Do I REALLY need to have chemotherapy?

Every week Dr Martin Scurr, a top GP, answers your questions

IN SEPTEMBER, I had a successful keyhole operation for the removal of a tumour in my colon. I am having trouble making up my mind about having chemotherapy (a type called 5FU).

I understand it is six months of purgatory, with no positive result. Is there any other treatment with a good result? I’m a fit, active, 82-year-old woman. Mrs M. Hughes, Ormskirk, Lancs.

WHAT a relief that you have fully recovered from your operation five months ago. Surgery is the only treatment that can potentially cure colon cancer.

The outcome is dependent on the stage of the tumour — this is a way of describing how much the cancer has spread, and it can only be established once the tumour and surrounding tissues have been examined by the pathologist.

The concern, for doctors and patients, is whether any cancer cells may have migrated from the original tumour to elsewhere in the body, which may allow the disease to recur in future.

The aim of adjuvant therapy (as post-operative chemotherapy is known) is to eradicate these cells and increase the cure rate and reduce the chance of the cancer recurring.

This is why your surgeon, or oncologist, has suggested 5FU (or 5 fluorouracil) chemotherapy — fluorouracil is a chemotherapy drug used to treat a number of different types of cancer.

From the information in your longer letter, I gather your cancer is stage IIIb.

I have gleaned this from the fact that the cancer had spread to two lymph nodes ( small glands connected to the lymph vessels that collect bacteria and harmful substances in the lymph fluid), and that it was also found in some of your blood vessels.

THe

five-year survival rate for patients with this stage of cancer is between 64 and 83 per cent, but adjuvant chemotherapy has been clearly demonstrated to reduce the recurrence of cancer and improve the survival rate.

Studies have shown that adjuvant chemotherapy in general may reduce the risk of cancer recurring by 30 per cent.

early studies of 5FU chemotherapy failed to show that it improved survival. but there was renewed interest in the treatment in the late eighties, when it became apparent that, when combined with other chemotherapy drugs, 5FU did cut the rate of recurrence and help patients live longer.

I expect that you have actually been offered a combination of drugs — for example, oxaliplatin with 5FU and leucovorin (a package known as FOLFOX treatment) as 5FU is less effective when given alone (though it will inevitably mean more side-effects).

There are different ways of administering the chemotherapy. Typically, it is injected into a vein while you are in hospital.

Sometimes patients are given a portable chemotherapy pump, which continues to deliver a slow, continuous dose once they are at home.

either way, you may have a catheter surgically implanted into a large vein under the skin of your chest, under local anaesthetic.

This is known as a ‘port’, and will make it easier to have the regular infusions, typically given in several sessions over the course of several months. The side-effects depend upon the type, combination, dose and method of administration of the drugs.

In the case of 5FU, common sideeffects are diarrhoea, soreness in the mouth and a temporary lowering of your blood cell count. Patients are less likely to lose their hair when the drug is given slowly, over a longer period of time, than when given as a quick injection.

Other side- effects will depend upon additional types of chemotherapy that may be given in combination.

AS

yOU will have gathered, I believe adjuvant chemotherapy is a worthwhile step to take. Do also bear in mind that a healthy diet and regular exercise can improve the outlook further, as studies show.

What is particularly interesting is the fact that drinking more coffee (at least four cups a day) during and after adjuvant therapy is associated with significantly reduced recurrence in colon cancer that has spread to the lymph nodes.

Low levels of vitamin D also appear to be associated with worse outcomes in colon cancer patients — those with the highest levels survive longer than those with the lowest — so do ask your doctor to do a blood test to check yours.

The key point to stress is that you do need the 5FU treatment, but it must be combined with other chemotherapy drugs (your oncologist will no doubt advise you on this). Unfortunately, side-effects are a necessary hazard, but I assure you they will resolve once treatment is completed. I WAS recently asked by my GP if I had eaten lots of bananas or tomatoes after a blood test. I thought nothing more of it until a friend mentioned hyperkalaemia. Should I be concerned?

David Cottrell, Pontypool, Monmouthshire. THe term hyperkalaemia refers to a high level of potassium in the blood. In healthy people, the body is very good at controlling potassium levels, and a raised amount is only seen in those with kidney failure, or those taking excessive doses of potassium supplements.

Supplements are prescribed to patients who regularly take diuretics for conditions such as heart failure, which causes excess fluid to build up in the system.

The way most diuretics work means that, as well getting rid of the excess fluid, potassium is lost from the body, too (though a couple of diuretics have the opposite effect, raising potassium levels).

Patients are typically given supplements and may be encouraged to choose a potassium-rich diet including bananas, fruit juices, instant coffee, and peanuts. Somehow, this has led some doctors to urge caution about eating too much of these foods.

but this is unnecessary advice, as normal kidney function will always, reliably, pass out excess amounts of potassium in the urine.

I am told a healthy person would have to eat more than 100 bananas a day to push their potassium outside the normal range.

Another point to mention is that sometimes healthy people are found to have falsely elevated potassium levels in samples of their blood. This is referred to as an artifact — a false and misleading result — and is caused by a delay in the blood sample reaching the laboratory for analysis.

As blood cells die, they rupture and release potassium, which may result in high levels being recorded in samples. This is a common scenario and I sense you probably have no reason to be concerned.

WRITE TO DR SCURR

TO CONTACT Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details. Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.