Chemotherapy - the kind of treatment that uses cytotoxic drugs in the fight against malignant diseases. Basically it is a systemic therapy, have an impact on the entire body completely, but also applies a regional treatment, the exposure of specific areas of the body.
Chemotherapy for bowel cancer in Assuta hospital assigned in the following cases:
- Before surgery, the complex or without radiation therapy to reduce the tumor. Neoadjuvant chemotherapy is particularly effective in colorectal cancer because the tumor is located near the anal sphincter. If the tumor reduced in size, there is the possibility of sphincter preservation.
- After surgery with or without radiotherapy to eliminate the cancerous remaining segments and reduce the likelihood of disease return.
- For the treatment of colon cancer that had metastasized to the liver - holding regional chemotherapy.
- For the treatment of advanced colorectal cancer to ease pain or control symptoms.
chemotherapy drugs for intestinal cancer in the clinic Assuta
The most common cytotoxic agents used for the treatment of colorectal cancer are:
- 5-fluorouracil - it is administered by intravenous injection or continuous infusion.
- Capecitabine (Xeloda) is administered orally.
- Irinotecan (Camptosar, CPT-11) administered intravenously.
- Tomudex (raltitreksida) is administered as an injection.
Most often, the following combination chemotherapy for intestinal cancer in the clinic Assuta:
- 5-fluorouracil (Adrucil, 5-FU) and leucovorin (Leucovorin) [Folinic acid (Folinic Acid)]). Leucovorin is normally added to increase the effectiveness of 5-FU.
- FOLFOX: Oxaliplatin (Eloxatin) in combination with 5-fluorouracil and folinic acid. This chemotherapy regimen with bowel cancer may be administered alone or in combination with bevacizumab.
- FOLFIRI: irinotecan in combination with 5-fluorouracil and folinic acid. It is held in its original form or with bevacizumab.
- FOLFOXIRI: a combination of irinotecan, oxaliplatin, 5-fluorouracil and folinic acid. Irinotecan and capecitabine may be combined with bevacizumab and capecitabine and oxaliplatin, and with him.
Chemotherapy for bowel cancer in the clinic Assuta carried out usually on an outpatient basis. The bulk of drugs injected intravenously via various devices. Let us examine them.
- Cannula - plastic tubes, which are placed in a vein in the back of the hand or arm. Recovered after the procedure.
- PICC line - a central venous catheter, peripherally implanted under the skin. One of the indications for its use is an intravenous systemic chemotherapy. He stays up until the treatment is complete.
- Central catheter - a long, thin, flexible tube that is inserted into a vein in the chest, goes under the skin, the end is expelled. He stays until the end of chemotherapy for bowel cancer.
Sometimes the central catheter, or PICC line connects portable, small pump. Use it for a certain time in the blood continuously supplied a controlled amount of drug.
If colorectal cancer does not respond to some drugs or back again, other drugs can be used, for example, cetuximab (Erbitux).
This targeted agents can be combined with irinotecan as a second or third line therapy. Its use depends on which drugs have been used before, and whether KRAS gene mutation site. When present, this treatment would be inefficient, since it is aimed to epidermal growth factor receptor EGFRs, which transmits signals to the cancer cells for growth and survival.
Data targeted drug therapy used in treatment of metastatic colorectal cancer, who had previously been treated with 5-flurouracil, oxaliplatin or irinotecan.
Regional chemotherapy of metastases in the liver (chemoembolization)
Local chemotherapy for bowel cancer in the clinic Assuta is applied in the following cases:
- In order to destroy malignant cells that infiltrated the liver, but has not yet developed a tumor.
- To eliminate the remaining cancer after the operation segments.
- To reduce the size of cancer before surgery.
- For treatment of tumors, which can not be removed surgically.
Floxuridine (FUDR), similar to the action of 5-FU, is introduced through a small catheter is placed into the hepatic artery, the blood flow is blocked for a short time. Another option - a small size pump implanted near the liver.
This type of local chemotherapy regionarnaoy also called liver perfusion or liver infusion. Local treatment floxuridine may be replaced by a systemic therapy of 5-FU.
Regional chemotherapy deliver high concentrations of drugs directly to the tumor, which usually leads to a decrease of side effects in the rest of the body - this advantage. The disadvantage is the lack of effects on cells, which may be outside the liver.
In two clinical studies, this type of treatment can increase the survival rate in some patients.
Chemoembolization is sometimes used also to slow the growth of tumors in people who are on the waiting list for liver transplantation.
The most common adverse effects of treatment include diarrhea, inflammation of the intestines and stomach, chronic hepatitis, gastric ulcer, a thickening and hardening of the bile duct, the catheter thrombosis (blood clots).
Potential side effects of bowel cancer:
- Bone marrow suppression involves reducing the number of one or several main types of blood cells (neutrophils, platelets, red blood cells). This leads to the development of neutropenia, thrombocytopenia or anemia, which in turn increases the risk of infections, bruising and bleeding, fatigue and malaise.
- Nausea and vomiting, which often provoke a combination of chemotherapy drugs for bowel cancer. Doctors prescribe drugs that prevent and control these symptoms.
- Appetite loss is due to various reasons, including the temporal changes of taste sensations, fatigue, and so forth.
- Inflammation in the mouth. The medical clinic staff inform patients about proper oral care, are also prescribed analgesics and oral solutions.
- Loss or thinning of hair growing under the influence of chemotherapy drugs for bowel cancer. Some drugs, such as irinotecan lead to complete loss of hair. After the treatment, they are restored.
- Diarrhea is caused by the type and dose of drugs, frequently seen with combinations thereof. Appointed by antidiarrheals. If this symptom is important to monitor the level of fluid intake, at least two liters daily. In some cases, there is a need for antibiotics.
- Hand-foot syndrome is a toxic reaction to some drugs for intestinal cancer chemotherapy. There have been a rash, painful swelling, swelling, tingling in the soles of the feet and palms of the hands.
- Peripheral neuropathy may be caused by the action of oxaliplatin. Marked manifestations such as hearing changes, numbness or tingling. Sometimes you need to decrease the dose of the drug.
- Severe fatigue can be caused by many factors - the specific chemotherapy agents for intestinal cancer, anemia, lack of appetite, depression. The patient will be useful short walks.
- Cutaneous reactions include rashes, dryness, redness, nail changes, itching, sensitivity to the sun.
- Pain in the muscles and joints aching, for the facilitation appointed analgesics.
- Hypersensitivity reactions are the result of intravenous chemotherapy drugs for intestinal cancer.