What are the Side Effects of Chemotherapy for Colon Cancer?

Carolyn Vachani, MSN, RN, AOCN
Last Modified: June 30, 2002

Share article


Question

Dear OncoLink "Ask The Experts,"
What are the Side Effects of Chemotherapy for Colon Cancer?  

Answer

Carolyn Vachani, MSN, RN, AOCN, OncoLink's Clinical Trials Coordinator, responds:

Chemotherapy kills cells that divide rapidly. Unfortunately, this includes both good cells (hair follicles, mucosa of mouth and GI tract, red and white blood cells, etc.) and bad cells (tumor). Every chemotherapy has slightly different side effects, which vary from patient to patient. The following paragraphs describe the most common side effects for each medication and some ways to manage them.

Fluorouracil (5-FU)

Diarrhea: This can often be managed with loperamide (Imodium) or lomotil (anti-diarrheal medications). A doctor or nurse can give you instructions on how to take them, as it often differs from the instructions on the box. Patients with diarrhea should drink plenty of non-alcoholic fluids to prevent dehydration. Diarrhea can be very serious and require a reduction in the dose of chemotherapy, so be sure to let your physician know if you have it.

Mouth sores: Patients should get in the habit of rinsing their mouth with sterile water (or normal saline) or a mouth rinse that does not contain alcohol. If you do get mouth sores, your doctor or nurse can suggest a numbing mouth rinse (magic mouthwash, xylocaine, and hurricane) to ease any discomfort. Popsicles or soft cold foods may feel soothing to a sore mouth. Avoid spicy or hot foods, as these might irritate the mouth.

Eye problems: Patients may notice gritty or watery eyes. Lubricating drops, such as normal saline, can help with gritty, irritated eyes. This is temporary and should go away after treatments are stopped.

Lowering of blood counts: Effects on blood counts vary depending on the dose and schedule of chemotherapy. Your doctor or nurse can tell you what to expect in your particular case. A low hemoglobin (cell that carries oxygen) count is called anemia and can make you feel tired or, when more severe, short of breath. A low platelet count leads to easy bruising and bleeding, and a low white blood cell count puts a patient at higher risk for infection. While receiving chemotherapy you should notify your doctor or nurse if you have a temperature >100.5 or easy bruising or bleeding.

Changes to nails and skin: Nails can become dark, brittle, and chipped. These changes will grow out when treatment is stopped. Skin may also darken, particularly around the veins where the chemotherapy is given. These changes are also temporary. In addition, patient's skin is more sensitive to sunlight, and may burn easier than normal so be sure to use sunscreen and avoid sun exposure.

Less common side effects include:

Nausea and vomiting: there are several types of medications available to treat nausea and vomiting. You should let your doctor know if you have nausea or vomiting so they can give you medications to prevent this. You should stick to a bland diet (chicken broth, toast, rice) when feeling sick and be sure to drink plenty of fluids.

Hair loss: This is not too common with 5-FU treatment, but you may notice thinning of your hair. This usually starts about 3-4 weeks after treatment has begun. Hair will grow back after therapy is finished.

Soreness or redness of the palms: Also called palmer-planter syndrome, or hand and foot syndrome. This is a reddening and peeling of the soles of the feet and the palms of the hands, which can get severe if treatment is not stopped to allow heeling. It is most commonly seen with the continuous infusion or oral forms or 5-FU (Xeloda).

CPT-11 (Irinotecan)

Reaction during infusion: some patients may experience sweating, watery eyes, abdominal cramping, and diarrhea during the infusion. If this happens, a medication called atropine is given to stop or prevent the symptoms.

Diarrhea: The most common side effect of this medication is diarrhea. It typically starts a few days after treatment, and can be severe. Your doctor or nurse should provide you with special instruction on how to take loperamide (Imodium), as it is different from the instructions on the box. It is very important to let your doctor know how severe the diarrhea is - usually by the number of bowel movements per day. This may require your chemotherapy dose to be decreased. It is also important to drink a lot of fluids when you have diarrhea.

Nausea and vomiting: There are several types of medication available to treat nausea and vomiting. You should let your doctor know if you have nausea or vomiting so they can give you medications to prevent this. You should stick to a bland diet (chicken broth, toast, rice) when feeling sick and be sure to drink plenty of fluids.

Lowering of blood counts: Blood counts reach their lowest point 7-10 days after treatment and return to normal about 21 days after treatment. Effects on blood counts vary depending on the dose and schedule of chemotherapy. Your doctor or nurse can tell you what to expect in your particular case. A low hemoglobin (cell that carries oxygen) count is called anemia and can make you feel tired or, when more severe, short of breath. A low platelet count leads to easy bruising and bleeding, and a low white blood cell count puts a patient at higher risk for infection. While receiving chemotherapy you should notify your doctor or nurse if you have a temperature >100.5 or easy bruising or bleeding.

