This information is about a chemotherapy treatment that uses cisplatin and fluorouracil (5FU). It is used to treat different types of cancer, including cancers affecting the gullet (oesophagus), the head and neck area, and anal cancers. Sometimes cisplatin and 5FU chemotherapy is given at the same time as radiotherapy, which is known as chemoradiation.

The information describes the drugs used, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer information nurse specialists.

This treatment involves two chemotherapy drugs: cisplatin and fluorouracil, which is also known as 5FU.

Cisplatin and 5FU treatment can be given to you either during a short stay in hospital, or as a day patient. Before treatment, you will need to have a blood test - either on the same day, or a few days beforehand. You will also be seen by a doctor. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.

The nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable, or a little painful, but it should not take long. Some people have their chemotherapy given through a thin plastic tube which is inserted under the skin into a vein near the collarbone (central line), or passed through a line in your arm (PICC line). A central, or PICC, line will almost certainly be needed if you are treated as an outpatient. Your doctor or nurse will explain more about this to you.

You will be given some anti-sickness drugs. These are usually given by injection through the cannula, central line, or PICC line, which is connected to a drip (infusion). Some anti-sickness medicines may be given as tablets.

After the anti-sickness drugs, you will be given the cisplatin (a clear fluid) as a drip into a vein through your cannula or line. Before and after the cisplatin, you will be given plenty of fluid through your drip to keep your kidneys working normally. This is known as pre- and post-hydration.

After this, you will be given 5FU (a clear fluid) through the drip. Because the 5FU is given as a continuous infusion, you will need to stay in hospital, unless you have a central or PICC line. If you do have a line, this part of the treatment can be given to you using a small, portable pump, which allows a controlled amount of the drug to be pumped into your bloodstream over a set period of time. The pump is small enough to be carried in a belt or holster. This means that once the pump is connected to your central line and the treatment is started, you can go home.

When the infusion is finished there may be some fluid left in the pump. This may be normal as some types of pump need to be overfilled to get the correct dose. You can check with your nurse or pharmacist whether you have this type of pump.

If you are having your treatment as a day patient, you can go home when it is finished and the cannula will be removed before you go. If you have a central or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You will be shown how to look after the line.

You will be given a supply of anti-sickness drugs to take at home. It's important to take these as directed even if you aren't feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than at stopping it once it has started.

Your doctor may use the word 'regimen' (eg the cisplatin 5FU regimen) when talking about your chemotherapy. This means the whole plan, or schedule, of the treatment that you are receiving.

There are different ways of giving cisplatin and 5FU, depending upon your situation. Below are descriptions of three different schedules for giving this chemotherapy regimen. Your doctor or nurse can explain how you will be having your chemotherapy.

Schedule A

On the first day of your treatment you will be given an infusion of cisplatin with pre- and post-hydration. After this, you will also start an infusion of 5FU that lasts for four days. If you have a central or PICC line, you can go home with a portable pump attached. You will need to return to the hospital on the fifth day to have the pump disconnected, although it may be possible for a nurse to visit you at home to disconnect the pump. If you don't have a line, you will need to stay in hospital until the infusion is finished.

After this you will have a rest period, with no chemotherapy for 17 days. This completes what is called a cycle of your chemotherapy treatment.

You will start the next cycle after the rest period, which will be three weeks after you began your treatment. Usually, 2–6 cycles are given.

Schedule B

On the first day of your treatment, you will be given an infusion of cisplatin with pre- and post-hydration. You will also be given an infusion of 5FU that lasts for 22 hours. Over the next three days (days 2, 3 and 4), you will repeat the 22-hour infusions of 5FU. Unless you have a central or PICC line, you will need to stay in hospital until the fifth day, when the infusions have finished. If you have a line, this part of the treatment can be given to you through a small, portable pump, so that you can go home and return the next day for the 5FU infusion to be changed. Once the 5FU infusions have finished, you will have a rest period, with no chemotherapy, for 17 days. This completes a cycle of your treatment. 

You will begin the next cycle after the rest period, which will be three weeks after you started your treatment. Usually, 2–4 cycles of chemotherapy are given.

Schedule C

On the first day of your treatment you will be given an infusion of cisplatin with pre- and post-hydration. You will also start a continuous infusion of 5FU that lasts for 21 days, using a small, portable pump. Usually the pump is changed every seven days (you will have a pump on day 1, a new pump on day 8, and a new pump on day 15). You will need to have either a central line or a PICC line for this treatment. This completes the cycle of your treatment.

