Chemotherapy is the treatment of cancer with anticancer (cytotoxic) medicine. The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells. There are many types of chemotherapy treatment and different combinations can be used.
Chemotherapy may be given in a number of situations.
- Before surgery to try to shrink the cancer and make the operation easier
- During radiation treatment (chemo-radiation) to increase the effectiveness of the radiation treatment
- After surgery to reduce the chances of the cancer coming back
- As palliative treatment for a large cancer in the bowel, or for cancer that has spread beyond the bowel, to reduce symptoms and improve your quality of life or extend your life
Chemotherapy is usually given as a day procedure, which means you arrive and go home on the day you have treatment (outpatient).
Usually treatment is given in cycles, spread over weeks or months. Chemotherapy is given by injection or drip into a vein, or via a portable infusion pump worn on the body to deliver the medicine continuously into the veins. Some chemotherapy treatments are given as tablets or capsules that you probably take every day. The number of treatments you have depends on the type of bowel cancer you have. It also depends on how well your body is handling the side effects.
For more information on this subject you can read the Cancer Society’s booklet Chemotherapy/Hahau . You can get a copy by phoning the Cancer Information Helpline 0800 CANCER (226 237) or by contacting your local Cancer Society office. You can also download a copy from the Cancer Society’s website (www.cancernz.org.nz).
Side effects of chemotherapy
Side effects usually go away within a few months of finishing treatment. Some people manage to continue with their normal lives at home and work throughout their chemotherapy.
Side effects may include:
- diarrhoea (this can become severe, so let your doctor or nurse know straight away if you develop diarrhoea)
- redness of, pain in and peeling of hands or feet (sometimes called hand and foot syndrome)
- numbness and tingling in fingers and toes (peripheral neuropathy)
- infections (the medicine can lower your ability to fight infections)
- a sore or dry mouth
- loss of appetite or taste changes
- feeling sick or vomiting, but this is not common
- weight loss
- for women, less regular periods or no periods at all
- hot flushes, a dry vagina, mood swings or other symptoms of menopause
- vaginal itch, burning or infections.
Hair loss is not common for people having chemotherapy for bowel cancer.
You and your partner should use a contraceptive during treatment because the treatment can cause birth defects or miscarriage.
If fever develops (your temperature is 38 degrees or over) or you feel unwell even with a normal temperature, do not wait to see what happens—take action quickly. Contact your doctor or nurse and follow the advice given.
Radiation treatment is used to kill cancer cells by using X-ray beams that target the area affected by cancer.
It is often given in combination with oral chemotherapy to treat:
- locally advanced rectal cancer (cancer that has spread to areas close to the rectum) before surgery, to try to shrink the cancer and make surgery easier, and also to help reduce the risk of the cancer coming back
- metastatic rectal cancer (cancer that has spread to other distant parts of the body [for example, the liver]), either before surgery, to try to shrink the cancer and make the operation easier, OR when surgery is not planned, to get control of the cancer and slow down its spread.
Less commonly it is given with oral chemotherapy after surgery for rectal cancer to reduce the chances of your cancer coming back.
It may be given on its own:
- as a palliative treatment to treat cancer that has spread to other organs beyond the bowel
- to reduce symptoms and improve your quality of life
- to extend your life.
Radiation is usually given each day, Monday to Friday. Treatment for rectal cancer is normally over a period of five to six weeks. This may vary slightly, depending on the size of the tumour, the kind of treatment being used, the dose required, and the aim of your treatment.
The following can help with planning your treatment: routine blood tests, an MRI scan and a CT scan.
Blood tests are done regularly during treatment, and an MRI scan is repeated before surgery. You will be seen by your doctor or oncology nurse throughout treatment.
At the planning CT scan, your radiation therapist makes a few pin-sized marks (tattoos) on your skin. This is to ensure your body is in the right position and the same area of your body is treated each time.
During treatment you lie on a treatment bench (very similar to a CT scan bench). A machine delivering radiation is positioned around you. The treatment session takes 10 to 15 minutes. Radiation treatment is painless and there is no sensation of heat. The radiation therapist will make you as comfortable as possible.
For more information on this subject, you can read the Cancer Society’s booklet Radiation Treatment/Haumanu Iraruke . You can get a copy by phoning the Cancer Information Helpline 0800 CANCER (226 237) or by contacting your local Cancer Society office. You can also download a copy from the Cancer Society’s website (www.cancernz.org.nz).
“It’s like an X-ray machine. No worries. You’ve got a comfortable room, music going, then it’s over.” Milly
Side effects of radiation treatment
Although radiation treatment is not painful, there are side effects, which may build up over the course of your treatment. Usually these are temporary. It is important to discuss any side effects with your multidisciplinary team, who can advise you on how to manage these effects.