Hair loss: This usually begins 3-4 weeks after starting treatment, but can begin earlier. You may lose all of your hair, including eyebrows, eyelashes, and other body hair. Hair will grow back after treatments are completed, although it may be different in color or texture than before treatment. In the meantime you may chose to wear a wig, hat or scarf. If you chose to wear a wig, it is a good idea to get one before you lose your hair, so you can match it to your natural color. In the cold weather it is helpful to wear a hat to keep warm.

Less common side effects:

Mouth sores: Patients should get in the habit of rinsing their mouth with sterile water (normal saline) or a mouth rinse that does not contain alcohol. If you do get mouth sores, your doctor or nurse can suggest a numbing mouth rinse (magic mouthwash, xylocaine, and hurricane) to alleviate any discomfort. Popsicles or soft cold foods may feel soothing to a sore mouth. Avoid spicy or hot foods, as these might irritate the mouth.

Skin rash: CPT-11 (Irinotecan) can cause an itchy rash. If this occurs, let your doctor know, a medication can be prescribed to help with the itching.

Oxaliplatin

Numbness or tingling: Patients often report a numb or tingling feeling in their hands, feet, or throat. Often times it is brought on by cold, for example, drinking a cold drink or touching a cold steering wheel. It may not occur until after several treatments, and may get worse over the course of treatments, but should return to normal once treatments are stopped. To help with cold related feelings you should avoid cold beverages, wear gloves in the cold weather, and bundle up when going outside in cold weather or into air conditioned buildings.

Lowering of blood counts: The blood counts reach their lowest point 7-10 days after treatment, then increase slowly, returning to normal 21-28 days after treatment. Your doctor or nurse can tell you what to expect in your particular case. A low hemoglobin (cell that carries oxygen) count is called anemia and can make you feel tired or, when more severe, short of breath. A low platelet count leads to easy bruising and bleeding, and a low white blood cell count puts a patient at higher risk for infection. While receiving chemotherapy you should notify your doctor or nurse if you have a temperature >100.5 or easy bruising or bleeding.

Nausea and vomiting: There are several types of medication available to treat nausea and vomiting. You should let your doctor know if you have nausea or vomiting so they can give you medications to prevent this. You should stick to a bland diet (chicken broth, toast, rice) when feeling sick and be sure to drink plenty of fluids.

Diarrhea: This can often be managed with loperamide (Imodium) or lomotil (anti-diarrheal medications). A doctor or nurse can give you instructions on how to take these. Patients with diarrhea should drink plenty of non-alcoholic fluids to prevent dehydration. Diarrhea can be very serious and require a reduction in the dose of chemotherapy, so be sure to let your physician know if you have it.

Less common side effects:

Allergic reactions: A few patients may have an allergic reaction to this medication. This may present during the infusion as hives and itching, shivering, a high temperature, redness of the face, shortness of breath or anxiety. Let your nurse know immediately if you experience these symptoms. A medication can be given to reverse the reaction and, for future doses, medication can be taken prior to the chemotherapy to prevent this reaction.

Mouth sores: Patients should get in the habit of rinsing their mouth with sterile water (normal saline) or a mouth rinse that does not contain alcohol. If you do get mouth sores, your doctor or nurse can suggest a numbing mouth rinse (magic mouthwash, xylocaine, and hurricane) to help alleviate any discomfort. Popsicles or soft cold foods may feel soothing to a sore mouth. Avoid spicy or hot foods, as these might irritate the mouth.


News
ASCO: Gastrointestinal Cancer Treatments Analyzed

Oct 1, 2014 - In patients with synchronous stage IV colorectal cancer who receive up-front modern combination chemotherapy, immediate colon surgery to remove the primary tumor is seldom necessary, according to research presented at the annual meeting of the American Society of Clinical Oncology, held from May 29 to June 2 in Orlando, Fla. These findings accompanied several other studies presented at the conference focusing on treatment of gastrointestinal cancers.



I Wish You Knew

How cancer patients have changed my life

View More



Blogs and Web Chats

OncoLink Blogs give our readers a chance to react to and comment on key cancer news topics and provides a forum for OncoLink Experts and readers to share opinions and learn from each other.




OncoLink OncoPilot

Facing a new cancer diagnosis or changing the course of your current treatment? Let our cancer nurses help you through!

Learn More