Chemotherapy for stomach cancer
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.
Chemotherapy may be used on its own or along with surgery, radiotherapy or a targeted therapy drug.
Chemotherapy for stomach cancer may be given:
before and after surgery to remove the cancer
before surgery to shrink a cancer that’s too large to remove – this sometimes works well enough to make an operation possible
occasionally, in combination with radiotherapy (chemoradiation), after surgery – this is for people who didn’t have chemotherapy before surgery and is normally given as part of a clinical trial
to help control the cancer and improve symptoms if an operation to remove it isn’t possible.
The most common use of chemotherapy with surgery is perioperative chemotherapy. This shrinks the cancer to make surgery more effective and reduces the chance of cancer coming back. This treatment is usually given as three cycles of chemotherapy over nine weeks before the operation, and again after it.
If the cancer has spread to other parts of the body (advanced cancer), chemotherapy is the main treatment. It can help you to live longer and reduce symptoms. You may be given the chemotherapy for up to six months. Some people have a targeted therapy drug called trastuzumab (Herceptin®) as well as chemotherapy.
How chemotherapy is given
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You‘ll usually have chemotherapy as an outpatient, which means you can go home on the same day. If you have it as an inpatient, you only need a short stay in hospital.
Chemotherapy is usually given as a course of several sessions (or cycles) over a few months. A cycle often takes three weeks. Your doctor or nurse will explain more about this.
You have the chemotherapy drugs given into a vein (intravenously) or as tablets. Stomach cancer is often treated with a combination of both.
The chemotherapy nurse will give you the drugs into a vein by injection or as a drip (infusion). The drugs are given to you through a small tube (cannula) in your arm, or a soft plastic tube called a central line or PICC line. A central line goes into a vein in your chest and a PICC line is put into a vein above the bend in your arm.
If you have a central or PICC line, your nurse will show you how to look after it. These lines are designed to stay in until all your chemotherapy treatment is over. We have more information about central lines and PICC lines that we can send you.
Some people are also given a course of chemotherapy tablets called capecitabine to take at home. Or you may have a chemotherapy drug called fluorouracil through a small pump attached to your central or PICC line. You can go home with this in.
Get more information about chemotherapy by watching videos featuring health professionals and people having treatment.
Chemotherapy drugs used
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Usually, a combination of drugs is used. The treatments are named after the initials of the drugs included. Possible treatments include:
ECX, which is made up of epirubicin, cisplatin and a tablet called capecitabine (Xeloda®)
EOX, which is made up of epirubicin, oxaliplatin and capecitabine (Xeloda®)
ECF, which is made up of epirubicin, cisplatin and fluorouracil (5FU).
Sometimes, only two of these drugs are given together. Other drugs such as irinotecan and docetaxel can also be used.
With ECF chemotherapy, you have fluorouracil (5FU) given continuously through a small pump attached to your central or PICC line. The pump gives you a low dose of the drug continuously while you’re at home. You can carry it in a belt or a small bag. Your nurse will show you how to look after it.
We have more information about individual drugs available.
Chemotherapy drugs may cause unpleasant side effects, but these can usually be well controlled with medicines and will normally go away once treatment has finished. Not all drugs cause the same side effects, and some people may have very few. You can talk to your doctor or nurse about what to expect from your treatment.
Risk of infection
Chemotherapy can reduce your number of white blood cells, which help fight infection. If your number of white blood cells is low, you’ll be more prone to infections. A low white blood cell count is called neutropenia.
Contact the hospital immediately on the 24-hour contact number you’ve been given and speak to a nurse or doctor if:
You develop a high temperature – this may be over 37.5°C (99.5°F) or over 38°C (100.4°F) depending on the hospital’s policy. Follow the advice that you have been given by your chemotherapy team.
You suddenly feel unwell, even with a normal temperature.
You feel shivery and shaky.
You have any symptoms of an infection, such as a cold, a sore throat, a cough, diarrhoea, or if you’re passing urine frequently (sign of a urine infection).
If necessary, you’ll be given antibiotics to treat any infection. You’ll have a blood test before each cycle of chemotherapy to make sure your white blood cells have recovered.
Occasionally, your treatment may need to be delayed if the number of white blood cells is still low.
Some chemotherapy drugs can make you feel sick (nauseated) or possibly be sick (vomit). Your cancer specialist will prescribe anti-sickness (anti-emetic) drugs to prevent this. Let your doctor or nurse know if your anti-sickness drugs are not helping, as there are several different types you can take.
Some chemotherapy drugs can cause diarrhoea. Your doctor can prescribe drugs to control this. Make sure you drink plenty of fluids if you have diarrhoea.
If you’re taking capecitabine tablets at home, it’s important to let your doctor or nurse know if you have diarrhoea. Sometimes, your treatment may need to be interrupted.
Sore hands and feet
This is sometimes known as palmar plantar or hand-foot syndrome. It can be caused by capecitabine or 5FU and will improve when the treatment is finished. Using unperfumed moisturising creams can often help to relieve symptoms. Your doctor can prescribe creams if necessary.
Chemotherapy can cause mouth problems such as a sore mouth, mouth ulcers or infection. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Your chemotherapy nurse will explain how to look after your mouth to reduce the risk of problems. They can give you mouthwashes, medicines and gels to help.
We have a video on our website about looking after your mouth during chemotherapy.
Anaemia (reduced number of red blood cells)
Chemotherapy may reduce the number of red bloods cells in your blood. This can make you feel very tired and you may become breathless. Anaemia can be treated with blood tranfusions. This should help you to feel more energetic and ease the breathlessness.
Bruising and bleeding
Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. If you develop any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin, contact your doctor or the hospital straight away.
Some chemotherapy drugs may cause hair loss. Some people may have complete hair loss including eyelashes and eyebrows. Others may only experience partial hair loss or thinning. It depends on what chemotherapy drugs you’re having.
Your doctor or nurse can tell you more about what to expect. If you lose your hair, it will start to grow back again once your chemotherapy is over. Your nurse can give you advice about coping with hair loss and how to look after your scalp.
We have a video about one person’s experience of hair loss on our website.
Effects on the nerves
Some chemotherapy drugs can affect the nerves in your hands or feet. This is called peripheral neuropathy and can cause tingling or numbness, a sensation of pins and needles, or muscle weakness.
It’s important to let your doctor know if this happens. They may need to change the chemotherapy drug if it gets worse. Usually, peripheral neuropathy gradually gets better when treatment is over, but it can sometimes become permanent.
You’re likely to become tired and have to take things slowly. Try to pace yourself and save your energy for things that you want to do or that need doing. Balance rest with some physical activity – even going for short walks will help increase your energy levels.
Effects on fertility
Some chemotherapy drugs can affect your ability to become pregnant or father a child. If this concerns you, it’s important to talk about it with your cancer doctor before you start chemotherapy.
Younger women may find that chemotherapy causes an early menopause. This can cause menopausal symptoms such as hot flushes and sweats. Your doctor can prescribe hormone replacement therapy (HRT) to help with this. You can talk this over with your cancer doctor or specialist nurse.
It’s not advisable to become pregnant or father a child while having chemotherapy, as the drugs may harm the unborn baby. It’s important to use effective contraception during your treatment and for a few months afterwards.
Condoms should be used if you have sex within the first 48 hours after chemotherapy. This is to protect your partner from any of the drug that may be present in vaginal fluid or semen.