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This information is about a chemotherapy| treatment called ECX that is used to treat cancers of the gullet| (oesophageal cancer), the stomach| and of the gastro-oesophageal junction (where the gullet and the stomach join together).
ECX is named after the initials of the chemotherapy drugs used, which are:
Your chemotherapy treatment can usually be given to you as a day patient or during a short stay in hospital. The treatment is then continued at home.
Before you start your treatment you will need a blood test on the same day or a few days beforehand. You'll also be seen by a doctor, specialist nurse or pharmacist. 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.
Before treatment starts the nurse will put a thin, flexible tube (cannula) into a vein in your arm. You may find this uncomfortable or a little painful, but it shouldn't take long. Some people have their chemotherapy given through a fine, plastic tube that is inserted under the skin and into a vein near the collarbone (central line|), or passed through a vein in the crook of their arm (PICC line|).
Once your chemotherapy is ready you will be given anti-sickness (anti-emetic)| medication, either by injection through your cannula or line, or in tablet form.
You'll then be given epirubicin (a red fluid) along with a drip (infusion) of salt water (saline). After this you will be given cisplatin (a colourless fluid), which is also given as an infusion. Before and after treatment with cisplatin you will be given plenty of fluid through the drip to keep your kidneys working normally. This may mean that you will need to stay in hospital overnight, especially if your treatment has started in the afternoon or evening.
Capecitabine is given as tablets twice a day. The tablets should be swallowed whole with a glass of water. They should be taken within half an hour of finishing a meal, as capecitabine works best if it's broken down in the stomach with food. You should take them in the morning just after breakfast, and then again just after your evening meal, so that the doses are spaced at least eight hours apart.
If you have trouble swallowing capecitabine tablets, they can be dissolved in a 200ml glass of warm water. The mixture should be stirred with a spoon until the tablets are completely dissolved, and then drunk immediately. You can add some blackcurrant juice just before swallowing to help disguise the taste. The glass and spoon should be washed and kept separate from your other crockery and cooking utensils.
Capecitabine tablets are available as 500mg peach-coloured tablets, and 150mg light peach-coloured tablets.
Your doctor may want you to take a combination of 500mg and 150mg tablets, depending on the dose you need. It's important to take the tablets as directed by your doctor, specialist nurse or pharmacist.
You may hear your doctor use the word 'regimen|' (eg The ECX regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular treatment you are receiving.
On the first day of your treatment you'll be given epirubicin and cisplatin as described. On the same day, you will also start your capecitabine tablets, which are usually taken twice a day for 21 days.
The first dose of capecitabine is often taken on the evening of day one of your treatment and the last dose in the morning of day 22 (just before you start the next cycle of the treatment). Before you leave hospital check with your doctor or nurse how long you'll need to take your capecitabine tablets for. Always follow the prescribed dose.
Three weeks after the first day of treatment, you will have completed what is called a cycle of chemotherapy. The treatment will then be repeated. On day one of the next cycle, the epirubicin and cisplatin will be given and you will start another 21-day course of the capecitabine tablets. You'll usually take capecitabine tablets twice a day throughout the whole course of your chemotherapy treatment. This is because each cycle takes three weeks (21 days) and the capecitabine tablets are taken for 21 days of each cycle.
You can have up to eight cycles of ECX chemotherapy over a 24-week period. Sometimes four cycles of ECX chemotherapy can be given before surgery, followed by four cycles after surgery.
Your doctor will advise you about the number of cycles you will have.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone who is having this treatment.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you do notice any effects that aren't listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
ECX chemotherapy can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow|. If the number of your white blood cells is low you'll be more prone to infections|. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
ECX chemotherapy can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion| if your platelet count is low.
ECX chemotherapy can reduce the number of red blood cells, which carry oxygen around
the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless|. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion| if the number of red blood cells becomes too low.
ECX chemotherapy can cause diarrhoea|. This can be severe, but can usually be controlled with medicines. It is important to drink plenty of fluids and you may be given medicine to take. Follow the instructions and take it immediately. If you have diarrhoea more than 4−6 times a day, or if you have it at night, contact your specialist for advice immediately. You may be advised to stop taking capecitabine. However, once the diarrhoea has eased your doctor will tell you if you can restart the treatment, perhaps at a lower dose.