Side effects may include:
- skin irritation/broken skin (sometimes broken skin in the anal area)
- loss of pubic hair
- loss of appetite
- nausea or vomiting.
Because of the difficulty of shielding ovaries from radiation, pre-menopausal women may find their periods stop during treatment or for a few months afterwards, and may not return. They may also have hot flushes, a dry vagina or other symptoms of menopause. Menopausal symptoms can be controlled.
If pre-menopausal women have radiation to the pelvis it is very likely that they will no longer be able to get pregnant naturally. If this is of concern to you, please discuss it with your doctor.
Men who are treated in the pelvic or abdominal area are less likely to have sexual problems because it is much easier to shield the testicles from radiation.
Skin care (practical advice for a raw, sore bottom)
When bowel motions are frequent and loose, the skin around the anus can become raw, sore, itchy and prone to bleeding.
Keeping your skin clean and protected will improve the situation.
Cleaning your skin
Use products that do not contain alcohol or soap. Alcohol-free baby wipes can be used to clean the anal area after a bowel motion. Using soap and water to clean the area around your anus can alter the pH of your skin and increase the risk of breaks in the skin.
Clean the skin frequently and always after a bowel motion. Use warm water and a mild pH-balanced cleansing product, such as baking soda in warm water. Ask your chemist for a suitable product. Unscented toilet paper is also recommended.
Protecting the skin
The first step is to avoid or reduce contact with bowel motions. Use a barrier cream to protect your skin. Apply a thick layer to get a good coverage of the area.
To absorb leakage, a range of pads and absorbent products is available. These contain super-absorbent (and odour-reducing) substances to protect the skin from damage. You can buy these products at supermarkets and pharmacies, or you may get a discounted price from a supplier. It is best to avoid using women’s sanitary products because these are not designed to absorb leakage from the bowel.
Treating raw, sore skin
Raw skin around the anus is prone to fungal infection. Your doctor may prescribe an anti-fungal or cortisone-based cream to heal your skin. These creams tend to wipe off easily. To help them last, you can combine them with an equal amount of protective barrier ointment/cream.
Applying creams and ointments
Always cleanse and dry the skin well before applying any creams or ointments.
Apply the cream according to the instructions (for example, some anti-fungal creams should be applied sparingly).
Using a salt-water solution
To soothe skin and help with healing, sit with your bottom in a shallow bath of weak salt-water solution for five minutes several times a day.
1 teaspoon of salt per cup of boiling water. Allow this to cool before use.
Research has shown that, for many people with rectal cancer, a combination of chemotherapy and radiation treatment before surgery is effective in reducing the risk of cancer coming back. This treatment may be done over a five-week period, and is usually followed by a break of several weeks to give the person time to recover from the radiation treatment. After this break, surgery is usually done.
If your cancer has spread, your doctor will discuss various treatments for specific problems caused by the cancer.
These may include:
- surgery to remove the cancer or to bypass any obstruction so that your bowel continues to work normally
- surgery to remove the cancer in other parts of your body, such as the liver or lungs
- chemotherapy and radiation treatment, which can shrink the cancer and control symptoms such as pain and bleeding
- targeted therapies (see below)
- ablation therapy, which includes radio frequency or alcohol ablation and cryotherapy (freezing treatment), for areas of cancer in the liver
Targeted therapies aim to stop (‘block’ or ‘inhibit’) bowel cancer cells growing, by targeting changes (mutations) in the genes of the cells. These changes may be either on the surface of the cells or on the growth pathways inside the cells.
Not all bowel cancers respond to targeted therapies. Your doctor may test cells from your cancer for specific genes to decide if this is a treatment option that may work for you.
Targeted therapies are often given in combination with chemotherapy, as they work differently. They are usually injected into a vein.
Many of these are not free in the public health system. Please check with your doctor for more information.
Some targeted therapies can cause an allergic reaction. The most common side effect is skin rash. Other side effects may include:
- high blood pressure
- protein in your urine (your doctor may test your urine for protein and adjust your treatment if levels become too high)
- delayed wound healing
Taking part in a clinical trial
Your doctor may suggest that you consider taking part in a clinical trial. You could also ask if there is a clinical trial for your kind of cancer. Clinical trials are a vital part of the search to find better treatments for cancer and to test new or modified treatments and to see if they are better than existing treatments. Many people all over the world have taken part in clinical trials that have improved cancer treatments. The decision to take part in one is yours. If you are asked to take part in a clinical trial, make sure that you fully understand the reasons for the trial and what it means for your treatment. You could ask:
- what is the standard treatment if I do not participate in the trial?
- what is the possible benefit?
- which treatments are being tested and why?
