Wednesday, 3 April 2019

My Bowel Cancer Treatment, so far...

For those of you who have followed my "YES! I've got Bowel Cancer and..." Blog - - you'll realise that I've been raising awareness of my experience of "Bowel Cancer", the Stoma Operation, because of fear that my Colon would get blocked, and the use of a Urinary Catheter.

"All of that's taken place so I could start Chemotherapy."

Chemotherapy is a cancer treatment where medication is used to kill cancer cells.

There are many different types of chemotherapy medication, but they all work in a similar way.

They stop Cancer cells reproducing, which prevents them from growing and spreading in the body.

Unfortunately, due to all the things listed above...

"My Bowel Cancer had spread to other parts of the body, e.g.the liver which is apparently known as stage 4, secondary or Metastatic Bowel Cancer"

As I've said before...

"It's Still Bowel Cancer even now it's present in my Liver"

If you read earlier posts you'll be aware that my Lymph Glands had also swollen.

If you're diagnosed with cancer, you'll be cared for by a team of specialists. Your team will...

"...recommend Chemotherapy if they think it's the best option for you, but the final decision is yours"

Making that decision wasn't difficult for me, but it can be difficult. 

Individuals may find it useful to write a list of questions to ask their Medical Team.

For example, Individuals may want to find out:

  • what the aim of treatment is – for example, is it being used to cure your cancer, relieve your symptoms or make other treatments more effective
  • about possible side effects and what can be done to prevent or relieve them
  • how effective chemotherapy is likely to be
  • whether any other treatments could be tried instead

If, as I did, you agree with your team's recommendation, they'll...

"...start to plan your treatment once you've given your consent to treatment"

Tests and checks
Before Chemotherapy begins, individuals will have tests to check your general health and make sure the treatment is suitable for them.

The tests they'll have may include...

  • blood tests – to check things such as how well your liver and kidneys are working, and how many blood cells you have
  • X-rays and scans – to check the size of your cancer
  • measurements of your height and weight – to help your team work out the correct dose 

During treatment they'll also have tests to monitor their progress.

Your treatment plan

 Chemotherapy involves several treatment sessions, in my case...

"12 were planned, typically spread over the course of a few months"
Before treatment starts, the care team will draw up a plan that outlines:

  • the type of Chemotherapy you'll have
  • how many treatment sessions you'll need
  • how often you'll need treatment – after each treatment you'll have a break before the next session to allow your body to recover

Your treatment plan will depend on things such as the type of Cancer you have and what the aim of treatment is.

How chemotherapy is given

1: Into a vein (intravenous chemotherapy)

In most cases, Chemotherapy is given directly into a vein. This is known as "Intravenous Chemotherapy".

This usually involves medicine being given slowly from a bag of fluid that's attached with a tube to one of your veins.

This can be done using:

Peripherally Inserted Central Catheter
 (PICC) line
  • a cannula – a small tube that's placed into a vein in the back of your hand or lower arm for a short time
  • a Peripherally Inserted Central Catheter (PICC) line – a small tube inserted into a vein in your arm that usually stays in place for several weeks or months (that's me)
  • a central line – similar to a PICC, but inserted into your chest and connected to one of the veins near your heart
  • an implanted port – a small device inserted under the skin that's kept in place until your treatment course finishes; medicine is given using a needle inserted into the device through the skin

The time it takes to have a dose of Intravenous Chemotherapy can range from several hours to several days.

You usually come into hospital for the treatment and go home when it's finished.

I have my Second Round of Chemotherapy via a Pressurised bottle connected to my PICC Line.

A District Nurse removes the bottle, when empty, on Saturday Morning.

2: Tablets (oral chemotherapy)

Sometimes Chemotherapy is given in tablets. This is known as Oral Chemotherapy.

Individuals will need to come into hospital at the start of each treatment session to get the tablets and have a check-up, but they can take the medicine at home.

It's essential those on Oral Chemotherapy,  follow the instructions given by their care team. Taking too much or too little medicine may reduce its effectiveness and could be dangerous.

If Individuals experience any problems with their medicine, such as forgetting to take a tablet or being sick shortly after taking one, they MUST Contact the care team 

Other types of chemotherapy

Less commonly, Chemotherapy may be given as:

  • injections under the skin – known as "Subcutaneous Chemotherapy"
  • injections into a muscle – known as "Intramuscular Chemotherapy"
  • injections into the spine – known as "Intrathecal Chemotherapy"
  • a skin cream

Issues during treatment

During Chemotherapy treatment, there are a number of important things to bear in mind.

1: Taking other medicines
While having Chemotherapy, it's important to check with the care team before taking any other medication – including over-the-counter medicines and herbal remedies.

NOTE: Other medicines could react unpredictably with your Chemotherapy medication, which may affect how well it works and could cause dangerous side effects.

