ECX is a chemotherapy treatment used to treat cancer of the gullet(oesophageal cancer) and stomach cancer.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
ECX is named after the initials of the drugs used:
You will have ECX in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you will usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will also give you anti-sickness drugs as an injection into a vein. They give you the drugs and chemotherapy through one of the following:
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
a short, thin tube (cannula) put into a vein in your arm or hand.
The nurse will give you epirubicin (a red fluid) as an injection directly into your line or cannula, with a drip (infusion) of fluids to flush it through. You then have cisplatin as a drip. They usually run the drip through a pump, which gives you the treatment over a set time. You’ll have extra fluids through a drip before and after the cisplatin. This is to protect your kidneys.
You have capecitabine as tablets, which you take at home - see below.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy:
Rarely, cisplatin may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
The drug leaks outside the vein
If this happens when you’re having treatment it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common but if it happens it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
Taking your chemotherapy tablets
Before you leave hospital, the nurse or pharmacist will give you chemotherapy tablets to take when you are at home. Always take your tablets exactly as explained. This is important to make sure they work as well as possible for you.
You take capecitabine tablets twice a day. Swallow them whole with a glass of water within half an hour of meals. Capecitabine works best if it's broken down in the stomach with food. Take them in the morning after breakfast and then after your evening meal. Make sure the doses are at least twelve hours apart.
Tell your doctor if you find it difficult to swallow the tablets. They may suggest that you dissolve the capecitabine tablets in water. In this case, dissolve the tablets in a 200ml glass of warm water, stir with a spoon until the tablets are completely dissolved and then drink it immediately. The glass and spoon should be washed and kept separate from your other crockery and cooking utensils.
If you are sick just after taking the tablets, contact the hospital. You may need to take another dose. If you forget to take a tablet, do not take a double dose. Keep to your regular schedule and let your doctor or nurse know.
Other things to remember about your tablets:
Keep them in their original package at room temperature, away from heat and direct sunlight.
Keep them safe and out of the reach of children.
Return any remaining tablets to the pharmacist if your treatment is stopped.
Your course of ECX
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of ECX takes 21 days (three weeks).
On day one you have epirubicin and cisplatin. You also start taking the 21-day course of capecitabine tablets. You will take these every day of your treatment.
At the end of the 21 days you start your second cycle of ECX. This is exactly the same as the first cycle. You have up to eight cycles of ECX. Some people have three or four cycles before surgery and three or four cycles after surgery. Your doctor or nurse will tell you the number of cycles you are likely to have.
Before you go home the nurse or pharmacist will give you anti-sickness drugs to take. They may also give you anti-diarrhoea tablets if you need them. Take all your tablets exactly as they have explained to you.
Possible side effects of ECX
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We explain the most common side effects of ECX here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these. It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you.
Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
Chemotherapy can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection - this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
ECX can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen in the first few days of treatment. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Some anti-sickness drugs can make you constipated. Tell your doctor or nurse if this is a problem.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
This can sometimes be severe. Your doctor can prescribe anti-diarrhoea drugs to control it. You may be given these before you leave hospital. It’s important to take them exactly as your nurse or pharmacist explains. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
If you have diarrhoea more than four to six times a day, or at night, contact the hospital straight away on the numbers your nurse gave you. Your doctor may ask you to stop taking capecitabine. When the diarrhoea is better, they will tell you if you can start taking it again. Sometimes they reduce the dose.
Your urine may be a pink-red colour for up to 48 hours after you’ve had your treatment. This is due to the colour of epirubicin.
You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Treatment can cause a rash, which may be itchy.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat.
Your skin may darken. It will return to its normal colour after you finish treatment. If you’ve had radiotherapy (either recently or in the past), the area that was treated may become red or sore.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Numb or tingling hands or feet
These symptoms are caused by the effect of cisplatin on nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes but in some people they may never go away. Talk to your doctor if you are worried about this.
Your nails may become brittle and break easily. They may get darker or discoloured, or you may get lines or ridges on them. These changes grow out after treatment finishes. Wearing gloves when washing dishes or using detergents will help protect your nails during treatment.
Changes in hearing
Cisplatin can affect your hearing. You may have a hearing test before you start treatment.You may get ringing in your ears (tinnitus) and lose the ability to hear some high-pitched sounds. Tinnitus usually gets better after treatment ends. Some hearing changes can be permanent. Tell your doctor if you notice any changes in your hearing.
Your eyes may become watery and feel sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops.
Changes in the way the kidneys work
Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this. You’ll have extra fluids through a drip before and after cisplatin. This is to protect your kidneys. Your nurse will ask you to drink plenty of fluid. Tell them if there are any changes in how much urine you are producing.
Changes in the way the liver works
Treatment may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.
Less common side effects of ECX
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Changes in the way the heart works
Some of the drugs can affect the way the heart works. You may have tests to see how well your heart is working before, during and sometimes after treatment.
If you have pain or tightness in your chest, feel breathless, or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions but it’s important to get them checked by a doctor.
Effects on the lungs
Cisplatin can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, a fever or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
It’s important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about ECX
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Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Chemotherapy can interact with other medicines you are taking. This treatment can interact with a number of different drugs, such as phenytoin (epanutin ®). It may also affect the way that drugs that thin the blood work, such as warfarin.
Let your doctor know if you are taking any other medicines. You should also tell your doctor if you’re taking folic acid because it might increase the side effects of capecitabine.
Medicines you can buy in a shop or chemist may also be harmful when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Treatment may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using a number of reliable sources, including:
electronic Medicines Compendium (eMC). medicines.org.uk (accessed December 2013)
Perry MC. The Chemotherapy Source Book. 5th edition. 2012. Lippincott Williams and Wilkins.
With thanks to Bruce Burnett, Teacher Practitioner in Clinical Pharmacy Practice, who reviewed this edition.
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