Stage III Chemotherapy

If you are diagnosed with stage III colon cancer, then it is recommended that you receive post-surgery (adjuvant) chemotherapy.  The current standard of care is a combination of two chemotherapies and is given for 6 months.  The combination shown to be most effective in  large clinical trials is 5FU with Oxaliplatin (called FOLFOX).  These therapies are delivered every two-weeks by an intravenous infusion and require a semi-permanent catheter or PORT.  An alternate pill form of 5FU (Xeloda) can be given orally with Oxaliplatin, which is given every 3 weeks.  This alternate regimen using the pill form of 5FU does not require a catheter or PORT.  At Johns Hopkins, your medical team will work with you to develop an individualized treatment plan targeting your specific tumor while being best suited to your lifestyle.


Overview of the Goals of Chemotherapy

Until recently, chemotherapy has meant the use of anticancer (antineoplastic or cytotoxic) drugs to destroy cancer cells, killing normal cells in the process. Now, the definition has been expanded to include targeted therapeutic drugs (biologics), which attack only cancer cells. Chemotherapy fights cancer by interfering with the growth process of cancer cells (the cell cycle), and preventing their reproduction.

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. The process of cell division is through the cell cycle, which moves from the resting phase, to active growing phases, and then to mitosis (cell division). Normal cells stop dividing when they come into contact with like cells (contact inhibition). Cancer cells lose this inhibition. The Johns Hopkins multidisciplinary team of medical researchers is investigating why this happens.

The ability of chemotherapy to kill cancer cells depends on its ability to halt mitosis. Usually, chemotherapy drugs work by damaging the RNA or DNA that instructs cells on how to copy themselves in division. If cells are unable to divide, they die (apoptosis). The faster that cells divide, the more likely chemotherapy is to kill the cells, causing the tumor to shrink.

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells at rest are called cell-cycle nonspecific. The scheduling of chemotherapy is based on the type of cells involved, the rate at which they divide, and the time at which a given drug is likely to be most effective; this is why chemotherapy is typically given in cycles.  Chemotherapy is called a systemic treatment because it affects the entire body. Patients may receive chemotherapy as an injection, a pill, or in a topical solution. Some drugs are given continuously over several days; some are given several times a week.