UNDERSTANDING FEC CHEMOTHERAPY

A Guide for Patients produced by the Western General Hospital, Edinburgh

Introduction
This guide has been designed to help you and your family understand more about the chemotherapy you are about to have as treatment for your cancer. If you need more information or have any further questions, please do not hesitate to ask your hospital doctor or chemotherapy nurse.

What Is Cancer?
Our bodies are made up of tiny structures called cells that cannot be seen by the naked eye. Normally these cells reproduce themselves by dividing in a regular fashion. This enables growth and repair of the body tissues. Sometimes an uncontrolled growth of cells occurs. This is what happens in cancer.

What is Chemotherapy?
Chemotherapy means treatment with medicines called cytotoxic drugs that are given to eradicate or control cancer cells that are known to be present and may be causing symptoms.

How Do Chemotherapy Drugs Work?
The drugs enter the bloodstream and are distributed to all parts of your body. It is likely to take at least 3-5 weeks from the start of your treatment for any benefit to be seen. The drugs destroy the cancer cells by interfenng with their ability to grow and divide. Chemotherapy can also affect normal cells which are growmg and dividing This may cause certain side effects, but these are temporary because healthy cells grow back to normal quickly. The side effects of the drugs in this treatment will be discussed later.

How Are Chemotherapy Drugs Given?
The drugs enter your bloodstream and are usually given through a venflon (a fine plastic tube which is inserted temporarily into a vein on the back of the hand or forearm which is attached to an intravenous drip containing saline). Your chemotherapy nurse will then administer the drugs slowly over 20-30 minutes through a port in the drip tubing.

What Can I Do While Having This Treatment?
While you are having this chemotherapy treatment you can get on with life as normal, Provided you feel well enough, you can carry on working and doing your favourite activities and hobbies. You should discuss this with the hospital doctor or chemotherapy nurse caring for you
If it fits in around your treatments you can go on holiday provided you discuss it first with your doctor or nurse before aranging it. If you are gomg abroad you may need a covermg letter You should also use a high factor sun lotion as you are more likely to burn in the sun.
You can eat and drink as normal while on this treatment and alcohol is permitted. You may find you experience taste changes; food and drinks may not taste as they did before This will return to normal once the treatment has finished.
You will need to have a simple blood test to determine whether we are able to give you your chemotherapy before each visit. This will be done before treatment by the practice nurse at your GPs surgery. It will be discussed with you by your nurse on your first chemotherapy visit.

What is FEC?
FEC is the combination of chemotherapy drugs which you will be receiving. It is a combination of 3 different chemotherapy drugs given over a period of 4 weeks. After 4 weeks you will have completed 1 cycle of chemotherapy and you will receive a maximum of 6 cycles

• Epirubicin is the name of the first drug. It is red in colour and is given once every 4 weeks
• Cyclophosphamide is the name of the second drug to be given. It is a colourless drug and is given on day 1 and day 8 of each cycle.
• 5-Fluorouracil is the name of the last drug It is clear in colour and is given on day I and day 8 of each cycle

The number of chemotherapy treatments given varies depending on each individual's treatment plan. You will be seen regularly by your specialist doctor at a clinic to assess this, so he/she can moniter the effect of your chemotherapy.

Will I have any side effects?
As with most forms of chemotherapy, it is likely that you will experience at least some side effects, although the extent of this vanes considerably from patient to patient. Below are some of the side effects which may be experienced and we will make every effort to minimise them.

1. Nausea and Vomiting
Some patients can experience nausea and vomiting with this treatment, However in most cases it can be effectively controlled with anti-sickness therapy, and there are a wide range of effective drugs Anti-sickness drugs will be given to you as a prevention during administration of the chemotherapy and you will be given a supply to take home with you

2. Hair Loss
it is very likely that total hair loss will be experienced and this will begin 3-4 weeks after your chemotherapy treatment begins However, your hair does regrow on completion of treatment, Your chemotherapy nurse will discuss measures to help prevent this ie, scalp cooling and the provision of a wig.

3. Red Urine
Your urine will become pink or red for up to 24 hours afler you receive epirubicin. This is to be expected and is due to the colour of the drug.

4. A Sore Mouth
Mouth ulcers both inside and outside the mouth i.e. lips, can occur during this regime. We will give you mouthwashes to use when you start your treatment to try and counteract any problems. Contact your GP for advice if your mouth becomes sore or ulcerated as there are further measures that can be given to help this

5. Diarrhoea
Diarrhoea may occur. If this becomes a problem drink plenty of fluids and contact your GP as tablets could be prescribed.

6. Increased Risk of Infection
During your chemotherapy you are more likely to pick up infections especially during days 7-14 after treatment as your blood count is at its lowest then. If you feel shivery, fluey, or have a sore throat or earache you should report this immediately to your GP If you are unable to contact your OP practice, phone the hospital for advice on the numbers given below Urgent treatment with antibiotics may be necessary

7. Other|
Less commonly patients have reported other side effects including flushing and redness along veins. Epirubicin may also affect the heart function at high doses and you will be monitored for this if necessary. You may also feel tired at times. This may get worse the more treatments you have but this should improve once your chemotherapy is finished.

When you attend for your next course of treatment please let your chemotherapy nurse know if you have experienced any side effects. The doctor may wish to adjust the dose of chemotherapy to lessen your side effects.

We hope this information leaflet will help you understand more about the FEC regime. If you have any further questions or do have any problems, please phone using the contact numbers given below

Contact Numbers:
Ward 1 (Mon - Fri 083 0-1630) 0131 5372219
Ward 4 (Emergency advice out of hours) 0131 537 2200