- what tests are involved?
- what are the possible risks or side effects?
- how long will the trial last?
- will I need to go into hospital for treatment?
- what will I do if any problems occur while I am in the trial?
- if the treatment I receive in the trial is successful for my cancer, is there a possibility of carrying on with the treatment after the trial?
If you decide to join a randomised clinical trial, you will be given either the best existing treatment or a promising new treatment.
You will be chosen at random by computer to receive one treatment or the other, but either treatment will be right for your condition. In clinical trials, people’s health and progress are carefully monitored. If you do not want to take part, your doctor will discuss the best current treatment options with you.
For more information, you can read the Cancer Society’s booklet titled Cancer Clinical Trials. You can get a copy by phoning the Cancer Information Helpline 0800 CANCER (226 237) or by contacting your local Cancer Society office. You can also download a copy from the Cancer Society’s website (www.cancernz.org.nz).
Often, people with cancer think about using complementary therapies, alternative therapies or traditional healing. Many people feel it gives them a greater sense of control over their illness, and that it is ‘natural’ and low risk. They just want to try everything that seems promising. For many it is their usual cultural practice (for example, rongoā). It is important to talk to your doctor about any other therapies you are using or thinking about, because they may interfere with hospital treatment.
Complementary and alternative therapies
“When it was painful I transported myself to the market at home with fresh fruit. I remembered songs that have no words that reminded me of home, like streams and natural sounds. I imagined myself at moments throughout my lifetime—special places on the beach, certain things we did as children. I took myself there.”
Traditional Māori healing
Traditional healing has always been an integral part of Māori culture. Values, belief systems and teachings from kaumātua and tohunga alike have seen Māori focus on total wellbeing encompassing taha tinana, taha hinengaro, taha wairua and taha whānau (the physical domain, the domain of mind and behaviour, the spiritual domain and the family/whānau or social domain).
When Māori are faced with tough decisions on health care or treatment, some opt for traditional healing methods. These can include rongoā Māori, romiromi or mirimiri to name a few customary remedies based on native plants, massage therapy and spiritual healing. If you are thinking about using these treatments, please talk about them with your multidisciplinary treatment team. Both treatment providers aim to give you the best possible care that has minimal side effects.
If you have difficulty expressing your needs to your treatment providers, find someone to advocate on your behalf, so that both traditional Māori healers and hospital treatment specialists are able to work together to support you.
Pacific traditional healing
Traditional healing has long been used by Pacific people to help in their recovery. It involves taking a holistic approach to treating the person, where the mental, emotional, physical and spiritual aspects of their wellbeing are looked after together, rather than as separate parts. The treatment offered to each person depends on their needs.
Medicinal plants and herbs may be used during the treatment process, as well as stones and massage. Pacific people may choose to complement Western treatments with traditional healing. If you choose to include traditional healing as part of your treatment, please make sure you let your doctors know. They may ask questions about the types of treatment your traditional healer is using. This can be difficult to explain, especially if it is tricky to work out which English words to use to translate certain Pacific concepts. If you find it hard to tell your doctors or nurses about the traditional healing methods being used by your healer, it may be helpful for your doctors or nurses to talk directly to your healer, or even a close family/whānau member who knows what treatments you are receiving.
It may sometimes feel as if the doctors and the traditional healer do not need to know what each other is doing. But it is important they do to make sure that the medicines you are taking are working well together and not causing side effects. Traditional plant medicines can sometimes react with Western medicines. It is possible to use both Western and traditional medicines as part of your healing. Both have their place and benefits.
Palliative care focuses on improving quality of life—it is not just about care at the end of life. Care can be offered in the community, in a hospital, in a rest home, at home or in a hospice. Palliative care is provided by specialist doctors, nurses, social workers, spiritual care workers, whānau and cultural health services. Palliative care aims to:
- Help you enjoy the best quality of life you can for as long as possible
- Help make sure that your physical, practical, emotional and spiritual needs are met as well as possible
- help manage symptoms of bowel cancer
- help manage side effects of treatment
- help you feel in control of your situation
- help make the time that you have as positive as it can be for you and your family/whānau.
It is a good idea to ask for palliative care early—it can help to reduce stress for both you and your family/whanau if you are able to deal with issues early rather than wait until they become difficult to manage.
You may also have to make some difficult decisions during your illness. The palliative care team may be able to explain things to you, and help you to find answers.
In general, palliative care services are free. However, there may be a charge for the hire of some equipment for home care.
Palliative care and hospice services are funded by both the government and voluntary donations.
For more information on advanced cancer, you can read the Cancer Society’s booklet Advanced Cancer/MatepukupukuMaukaha. You can download a copy from the Cancer Society’s website (www.cancernz.org.nz).