Hi,

I'm trying to find out about any possible negative effects of chemotherapy
(specifically 5-FU).

I'm not talking about the possible unpleasant experiences during the
chemotherapy - I've read up on these. I'm more concerned with any
longer-term negative effect on health and ability to fight the cancer.

For example, I've heard that chemotherapy can damage the immune system, the
very thing that's needed to fight the cancer.

And I've also seen suggestions that diet is very important in boosting the
immune system, but I've read that chemotherapy can damage the villi which
line the small intestine, so that some nutrients can no longer be digested,
and malnutrition can result.

So, for a colon cancer patient who has undergone surgery, is adjuvant
chemotherapy necessarily a good "insurance policy" to reduce the chance of
cancer returning in another part of the body in the future?

Thanks in advance for all help and opinions.

Peter

Chemotherapy certainly suppresses immune function, but a) this is temporary
and b) if you have developed an invasive cancer, the immune surveillance
system must have already failed.

No diet boosts the immune system. Again, any effects on intestinal
absorption due to chemotherapy is very temporary.

It depends on the stage. There is certainly good evidence that for T3
primary tumours, and node positive tumours, adjuvant chemotherapy reduces
the risk of recurrence.

I'd like to reinforce what Steph has said.   Except in certain desperate
straits it is unusual for chemotherapy to be applied without good evidence
from multiple controlled trials that it improves survival length or, in many
instances  the long term cure rate of the cancer.  .

This proves that, as Steph has said, any temporary immune suppression is
irrelevant to "fighting the cancer", as you put it.  It is unfortunate that
sections of alternative medicine to obsess about this point, in disregard of
readily available evidence.

It is true that later malignancies are more common in persons having
probably more aggressive types of chemotherapy, but this is not necessarily
an immune effect and is just one of several costs that cancer cure can
entail.

P Moran

A 'first person anecdote', Peter.

I am a 51 year old guy with stage IV colon cancer (liver mets). In
late September, I ended a seven month course with Chemo that included
5FU, LV, CPT and a trail drug, SU5416 (an anti-angiogenic agent). I
have been out of chemo for about six weeks now.

Please note. I reacted very well to my chemo. My understanding is that
my reaction was not 'typical', by any stretch of the imagination.
Further, you simply mention that you expect to be given 5FU. How one
responds to this drug is very much a function of age, general health,
the dosage, how it is given (phases of the moon, shoe size, hair
color, relative humidty, religious affiliation etc etc etc). Slow
infusion can be a lot easier to take than IV push, and the IV form of
the drug can be easier to handle than the pills, for example.

Be that as it may, here is my experience.

Throughout chemo, my {*filter*} counts and liver functions remained in the
normal range. That's thru all seven months. During that 7 month
period, I only missed one treatment, right at the start, due to a mild
alllergic reaction, most likely to the Trial Drug. The dosage given to
me of these {*filter*} was calculated based on surface area. My Onc was
given the option of selecting one of three dosing levels, depending on
my overall health, {*filter*} counts, hydration level, {*filter*}iness etc. I
started at the highest dosing level and stayed there throughout all
seven months. Again, as I understand it, this is NOT typical. Most
patients on 5FU, CPT and LV end up having some kind of dose reduction
in less than six months.

If my immune system suffered during Chemo, I certainly never noticed
it - that is, I never even got any 'opportunistic infections'- not so
much as a mild sniffle, let alone an bacterologic or fungal infection.
Further, I see no signs of any 'long term' damage to my immune system.
The chemo did shrink my two largest liver tumors by an order of
magnitude. Many other smaller tumors have apparently disappeared.
Despite the fact that chemo was NOT a pleasant experience, I was able
to continue working through the biggest part of it. More, if you saw
me on the street, you'd never guess that I had cancer, or that I had
just gone thru seven months of chemo. Even if you knew me well, and
even if you saw me while I was taking chemo, you would not be able to
tell.

As for having a screwed up digestive system - yeah - I DID have that.
In spades. Although conventional wisdom ascribed my problems to the
camptosar and not the 5FU, I had a terrible problem bouncing back and
forth between constipation and diarhhea. Neither got SO bad that I
needed anything much stronger than over-the-counter meds to handle it
though but it was both annoying and, at times, rather embarassing.

As for malnutrition, I never had a problem with it. After a month of
chemo, I deliberately put on a few pounds, just to prove I could.
After that, I found it very easy to maintain my weight at a very
constant 194 -196 pounds (88 to 89 Kilos). Once I stopped chemo, my
weight shot up by almost 10 pounds (~4 Kilos) almost over night!

So, you ask about diet. Diet IS important, so I strongly suggest that
you continue to eat. :)

Sure! Eat healthy. It can't hurt. But don't go nuts. Many of my cancer
patient friends tell me that the diet issue is one of the worst trials
in cancer. The issue? Everyone on God's Green Earth knows EXACTLY what
the patient should be eating- except the patient. And as weird as this
sounds, no two of them agree on anything. (My wife and all her new age
friends want me to eat a diet that consists mainly of dead birds,
sticks, chipmunk droppings, Roc Feathers, organically grown kelp, eye
of newt and tongue of bat. I want to eat pizzas with everything one'em
except chitlin and anchovies. We generally compromise and settle on a
pepperoni pizza with kelp and two side salads.)

My experience suggests that - if you are NOT a stage IV colon cancer
patient, take the chemo. IMHO, it's your best shot stopping the spread
of the damned crab and at recovering a normal life span. I know of a
couple of Stage II and III people who are taking both chemo and
radiation with that idea in mind - recovering a good portion of their
normal life span. If I were stage I, II or III, I'd probably do both
chemo and radiation as well, if my oncologist recommended it and made
a good case for trying it. (I may end up doing both anyway, as part of
a palliation program. Depends on how the damned stuff behaves from
here on out . . .)

What about at Stage IV? Well, that's another matter, yes? At stage IV,
you're faced with a lot of 'uncomfortable' options. It's up to your
doc to lay them out for you. These options range from 'extend my life
as long as possible and to hell with my comfort' to 'make me as
comfortable as possible and to hell with my longevity'.

There are lots of paths in between, like the one I took (Fight like a
maddened, warrior hampster until the Goddess Herself calls you home.
And, BTW, anyone who says there is no P in hampster never owned
one...)

In any event, my suggestion is find an oncologist that you'd trust
with your life, 'cause it will come down to that. Then ask the
oncologist these questions - not the newsgroups- and keep on asking
until you're sure you understand the answers. Then make up your own
mind what's best for you.

And please note - you will NOT be 'satisfied' with the answers. You
can't be. No one with cancer ever is. Even in the best of case, your
'universe of options' only includes a set of truly kucky choices. All
the onc can do is give you a better understanding of what is going on
and a laundry list of the options open to you. The doc can only give
advice - it's up to you to make the decisions.

In the meantime, keep your spirits up. For the cancer patient, the
fight is much more of a mental, spiritual and emotional battle than it
is physical.

Or at least, that's how a lowly labrat sees it.

Lowkey the lowly labrat.

Hi  For the BEST information on colon cancer go to
http://www.ourworld.compuserve.com/homepages/suthercon/      If you
click on November, my story is there. I posted on Nov 1st, so you will
have to scroll down a lot of new info on colon cancer to read it. It is
now 17 months without treatment for me...Stage IV  liver mets. I have
been upgraded to ctscans every six months now and feel great. It wasn't
the 5FU, leuc or CPT-11 that saved my life. Had them all. Take care and
God bless.  Cliff                                     " All things are
possible. Pass it on. "