What Is Folfox Chemotherapy
FOLFOX chemotherapy, also called Oxaliplatin de Gramont , is a type of cancer therapy that involves taking drugs containing anticancer chemicals. These chemicals target rapidly dividing cells such as cancer cells. They may also kill other healthy cells in your body that rapidly divide such as cells in your hair follicles, gastrointestinal tract, and skin cells.
FOLFOX uses the drugs folinic acid, fluorouracil, and oxaliplatin. FOLFOX can be broken down into other subtypes such as FOLFOX-4, FOLFOX-6, and FOLFOX-7 depending on how these three drugs are administered.
Researchers have found that taking these three drugs together is more effective than taking them alone. According to a
, FOLFOX is typically used as an adjuvant treatment and for advanced cancers that have spread beyond your colon.
The recommend that patients with metastatic colon cancer receive FOLFOX or one of two other chemotherapy regimens called XELOX or FOLFIRI. Metastatic colon cancer is when cancer spreads beyond the original site to other tissues and lymph nodes.
Clinical trials have found comparable results with all three types of treatment.
How Colorectal Cancer Is Treated
In cancer care, different types of doctors often work together to create a patients overall treatment plan that usually includes or combines different types of treatments. This is called a multidisciplinary team. For colorectal cancer, this generally includes a surgeon, medical oncologist, radiation oncologist, and a gastroenterologist. A gastroenterologist is a doctor who specializes in the function and disorders of the gastrointestinal tract. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called shared decision-making. Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for colorectal cancer because there are different treatment options. Learn more about making treatment decisions.
Where You Have Chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so its 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.
Clare Disney : Hello, my name is Clare and this is a cancer day unit.
So when you arrive and youve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. Were going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
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How Is Chemotherapy Given
You can get chemotherapy in different ways to treat colorectal cancer.
- Systemic chemotherapy: Drugs are put right into your blood through a vein or you take them by mouth. The drugs enter your bloodstream and reach almost all areas of your body.
- Regional chemotherapy: Drugs are put right into an artery that leads to the part of the body with the cancer. This focuses the chemo on the cancer cells in that area. It reduces side effects by limiting the amount of drug reaching the rest of your body. Hepatic artery infusion, or chemo given directly into the hepatic artery, is an example of regional chemotherapy sometimes used for cancer that has spread to the liver.
Chemo drugs for colon or rectal cancer that are given into a vein , can be given either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctors office, infusion center, or in a hospital setting.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. These are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take blood for testing.There are many different kinds of CVCs. The most common types are the port and the PICC line.
Dont Ignore Your Cancer Treatment Side Effects
There is often something that can be done to reduce your discomfort. Dont just suffer through. You should talk to your oncologist and your nurse about what youre experiencing. And if there is anything that causes you to be suddenly concerned, please dont hesitate to call and ask.
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Chemotherapy For Bowel Cancer
Chemotherapy uses anti-cancer drugs to treat bowel cancer.
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These drugs disrupt the way cancer cells grow and divide, but they also affect normal cells.
Chemotherapy may be given:
- after surgery, to reduce the risk of cancer coming back
- before surgery, to shrink the cancer and reduce the risk of it coming back
- as the main treatment, if the cancer has spread to parts of the body such as the liver or lungs
- with radiotherapy to treat rectal cancer. This is called chemoradiation.
- fluorouracil often given with folinic acid
Often, two or more chemotherapy drugs are given in combination. The three most commonly used combinations are:
How Can I Choose From Among The Options
The team of doctors responsible for your care will provide you with information specific to your care. Your doctors will recommend the appropriate type of treatment for you and will discuss these options with you. Generally, patients undergo a specific therapy because a cancer specialist has recommended it as the best way to treat the cancer.
If you are to undergo radiation therapy, a radiation oncologist will determine how much radiation is needed and where. They will also determine how many treatments will be necessary.
