Colorectal Cancer

Chemotherapy for advanced bowel cancer

Advanced bowel (colorectal) cancer, usually means the disease has spread from the large bowel to the liver or lungs. Treatment with chemotherapy is unlikely to cure advanced bowel cancer, but improvements in surgical techniques and drug treatment can improve outcomes, and chemotherapy can help to control the symptoms, shrink the tumours, maintain a reasonable quality of life, and prolong life in some cases. Sometimes drugs called monoclonal antibodies (biological therapy) are also given in combination with chemotherapy and this too can help improve quality and length of life.

For some people, chemotherapy is the only treatment available, so deciding whether to have it can be straightforward. However, when chemotherapy is given over a long period of time, balancing the benefits of the treatment against the unpleasant side effects can become increasingly difficult. 

One man described his generally positive feelings at the prospect of having chemotherapy. However, for another man, who was much farther into his treatment, the decision making had become more complex.

For almost everyone we talked to receiving treatment for advanced bowel cancer the availability of their drugs had been an issue. Two people were being treated privately and were aware that their drugs might not have been available on the NHS. One NHS patient had to travel to a different hospital in her area for treatment until it became available closer to home. Another woman being treated on the NHS became involved in a high profile campaign for the right to receive treatment in her area rather than having to travel to another part of the country.

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The availability of some drugs for advanced bowel cancer has improved since these interviews and only certain drugs are limited to people taking part in clinical trials.

The use of Hickman lines, PICC lines and portacaths (central lines for administering drugs that are inserted and then left in place) or tablet forms of chemotherapy meant that people were not necessarily spending long periods of time in hospital and could enjoy a reasonable quality of life. Knowing their patterns of recovery from chemotherapy also allowed them to plan their activities.

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The side effects of palliative chemotherapy are different for each person and everyone develops their own ways of coping with them. One woman describes her efforts to live as normally as possible despite the obstacles. A man whose illness was more advanced found his side effects increasingly difficult to live with despite his determination to do so.

Stephen had a rare form of advanced bowel cancer. His cancer had spread to form tumours in his leg. As part of his treatment he had an unusual form of chemotherapy called isolating limb perfusion chemotherapy.
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Sometimes the side effects cause problems that cannot be ignored and decisions must be made about further treatment. One woman describes balancing the effects of drugs against the problems caused by side effects and explains how her choices are becoming more limited.

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All patients were aware that, at some point, their options would run out, but they tried to focus on what was possible and maintaining their quality of life.

Last reviewed August 2016.

Last updated August 2016.

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