Treatment for metastatic bowel cancer
You might have chemotherapy if you have metastatic bowel cancer. Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout your body in the bloodstream.
Metastatic bowel cancer is cancer that started in either the back passage (rectum) or large bowel (colon) and has spread to another part of the body. It is also called advanced cancer.
Bowel cancer can spread to the:
liver
lungs
lymph nodes
bones
Find out about chemotherapy for colon cancer that hasn't spread
Chemotherapy for metastatic bowel cancer can relieve symptoms. It can also control the cancer and improve your quality of life for a time. But the treatment on its own can’t cure the disease.
You might have chemotherapy before surgery to remove cancer that has spread to your liver. This is to try to shrink it, so it is easier to remove. You usually have chemotherapy both before and after surgery.
Making decisions about treatment for bowel cancer that has spread
You usually have chemotherapy every 2 to 3 weeks depending on what drugs you have. Each 2 to 3 week period is called a cycle.
You usually have treatment as long as it is working and the side effects are not too bad.
You usually have a every 2 to 3 months to see if treatment is helping.
Usually you have a combination of 2 or 3 drugs.
The most common chemotherapy drugs for metastatic bowel cancer are:
capecitabine (Xeloda)
fluorouracil (5FU)
oxaliplatin (Eloxatin)
irinotecan (Campto)
raltitrexed (Tomudex) if you can't have 5FU or capecitabine
trifluridine and tipiracil (Lonsurf )
Combinations of these drugs may include:
folinic acid (leucovorin or calcium folinate), fluorouracil and oxaliplatin (FOLFOX)
folinic acid (leucovorin or calcium folinate), fluorouracil and irinotecan (FOLFIRI)
folinic acid, fluorouracil, oxaliplatin and irinotecan (FOLFOXIRI)
oxaliplatin and capecitabine (XELOX)
irinotecan and capecitabine (IrCap, XELIRI, CAPIRI)
You have most of these drugs into your bloodstream through a drip into your arm. A nurse puts a small tube into one of your veins and connects the drip to it.
Or you might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
Find out more about central lines
You have capecitabine as tablets.
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, no more, no less. Never stop taking a cancer drug without talking to your specialist first.
You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test.
Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.
Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.
Common chemotherapy side effects include:
feeling sick
loss of appetite
losing weight
feeling very tired
a lower resistance to infections
bleeding and bruising easily
diarrhoea or constipation
hair loss
Side effects depend on:
which drugs you have
how much of each drug you have
how you react
Tell your treatment team about any side effects that you have.
Read more about chemotherapy in the general treatment section
Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.
Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.
You might have surgery combined with chemotherapy if you have bowel cancer that has only spread to the . This is also called stage 4c bowel cancer.
Surgery combined with chemotherapy is also called cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC).
It involves:
the surgeon removing any tissue affected by the bowel cancer
having heated chemotherapy drugs put directly into your abdomen during the surgery (HIPEC)
You have to be well enough to have this intensive surgery.
This treatment is only available in specialist centres. This means that you might have to travel for treatment.
We have more information about CRS with HIPEC in our information about pseudomyxoma peritonei. Pseudomyxoma peritonei is a rare cancer that starts in the appendix.
Chemotherapy for bowel cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.
Find out about trials looking at chemotherapy for bowel cancer
Last reviewed: 17 Dec 2024
Next review due: 17 Dec 2027
The aim of treatment for metastatic bowel cancer is usually to reduce symptoms, make you feel better and sometimes help you live longer.
Metastatic bowel cancer is cancer that has spread from the back passage (rectum) and large intestines (colon) to other parts of the body, such as the liver. It is also called advanced cancer. Treatment includes chemotherapy, surgery, targeted cancer drugs and radiotherapy.
You might have surgery if your bowel cancer blocks your bowel and causes symptoms of bowel obstruction. Sometimes you can have surgery to remove cancer that has spread to your liver or lungs.
Deciding about treatment can be difficult when you have cancer that has spread. Treatments such as chemotherapy, targeted and immunotherapy drugs and radiotherapy can help to reduce symptoms.
If you have metastatic bowel cancer there is information and support available to you, your family and friends.
Bowel cancer means cancer that starts in the colon (large bowel) or back passage (rectum). It is also known as colorectal cancer.
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