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Side Effects Of Radiation Therapy
Radiation therapy uses particles of ionizing radiation to destroy cancer cells in a specific spot in your body. After a few sessions, you may notice you feel very tired. Sometimes, people develop a reaction on their skin where the radiation was given. Your skin may feel red, itchy or dry. You may also notice that you need to have bowel movements more often than usual, or develop diarrhea. Some people lose their appetite.
Your doctor and cancer care team can help you manage these side effects so you can stay as comfortable as possible during your radiation treatment.
Why Many Stage 3 Colorectal Cancer Patients Skip Chemo
Chemotherapy after stage 3 colorectal cancer surgery is effective and its side effects are usually limited, yet about a third of patients do not receive the treatment.
To better understand why — and to inform practices that encourage patients to undergo chemo — Arden Morris, MD, a professor of surgery, and her colleagues surveyed patients. They found that the more social risk factors a patient faced, the more likely they were to skip chemotherapy. Those factors included not having health insurance, being low income, not having a spouse or someone else to care for them, and an experience of discrimination.
However, even when patientshad a number of risk factors, the likelihood they would complete chemotherapyimproved if they hada strong social support network — from a spouse or partner, faith community, friends, or coworkers.
“If you have people offering to help with chores, giving you rides, encouraging you to get to your appointments, you’re much more likely to undergo treatment,” Morris said.
The research was published June 9 in JAMA Network Open.
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What Happens During Radiation Therapy
Radiation therapy uses high energy x-rays or a stream of particles. At high dosesmuch higher than x-ray exams useit can destroy abnormal cells that cause cancer. It does this by damaging the cell’s DNA, which eventually causes the cell to die.
Because of the importance of treating the cancer but sparing healthy tissue, you will visit the medical center before actual therapy for treatment planning and simulation. The best patient positions for radiation exposure are determined for accurate, effective therapeutic results. The doctor may mark your skin with permanent ink. They may create customized lead shields to protect healthy organs or shape the radiation fields for your situation using special blocks inside the radiation machine. CT or MRI scans may help better visualize the tumor and the sensitive normal tissues and aid in treatment planning.
Sore Mouth Throat And Tongue
Some cancer treatments can cause mouth sores, ulcers, and tender gums, leading to dehydration, poor eating, and weight loss. Follow these tips to manage sore throat, mouth, and tongue.
- Choose soft, bland foods.
- Softer foods will be easier to chew and swallow.
- Soups and stews are good options, as long as meats are soft and tender.
- Try breakfast foods like instant oatmeal, grits, pancakes, waffles, and cold cereal that has been softened in milk.
- Pick side dishes like cottage or ricotta cheese, macaroni and cheese, mashed white or sweet potatoes, and rice or risotto.
- Try desserts like custard, tapioca pudding, ice cream, milkshakes, and sherbet.
- Choose snacks like applesauce, gelatin, smoothies, and yogurt.
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What Are Possible Side Effects Of Radiation Therapy
Side effects that develop during treatment vary from person to person. However, some side effects are typical.
There are usually no immediate side effects from each radiation treatment. Most patients gradually develop mild fatigue over the course of therapy. This slowly goes away one to two months following treatment. Some patients develop some redness, dryness, and itching of the skin after a few weeks. Other patients develop substantial irritation.
Skin reactions usually heal completely within a few weeks of completing treatment.
Diarrhea, frequent bowel movements, or appetite loss is likely to occur at some point during the course of treatment. Generally, side effects stop gradually once treatment ceases, but bowel function may remain different from what it was before the disease started.
Can Oral Chemotherapy Be Effective
Oral chemotherapy can be as powerful and effective as traditional chemotherapy.
When it comes to oral therapy, following directions and not skipping doses is key. It takes commitment to track your medications and take them on time and in the right dose. It also takes a lot of communication between you and your oncologist.
How effective your therapy is depends on:
- the type of cancer
- how well your body responds to therapy
- the severity of your side effects
Talk with a doctor about what you can expect from oral chemotherapy.
