adjuvant chemo

[Synth]

Hello: I just had a colon resection for a stage 2a tumor in the large colon. Thank God they found nothing in the liver, lungs, or 15 lymph nodes, but they want to follow up with "adjuvant" chemo. I might need the take home "pump yourself" type of treatment. I am very anxious about side effects. I don't do well with nausea and I have a phobia against vomiting. (ever since childhood). Any experiences you can relate?

[Fernando Roque, MD]

Hi.  Since you have stage 2a colon cancer, you're probably going to receive either one or a combination of the following drugs:  Capecitabine, Fluorouracil, and Oxaliplatin.  All three drugs, whether used singly or as part of a combination regimen, are relatively well tolerated and have "milder" adverse effects when compared to other chemotherapy drugs.  

The three drugs I mentioned can all cause some degree of nausea and vomiting, with Oxaliplatin having the greatest potential for causing this symptom (65% chance of nausea and vomiting when given as a single agent, and 90% when given in combination with Fluorouracil).  In actual practice, I seldom see patients who are receiving Capecitabine, Oxaliplatin or Fluorouracil experience nausea and vomiting.  This is because there are a lot of drugs (e.g. Granisetron, Ondansetron, and Aprepitant) available which are highly effective at controlling these symptoms. So with proper medication, you shouldn't worry too much about vomiting.  

Capecitabine comes in tablet form and is taken orally.  It commonly causes diarrhea and mouth sores (55% of those who take the drug).  The diarrhea is usually mild (the stools just get softer) and can be controlled by drugs such as loperamide.  It can also cause Hand-Foot Syndrome (15-20% chance of occurring), a form of drug reaction where the patient gets rashes, swelling, and peeling of the skin on the palm of the hands and soles of the feet.  This drug can also cause some numbness and tingling of  the tips of the fingers and toes, and discoloration of the nails.

Fluorouracil is a very similar drug to Capecitabine (it just given intravenously rather than by oral route) and has a similar side effect profile.

Oxaliplatin is also given by intravenous route.  It can also cause diarrhea (but to a lesser degree than Fluorouracil or Capecitabine) and neuropathy (numbness and tingling of hands and feet).  All three drugs can cause a decrease in red blood cell, white blood cell and platelet counts.  Use of the three drugs can also result in some degree of hair thinning, but you don't usually go bald with these medications.

The above side effects are temporary, and symptoms usually disappear a month or two after the last chemotherapy session.

[Synth]

Thanks so much for the feedback. It Still sounds scary, but I guess I want every stray cancer cell to bite the dust. Your time is appreciated, Synth