2: Side effects
Chemotherapy can cause a range of unpleasant side effects, although many can be treated or prevented and most will pass once your treatment stops.

"It's difficult to predict what side effects we'll get"

Here is a list of many of the common side effects, but it's unlikely individuals will have all of these.

  • Tiredness - One of my main side effects, along with breathlessness - 

is one of the most common side effects of Chemotherapy.

Many people having treatment feel generally tired a lot of the time or tire very easily during everyday tasks.

I found this side effect lasted longer as I progressed through the 12 weeks of treatment, to the stage where my doctor insisted on a break to help get back to a more normal situation.

It can help to...

  • get plenty of rest
  • avoid doing tasks or activities that you don't feel up to
  • do light exercise, such as walking or yoga, if you're able to – this can boost your energy levels, but be careful not to push yourself too hard
  • ask your friends and family for help with everyday tasks

If working, individuals may want to ask their employer for time off or to let you work part-time until the treatment has finished.

Contact your care team if you suddenly feel very tired and out of breath. This can be a sign of anaemia.

Feeling sick and vomiting - Many individuals having Chemotherapy will have periods where they feel sick or vomit; 
"I'm glad to say I'm not one of them"
Care teams can give those affected, anti-sickness medication to reduce or prevent this.

This is available as...

  • tablets or capsules
  • injections or a drip into a vein
  • suppositories – capsules you put into your bottom
  • a skin patch

Side effects of anti-sickness medicines include...

  • constipation
  • indigestion
  • problems sleeping and 
  • headaches.

Again it's Important to tell the care team if the medicine doesn't help or causes too many side effects. 

"There may be a different one that works better for you"
Hair loss 
A common side effect of Chemotherapy, although it doesn't happen to everyone. 

Just ask the care team if it's likely to be a side effect of the medicines you're taking.

"If you do lose hair, it usually starts within a few weeks of your first treatment session.
If you lose lots of hair this typically happens within a month or two."

It's most common to lose hair from your head but you can also lose it from other parts of your body, including your...

  • arms, 
  • legs, 
  • nose and 
  • face.

"The hair loss is almost always temporary. Hair should start to grow back soon after treatment has finished"
NOTE:  sometimes the hair that grows back is a slightly different colour or it may be curlier or straighter than it used to be.

Coping with hair loss
Hair loss can be upsetting. Talk to the care team if you find losing your hair difficult to cope with.

They understand how distressing it can be and can support you and discuss options with you.

For example, you may decide you want to wear a wig. 

Synthetic wigs are available free of charge on the NHS for some people, but you'll usually have to pay for a wig made from real hair.

Other options include headwear such as a headscarves.

Preventing hair loss
It may be possible to reduce the chances of hair loss by wearing a cold cap while having Chemotherapy.

A Cold Cap looks similar to a bicycle helmet and is designed to cool an individuals scalp during a treatment session. This reduces blood flow to the scalp, reducing the amount of medicine that reaches it.

Whether or not an individual can use a Cold Cap depends on the type of Cancer they have. 

"Cold caps also work better with certain types of Chemotherapy medicine, and they don't always work"

Just ask the care team whether a Cold Cap might help you.

Skin & Nail Changes (Probably the biggest side effect for me)

Some Chemotherapy medicines can cause temporary changes to your skin.

For example, your skin may become:

  • dry (I use an exfoliating Massage Glove/Mitt which ideal for removing dry skin and impurities to leave my skin feeling softer and smoother; I also rub in the "Aveeno Cream" provided by Aintree Hospital)
  • slightly discoloured (this may be patchy)
  • more sensitive to sunlight
  • red and sore; these are some images of my legs & the Creams used, plus cracks in finger tips & hands...

  • itchy

Again you should talk to your care team if you have any problems with your skin. 

"They can advise you about creams (and provide them) that can help and how to protect your skin".

Chemotherapy can also make your nails become brittle or flaky, and white lines may develop across them. This should go back to normal after your treatment has finished.

"Using moisturiser on your nails may help some individuals and/or nail varnish (but not quick-drying varnish or false nails) can be used to cover their nails during treatment if they'd like"
Chemotherapy can reduce an individuals ability to fight infection. 

This makes them more likely to pick up infections that could make them seriously ill.

To protect ourselves against infection, we should...

  • take our body temperature at least 3 times a day, as an early warning precaution
  • wash our hands regularly with soap and water – particularly after going to the toilet and before preparing food and eating (I use Antibacterial Hand Sanitiser Foam)
  • try to avoid close contact with people who have an infection – such as chickenpox or flu
  • have the annual flu jab and...

"...some of you may be put on a course of antibiotics to reduce your risk of developing an infection"
Chemotherapy lowers the amount of red blood cells, which carry oxygen around the body.

If an individuals red blood cell count drops too low, they'll develop anaemia.

Symptoms of anaemia include...

