adjuvant chemotherapy is given after a colorectal tumor is removed via surgery. Cancerous cells might linger in the body, such as those that may have metastasized or spread to the liver, so adjuvant chemotherapy may be used to kill the remaining cells that were missed by the surgery.

Palliative Chemotherapy

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

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.

Intravenous Chemotherapy

Intravenous chemotherapy are drugs that are injected into a vein. 5-Fluorouracil (5-FU) has traditionally been the first-choice drug for treatment of colorectal cancer. 5-FU is given in combination with the vitamin, leucovorin, which makes 5-FU more effective.

Regional Chemotherapy

Regional chemotherapy drugs are placed directly into the abdomen. This method is used when colorectal cancer has spread. They are usually administered along with 5-FU, plus Irinotecan or Oxaliplatin, for metastatic colorectal cancer. Some regional chemotherapy drugs include:

• Panitumumab (Vectibix)
• Cetuximab (Erbitux)
• Bevacizumab (Avastin)
• Ramucirumab (Cyramza)
• Aflibercept (Zaltrap)

Oral Chemotherapy

Oral chemotherapy drugs are tablets or capsules ingested by mouth and can be taken at home. It is a newer form of chemotherapy administration that is equally as strong as other forms of chemotherapy, as long as it’s taken on schedule, as prescribed by your doctor. Some oral chemotherapy drugs include:

• Capecitabine (Xeloda)
• Irinotecan (Camptosar)
• Oxaliplatin (Eloxatin)
• Combination pill: Trifluridine and Tipiracil (Lonsurf)
• Regorafenib (Stivarga)

For more on oral chemotherapy options, watch our webinar led by Anna Varghese, MD, a medical oncologist developing new treatment options for colorectal cancer. We discuss the emerging treatment option of oral chemotherapy, its advantages and challenges, and highlight current oral therapies more and more patients are receiving.

Chemotherapy drugs are designed to kill any rapidly dividing cells in the body. In the process of killing harmful, cancerous cells, chemotherapy drugs may also kill healthy cells that also divide rapidly. Healthy cells in the membranes lining the mouth, gastrointestinal tract, the hair follicles, and the bone marrow tend to be adversely affected by chemotherapy treatment. Side effects related to chemotherapy should eventually stop once treatment ceases.

The side effects of colorectal cancer chemotherapy might include:

• Nausea and vomiting
• Loss of appetite
• Hair loss or hair thinning
• Mouth sores
• Rash on the hands and feet
• Diarrhea

Chemotherapy may also affect the bone marrow, which is the main site of blood cell production. Adverse side effects can include:

• Increased risk of infection (from low white blood cell counts)
• Bleeding or bruising from minor injuries (from low blood platelet counts)
• Anemia-related fatigue (from low red blood cell counts)

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