Medical
Cancer Treatment - 5FU (Fluorouracil) and Leucovorin
How 5FU is administered
5FU is administered in one of three ways:
- continuously through a PICC line (before
my surgery)
- once a week
- 5 days every 4 weeks (after my surgery)
The third regimen is discussed on this page.
5FU and Leucovorin (a folinic acid)
are administered by an injection into a vein. Treatment is given for 5 days in a
row (1 cycle) and repeated every 4 weeks. This is repeated 4 times, making a
total of 20 injections over a 4-month period. This is my personal schedule,
other patients may be put on a different regimen.
Possible side effects
Mouth problems. Mouth soreness or ulcers can occur
7-10 days after treatment, and typically last for a few days. Some patients do
not got any mouth sores. You will be prescribed regular mouthwashes, and many
people prefer to use a very soft toothbrush to avoid damage. Putting ice cubes
in your mouth at the time chemotherapy is administered may also reduce mouth
ulcers.
Diarrhea. This is a common side effect, and also
occurs most often in the week after treatment. There are medications you can
have to control it. You should start taking these tablets as soon as the
diarrhea starts. It is important to increase your fluid intake to prevent
dehydration. If diarrhea worsens despite medication, you should contact your
doctor or nurse.
Fatigue. This is common. You may lack energy and have
trouble concentrating. Fatigue is not always relieved by rest and can persist
after treatment ends. Try to plan rest periods in your day. Eating well,
drinking plenty of fluids and light exercise may help.
Lowering of blood counts. There are 3 components of
your blood that may be affected by chemotherapy:
- Anemia (low red blood cells) is uncommon, but if severe may require
transfusion. Signs of anaemia include tiredness, low energy, shortness of
breath, dizziness when standing.
- Neutropenia (low white blood cells) occurs for only a few days in the
middle of each cycle, and does not cause symptoms unless you pick up an
infection. If this happens, you will be given antibiotics and may even need to
be admitted to hospital, as your immune system may be unable to fight off the
infection. Some patients develop more prolonged lowering of the white blood
cells, and G-CSF, a growth factor, may be given for 7-10 days after each
treatment by a daily injection under the skin.
- Thrombocytopenia (low platelet count). This is extremely rare. Signs
to watch out for include bruising and bleeding.
Contact your doctor or chemotherapy nurse if you feel unwell
and if you have any of the following symptoms: fever >38°C,
chills, bleeding.
Feeling or being sick. These drugs can cause nausea,
but it is often mild. There are now very effective anti-nausea drugs to prevent
or substantially reduce nausea and vomiting and these will be routinely given to
you with your chemotherapy. If it does happen it may begin a few hours after the
treatment is given and last for 24-48 hours. If vomiting persists, you could
become dehydrated. Tell your doctor at once as you may have to go to the
hospital.
Less common side effects
Hair thinning. Most patients have no hair loss, but
some do notice some hair thinning. This is usually not apparent to other people.
Hair will return to normal soon after treatment is finished.
Eyes. Excessive tearing can occur due to inflammation
of the eye surface (conjunctivitis). Eye drops may help.
Heart. Rare instances of irregular heart beats or
chest discomfort have been attributed to 5FU.
Skin/nail changes. You may develop a rash, or dry
skin, or discolouration over the vein used for treatment. White lines may also
appear on your nails. These changes usually disappear over a few months once
treatment has finished. Your skin may become more sensitive to the sun, and burn
more easily than normal. Always wear high protection factor sun-cream and
protective clothing outside.
Fertility and Contraception. Your fertility may be
affected temporarily by taking these drugs. It is not advisable to become
pregnant or father a child during treatment as the drugs may harm the developing
fetus. It is important to discuss fertility and contraception with your doctor
before treatment.
5FU sensitivity. About 1 in 1000 people have more
severe side effects and are considered to be extremely sensitive to 5FU. These
patients can usually continue to receive treatment at a lower dose.
Monitoring
You will see your doctor regularly during treatment to
monitor the effects of the chemotherapy. A blood test will also be taken before
each treatment to ensure that your blood counts have recovered. Discuss any
questions about your treatment and its side effects with your doctor or
chemotherapy nurse.
Leucovorin is the active form of the B complex vitamin,
folate. Leucovorin is used as an antidote to drugs that decrease levels of folic
acid. Folic acid helps red and white blood cell formulation and the synthesis of
hemoglobin. Some treatments require what is called leucovorin rescue, because
the drug used to treat the cancer or other infection has had an adverse effect
on folic acid levels.
- Fatigue - big time
- Diarrhea - typically the week after chemo - treated with Immodium
- Mouth problems - blister-like sores in the mouth, cracked tongue, bad taste;
usually lasts a week (mid first week to mid second week)
- Lowered blood counts - red and white cells for sure, platelet drop not
apparent
- Nausea and vomiting - last cycle was the worst
- Hair - thinning but no complete loss
- Eyes - sometimes trouble focusing
- Nails - cracked nail treated with nail hardening from cosmetics dept
- Skin - can get sunburn after a very short time in the sun - minimum SPF 50
recommended by CCI, I use 60
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