  • tiredness and lack of energy – this tends to be more severe than the general fatigue associated with Chemotherapy
  • shortness of breath
  • noticeable heartbeats (heart palpitations
  • a pale complexion

Again individuals should contact their care team as soon as possible if they have any of these symptoms.
"They may need treatment to increase their number of red blood cells"
Preventing anaemia
Including a high amount of iron in an individuals diet can help reduce their risk of anaemia, as iron helps the body make red blood cells.

Foods high in iron include...

  • meat – particularly liver
  • beans and nuts
  • dried fruit – such as dried apricots
  • wholegrains – such as brown rice
  • fortified breakfast cereals
  • dark-green leafy vegetables – such as watercress and curly kale

Bruising & Bleeding
Chemotherapy can reduce the number of cells called platelets in your blood. 
"Platelets help stop severe bleeding when you cut or injure yourself"

If you have a low number of platelets, you may have:

  • skin that bruises easily
  • severe nosebleeds 
  • bleeding gums

Again tell the care team if you experience these problems. 
"Individuals may need treatment to increase the number of platelets in their blood"
Sore Mouth (I get this after each round of Chemotherapy which seems to make the lining of my mouth sore and irritated. This is known as Mucositis)

Symptoms tend to develop a few days after treatment starts and include...

  • the inside of your mouth feeling sore – as if you've burnt it by eating very hot food
  • mouth ulcers, which can become infected
  • discomfort when eating, drinking and/or talking
  • a dry mouth
  • reduced sense of taste
  • bad breath (nope)

Heads up to your care team if you have any of these problems. 

"They may recommend painkillers or special mouthwashes that can help"
"After my Chemotherapy, I have to avoid spicy, salty or sharp foods which seem to trigger the effects listed above."
Mucositis usually clears up a few weeks after chemotherapy finishes.

Loss of appetite 
Individuals, me included, may lose their appetite while they're having Chemotherapy, but should try to drink plenty of fluids and eat what you can.

It may help to...

  • eat smaller meals more often instead of three large meals a day
  • eat healthy snacks regularly
  • eat light meals on the treatment days
  • sip drinks slowly through a straw, rather than drinking them straight from a glass

...and YES! Tell your care team if you're worried about your diet or lack of appetite.

Memory and concentration problems
Some individuals have problems with their short-term memory, concentration and attention span during Chemotherapy

As a result they may find that routine tasks take much longer than usual.

It's unclear why this happens, but the symptoms usually improve once treatment is finished.

Using things such as...

  • lists,
  • post-it notes,
  • calendars and
  • your mobile phone

...for reminders can help. 

  • Doing some mental exercises, eating well, and getting enough rest may also be useful.
Sleep problems (Not a problem for me I'm pleased to say!)
Individuals having Chemotherapy can have difficulty falling asleep, or wake up in the middle of the night and can't get back to sleep

This is known as Insomnia.

The following may help them...

  • set regular times for going to bed and waking up
  • relax before bed time – try taking a warm bath or listening to calming music
  • use thick curtains or blinds, an eye mask and earplugs to stop you being woken up by light and noise
  • avoid caffeine, nicotine, alcohol, heavy meals and exercise for a few hours before going to bed
  • avoid watching TV or using phones, tablets or computers shortly before going to bed 
  • write a list of their worries, and any ideas about how to solve them, before going to bed to help you forget about them until the morning

If that advice doesn't work, contact the care team as individuals may need additional treatment

Diarrhoea and constipation
Individuals may have diarrhoea or constipation a few days after they begin Chemotherapy.

Their care team can recommend suitable medication and diet changes that can help.

Emotional issues
Having Chemotherapy can be a frustrating, stressful and traumatic experience
It's natural to feel anxious and to wonder if the treatment will be successful.

"Stress and anxiety can also increase an individuals risk of getting depression"

If individuals are struggling to cope emotionally, they should speak to their care team, who can offer support and discuss possible treatment strategies.

Joining a Cancer Support Group may also help. 
Both Chris (My Wife) and I have joined 

"The Daisy Chain" - - based in Formby

They try to fill the gap that exists before and after diagnosis, when the shock hits individuals and their feelings are such that they cannot cope, or know who to turn to, the time when individuals feel they cannot talk to their family or friends.

Talking to other people in a similar situation can often reduce feelings of isolation and stress.

"The Daisy Chain" offers the opportunity to take individuals and/or partners away for a short time, from the stress of dealing with cancer, providing aromatherapy and hot stones massage, relaxation, acupuncture, chiropody, reflexology, and reiki to help individuals unwind and re-energise.  

Opportunities to make new friends and socialise over coffee and light lunches, and/or take part in a full social programme of bi monthly group lunches and day trips to places of interest or the theatre.