Your next cycle will begin when the 5FU is finished, which will be three weeks after you started your treatment. Usually 2–4 cycles of chemotherapy are given.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described below will not affect everyone who is having this treatment. We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drug, but which are not listed here, please let your nurse or doctor know.

Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti-sickness drugs to prevent or reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may be more effective. However, the 5FU in the pump is very unlikely to make you feel sick and it is unlikely that you will need anti-sickness medicines for more than a few days after your visit to the hospital.

Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this becomes a problem

Lowered resistance to infection Cisplatin and 5FU chemotherapy can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal before your next course of chemotherapy is due.

You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.

Contact your doctor, or the hospital, straight away if:

• your temperature goes above 38ºC (100.4ºF)
• you suddenly feel unwell (even with a normal temperature).

Bruising or bleeding Cisplatin and 5FU chemotherapy can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having this treatment you may become anaemic. This can make you feel tired and breathless. Let your nurse or doctor know if these effects are a problem.

Sore mouth Your mouth may become sore or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can also help. Tell your doctor if you have any of these problems, as special mouthwashes and medicines to help prevent or clear any mouth infection can be prescribed.

Constipation This may occur, but can usually be relieved by drinking plenty of fluids, eating a high-fibre diet and taking gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. Your doctor can give you these or you can buy them at a pharmacy.

Diarrhoea This can usually be easily controlled with medicine, but tell your doctor if it is severe or if it continues. It is important to drink plenty of liquids (2–3 litres a day) if you have diarrhoea.

Numbness or tingling in hands or feet (peripheral neuropathy) This is due to the effect of cisplatin on nerves. Tell your doctor if you notice these symptoms. The problem usually improves slowly, a few months after treatment is over.

Tiredness Many people feel extremely tired during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it's important to try to get as much rest as you need.

Gritty eyes and blurred vision If this happens it is important to tell your doctor, who can give you soothing eye drops.

Hair loss This is rare but hair may thin, or occasionally be lost completely. If this happens, it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. The hair loss is temporary and your hair will start to grow again once treatment has finished. Your nurse can give you advice about coping with hair loss.

Ringing in your ears and hearing loss (tinnitus) Cisplatin can cause some ringing in the ears. It can also cause some loss of ability to hear high-pitched sounds. This usually improves when the treatment is over. Tell your doctor if you notice any loss of hearing or ringing in your ears.

Strange taste Occasionally during treatment you may experience a strange taste, sometimes described as metallic or bitter. Some people find that sucking on a strongly-flavoured sweet or mint helps to disguise this. 

Loss of appetite A dietitian or specialist nurse at your hospital can give advice on boosting your appetite, coping with eating difficulties, and maintaining weight.

Your kidney function may be affected Usually this does not cause any symptoms and the effect is generally mild. Rarely, it may cause permanent damage to the kidneys unless the treatment is stopped. Before each treatment you will have a blood test to check your kidney function. You may be asked to drink more than normal during the day after treatment. It is important to tell your doctor, or chemotherapy nurse, if you are not able to drink enough. Let your doctor or nurse know if you are not passing as much urine as normal.

Skin changes You may develop an itchy rash. Your doctor can give you medicine to help with this. Rarely, your skin may darken. This darkening may occur over the veins where the 5FU has been injected. This usually returns to normal a few months after the treatment has finished.

During treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection-factor suncream and cover up with clothes.

Changes to nails Your nails may become brittle, chipped and ridged. These changes grow out slowly over a few months once treatment has ended.

Soreness and redness of the palms of the hands and soles of the feet This is sometimes known as palmar-plantar or hand and foot syndrome. It is temporary and improves when the treatment is finished. You may be given vitamin B6 (pyridoxine), which may help to reduce this effect.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straight away if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information.

Other medicines Some other medicines can be harmful to take when you are having chemotherapy (including those you can buy in a shop or chemist). Tell your doctor about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by this treatment. It's important to discuss fertility with your doctor before starting treatment.

Contraception It's not advisable to become pregnant or father a child while taking this treatment, as it may harm the developing foetus. It is important to use effective contraception whilst taking this drug, and for some time afterwards. Again, discuss this with your doctor.

This section is based upon our cisplatin and fluorouracil (5FU) chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (56th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2008.
• The Chemotherapy Source Book (4th edition). Ed Perry, Lippincott, Williams and Wilkins, 2007.

For further references. please see the general bibliography.