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How Vitamins Affect Chemotherapy Drugs
Many people want to take an active role in improving their overall health. They want to help their bodys natural defenses fight the cancer and speed up their recovery from chemo. Most people think of vitamins as a safe way to improve health, so its not surprising that many people with cancer take high doses of one or more vitamins. But some vitamins might make chemo less effective.
More research is needed, but until more is known about the effects of vitamins on chemo, keep these points in mind:
- If your doctor has not told you to take vitamins, its best not to take any.
- Always check with your doctor first before starting to take a vitamin of any kind, even a simple multivitamin.
- Ask your doctors if and when it might be OK to start taking vitamins after treatment.
- If youre concerned about nutrition, you can usually get plenty of vitamins by eating a well-balanced diet. See Nutrition for People With Cancer to learn more about nutrition during and after cancer treatment.
Treatment By Stage Of Colorectal Cancer
Different treatments may be recommended for each stage of colorectal cancer. The general options by stage are described below. For more detailed descriptions, see How colorectal cancer is treated, above. Your doctor will work with you to develop a specific treatment plan based on your specific diagnosis and needs. Clinical trials may also be a treatment option for each stage.
In general, stages 0, I, II, and III are often curable with surgery. However, many people with stage III colorectal cancer, and some with stage II, receive chemotherapy after surgery to increase the chance of eliminating the disease. People with stage II and III rectal cancer will also receive radiation therapy with chemotherapy either before or after surgery. Stage IV is not often curable, but it is treatable, and the growth of the cancer and the symptoms of the disease can be managed.
Stage 0 colorectal cancer
The usual treatment is a polypectomy, or removal of a polyp, during a colonoscopy. There is no additional surgery unless the polyp cannot be fully removed.
Stage I colorectal cancer
Surgical removal of the tumor and lymph nodes is usually the only treatment needed.
Stage II colorectal cancer
For stage II rectal cancer, radiation therapy is usually given in combination with chemotherapy, either before or after surgery. Additional chemotherapy may be given after surgery as well.
Stage III colorectal cancer
Metastatic colorectal cancer
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Managing The Emotional Side Effects Of Treatment
Cancer survivors often express concerns related to medical bills, anxiety about returning to work and stress about the future. Depression and anxiety are also fairly common in individuals who have been treated for cancer.
Many medical centers offer cancer survivorship programs that provide access to counseling, financial assistance and referrals to experts who can help with post-treatment issues.
Whats The Folfox Procedure Like
FOLFOX is usually delivered intravenously directly into your bloodstream. It may be administered through a short tube called a cannula that connects to a vein in your arm.
Its also possible to receive treatment through a peripherally inserted central catheter . A PICC is a long tube that inserts into your arm and releases the drug in the large central veins near your heart.
FOLFOX is delivered in 2-week cycles. The number of cycles you receive can vary, but might be as many as 12.
The exact treatment you receive can vary depending on the type of FOLFOX you receive, but heres one example of what FOLFOX treatment may look like:
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How To Store Chemotherapy Pills
Oral chemotherapy pills may have certain requirements for storage regarding temperature. Its important to make sure to keep your medication stored at the temperature recommended.
Also, make sure to keep your medication in a dry place. Certain areas, such as the bathroom, may be damp and cause the medication to break down. Also, keep oral chemotherapy pills sealed and away from childrens reach.
You and a doctor must consider many factors when deciding on oral versus traditional chemotherapy. This is how they compare with each other on some key points:
|You can take it at home in a matter of seconds, so theres less disruption to your life.
|It requires a visit to a doctors office or clinic for a treatment that may take hours. Over time, this can become burdensome.
|Its less invasive and causes little to no physical discomfort when you take it.
|Getting IV medications can be uncomfortable or even painful. It can take several hours and may increase your anxiety levels.
|You have to keep track of dosing and administration, making sure to take it exactly as directed, usually several times per day.
|Your healthcare team takes care of dosing and administration.
|Your health insurance plan might list it as a pharmacy benefit instead of a medical benefit. This could increase out-of-pocket costs.
|Major medical benefits usually cover it.