Sickness is most likely a few days after treatment with cisplatin and epirubicin, and less likely during the time you are taking capecitabine. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce these effects. 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.
Some anti-sickness drugs can cause constipation|. Let your doctor or nurse know if this is a problem.
Your mouth may become sore or dry|, 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 help to reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different|. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
This is known as palmar plantar, or hand-foot, syndrome. It's temporary and improves when the treatment finishes. If you get hand-foot syndrome, contact your specialist doctor or nurse for advice.
Your doctor may prescribe creams or a vitamin called pyridoxine (vitamin B6), which some people find helpful. It can also help to keep your hands and feet cool and to avoid tight-fitting clothing, such as socks, shoes and gloves.
This usually starts 3–4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair|. This is temporary and your hair will start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss|.
Your urine may become a pink-red colour. This is normal and is due to the colour of the epirubicin. It may last for up to two days after you’ve had your treatment.
Cisplatin can affect your kidneys|. This doesn't usually 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, your kidneys will be checked by a blood test. You’ll be given fluid through a drip (infusion) before and after the treatment to keep your kidneys working normally. You may be asked to measure and record what you drink and the amount of urine you pass. It’s important to tell your nurse or doctor if you pass less urine than usual.
If necessary, you may be given medicine to help you to pass urine. You may be asked to drink extra fluid before and after treatment. It's important to do this so let your doctor know if this is a problem, for example, if you are feeling sick.
Feeling tired| is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Capecitabine can cause pain in your tummy (abdomen) and constipation. Let your doctor know if you develop pain. It can usually be controlled with mild painkillers|.
Constipation can usually be helped by drinking plenty of fluids, eating more fibre and doing some exercise. You may need to take medicine to help (laxatives). Your doctor can prescribe these or you can buy them at a pharmacy.
The colour of your nails may change. They may become darker and white lines may appear on them. These usually grow out over several months once the treatment has finished. Some people have pain in the nail bed at the base of the nail but this is rare.
This is very rare with standard doses of epirubicin, but may occasionally occur with high-dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given, and sometimes before each treatment.
Capecitabine may affect the way your heart works. Some people experience chest pain and tightening across the centre of the chest while taking it. Chest pain can be caused by many different things other than chemotherapy. If you develop any of these symptoms, contact your doctor immediately.
This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy|. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It is important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly a few months after the treatment has finished. Sometimes symptoms can persist; talk to your doctor if this happens.
Cisplatin may cause ringing in the ears (tinnitus) and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally your sense of balance may be affected. Any hearing loss, and balance changes if they occur, may be permanent. However, tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
This may be caused by capecitabine and is temporary. You may also notice that your eyes become sore and inflamed (conjunctivitis). Let your doctor know so they can prescribe soothing eye drops if necessary.
Some people find that capecitabine causes headaches. Let your doctor know if you have headaches or feel dizzy. Your doctor or nurse can give you painkillers to relieve headaches.
Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety, and a feeling that you want to pass urine. You'll be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse about any side effects you have.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Cancer can increase the risk of developing a blood clot (thrombosis), and 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’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Capecitabine interacts with the drugs phenytoin (Epanutin®), allopurinol (Zyloric®) and interferon| (IntronA®, Roferon-A®). It may also affect the action of some medicines given to thin the blood (anti-coagulants) such as warfarin. Let your doctor know if you are taking any of these.
You should also tell your doctor if you’re taking folic acid because it might increase the side effects of capecitabine.
Some other medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies| and herbal drugs|.
If this happens when epirubicin is being given the tissue in that area can be damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility| with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while taking this treatment, as it may harm the developing baby. It’s important to use effective contraception while taking this drug, and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Due to the effect of chemotherapy on the ovaries women may find that their periods become irregular and they may eventually stop.
In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms| such as hot flushes, sweats and vaginal dryness.
There's a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based upon our ECX chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Content last reviewed: 1 December 2011
Next planned review: 2013
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If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.
Watch our slideshow with tips for coping with a poor appetite
Watch our slideshow with tips for coping with a sore mouth
Watch our video about coping with fatigue
Watch our slideshow about avoiding infection when you have reduced immunity
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© Macmillan Cancer Support 2013
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