"For those who need a human voice to talk to especially at night, an out of hours hours helpline is open and manned whenever the "The Daisy Chain" can"

Chemotherapy - What happens...
The Chemotherapy Drugs will work in two ways, either by shrinking the tumour so individuals can have surgery to remove it, or slow down the growth of the tumour to extend and enhance their quality of life.

"After 6 weeks of Chemotherapy, I'm pleased to say things were shrinking"

Before My Chemotherapy started, it was vital that I was tested for which type of RAS gene I had, as the Chemotherapy Drugs will only work in those of us with a ‘normal’ RAS gene (known as RAS wild type). 

Cetuximab and Panitumumab are the targeted therapies, which means they target the RAS gene

"Those drugs won’t work in patients with a fault or mutation in their RAS gene (RAS mutant)"
"YES! I had the RAS wild type but the time it took to get the initial results, meant I had only one of the two treatments"

In the next session I had Both lots of Chemotherapy...

1: Folinic acid, fluorouracil and oxaliplatin (FOLFOX)

FOLFOX Chemotherapy is the treatment all get with Bowel Cancer.

FOLFOX is a combination of Chemotherapy drugs used to treat Bowel Cancer

It is also known as Oxaliplatin de Gramont or OxMdG, which means modified Oxaliplatin de Gramont.

It is made up of:

  • folinic acid (also called Leucovorin, FA or calcium folinate)
  • fluorouracil (5FU)
  • Oxaliplatin

How it works

These Chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How individuals have FOLFOX chemotherapy

You have folinic acid, 5FU and oxaliplatin into your bloodstream

If you have a PICC line, like me - a thin, soft, long catheter (tube) that is inserted into a vein in your arm, leg or neck, it is used for...

1: the Blood Test 24 hrs before Chemotherapy (For me that's been a Wednesday, every two weeks) and

2: the Initial part of Chemotherapy 

The tip of the Catheter is positioned in a large vein that carries blood into the heart. 
"I have a PICC line or a portacath, which is used for my treatment and stays in place throughout the course of treatment"
NOTE: many have a thin short tube (a Cannula) that goes into a vein in their arm each time they have treatment.  

When do you have treatment?

I have FOLFOX chemotherapy as cycles of treatment each lasting 2 weeks. 

Depending on an individuals needs, they may have up to 12 cycles. 
"I'm on the 12 Chemotherapy Treatments"
NOTE: Due to some side effects, I've had my Chemotherapy Sessions Stopped, taking a break.

In those breaks so far, the improvements have be impressive and obviously the correct decisions.

When is Chemotherapy is used (in My Case a Thursdays)

Chemotherapy may be used to...

  • try to cure the cancer completely (Curative Chemotherapy)

  • make other treatments more effective – for example, it can be combined with Radiotherapy (Chemoradiation) or used before Surgery (Neo-Adjuvant Chemotherapy)

  • reduce the risk of the cancer coming back after radiotherapy or surgery (Adjuvant Chemotherapy)
  • relieve symptoms if a cure isn't possible (Palliative Chemotherapy)

The effectiveness of Chemotherapy varies significantly. 

It's important to ask your doctors about the chances of treatment being successful for you.

Types of chemotherapy

Chemotherapy can be given in several ways. Your doctors will recommend the best type for you.

The most common types are...

1: chemotherapy given into a vein (intravenous chemotherapy) – this is usually done in hospital and involves medicine being given through a tube in a vein in your hand, arm or chest

"In my case, it's Via my PICC Line"

2: chemotherapy tablets (oral chemotherapy) – this usually involves taking a course of medication at home, with regular check-ups in hospital

Individuals may be treated with one type of Chemotherapy medicine or a combination of different types.

"Individuals usually have several treatment sessions (I'm having 12, one every 2 weeks), which will typically be spread over the course of a few months"

Side effects of chemotherapy...

As well as killing Cancer cells, Chemotherapy can damage some healthy cells in the body, such as blood cells, skin cells and cells in the stomach.

This can cause a range of unpleasant side effects, which I've mentioned in more detail earlier, such as:

  • feeling tired most of the time
  • feeling sick and vomiting
  • hair loss 
  • an increased risk of picking up infections
  • a sore mouth
  • dry, sore or itchy skin- in my case, lower legs

  • diarrhoea or constipation

Many of these side effects can be treated or prevented and most, if not all, will pass after treatment stops.

Tomorrow, 4th April 2019, I would like, after a two week break, my Chemotherapy to start again. 

I had my Blood Tests today and the side effects have reduced considerably.

Fingers crossed that...
I hope that this post, along with the previous ones, have raised your awareness of what individuals may experience if, like me, they get "Bowel Cancer", have a Stoma Operation and an Indwelling urinary Catheter inserted and Chemotherapy.

"Please feel free to provide feedback on my post."

If you have any questions, feel free to ask, I'll do my best to provide honest answers.

Thank you! 

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