Chemotherapy for stomach cancer

Chemotherapy drugs commonly used to treat stomach cancer include:

• cisplatin,
• epirubicin
• and fluorouracil (also called 5FU).

These drugs may be given together as the ECF regimen|. Sometimes a tablet form of 5FU called capecitabine (Xeloda®)| is used in place of 5FU. The combination is then known as the ECX regimen|.

Another combination is called EOX| and this uses the drugs epirubicin, oxaliplatin and capecitabine.

When chemotherapy is given Back to top

Chemotherapy can be used on its own or with other anti-cancer treatments, such as surgery| or radiotherapy|. It may be used before surgery to reduce the size of the tumour, or after surgery to reduce the risk of cancer coming back after surgery. It may also be used to try to slow down the cancer and improve quality of life if an operation to remove the cancer isn’t possible.

You may be given chemotherapy as an outpatient, which means you can go home on the same day, or as an inpatient, which means you’ll stay in hospital for a short time.

If you’re having surgery to remove a stomach cancer, chemotherapy may be given before the operation to help reduce the chance of the cancer coming back. It may also be given if your doctors think the tumour is too large initially to be removed by surgery, as chemotherapy can sometimes shrink the cancer and make it easier to remove.

Your doctors may plan to give you chemotherapy both before and after surgery. This is called perioperative chemotherapy, which helps make surgery more successful and reduces the chance of the cancer coming back.

If the cancer has spread to other parts of your body, chemotherapy may be the main treatment. It is given to try to shrink the cancer, reduce symptoms and help you to feel better for longer. Chemotherapy is often a successful treatment for stomach cancer. However, it doesn’t always shrink the cancer and may cause side effects without giving much benefit.

It’s helpful to discuss with your cancer specialist the benefits and side effects of chemotherapy in your particular situation. If you have a cancer that has spread and you decide that you don’t want to have chemotherapy, your doctor can still prescribe medicines to help control symptoms| caused by the cancer.

How chemotherapy is given Back to top

Chemotherapy drugs can be taken as tablets, or given into a vein (intravenously) as injections or drips (infusions).

A cycle often takes three weeks. On the first day of each cycle you will usually be given chemotherapy by injection or infusion. This is often followed by chemotherapy tablets to take at home or a continuous infusion of chemotherapy. Your doctor or nurse will tell you how many cycles of treatment are planned for you and explain exactly how you will be given your chemotherapy.

Intravenous chemotherapy can be given through a small tube (cannula) in your arm or through a soft plastic tube called a central line| or PICC line|.

The central line is put into a vein in your chest under a general or local anaesthetic.

 

 

If you are having chemotherapy through a PICC line instead of a central line, a tube will be put into a vein in the bend of your arm.

 

 

 

You will be shown how to look after a central line or PICC line. 

Chemotherapy pumps

The chemotherapy drug fluorouracil (5FU)| may be given continuously through a central line or a PICC line attached to a small pump. The pump allows a low dose of the drug to be given continuously while you are at home. The pump can be carried around in a small bag strapped around the waist or over the shoulder.

If you’re having this type of chemotherapy, your doctors or nurses will explain how to use the pump.

Our section on chemotherapy| gives detailed information about the treatment and its side effects|.

Side effects Back to top

Chemotherapy can cause unpleasant side effects, but these can usually be well controlled with medicines. The main side effects are listed here, with links to more information about each of them, along with some ways to avoid or reduce them:

• lowered resistance to infections - Chemotherapy can reduce the production of white blood cells by the bone marrow, making you more likely to get an infection. The number of white cells will usually have returned to normal before your next cycle of chemotherapy is due. You should contact your doctor or the hospital straight away if your temperature goes above 38°C (100.4°F) or you suddenly feel unwell, even with a normal temperature 
• feeling sick - There are now very effective anti-sickness drugs (anti-emetics) to prevent or reduce nausea and vomiting. Your doctor will prescribe these for you
• diarrhoea - Your doctor can prescribe anti-diarrhoea medicines
• sore hands and feet -  This is known as hand/foot syndrome or palmar-plantar syndrome. Doctors can prescribe medicine to help relieve this side effects
• sore mouth - Regular mouthwashes can help to keep your mouth clean and relieve any soreness. Your nurse will show you how to use these properly
• changes to your sense of taste
• anaemia (low number of red blood cells) - While having chemotherapy, you may become anaemic. This may make you feel tired and breathless
• bruising and bleeding - 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
• hair loss - Ask your doctor if the drugs you’re taking are likely to make your hair fall out. Most patients are entitled to a free wig from the NHS and your doctor or nurse will be able to arrange this for you. Some people prefer to use hats or scarves. If your hair does fall out, it will grow back over a period of 3-6 months after the treatment ends
• numbness or tingling in hands or feet (peripheral neuropathy) - Some chemotherapy drugs can affect the nerves in your hands or feet. It can cause numbness or tingling or a sensation of pins and needles
• tiredness - You may feel very tired and have a general feeling of weakness. It’s important to allow yourself plenty of time to rest .

Fertility Back to top

Your ability to become pregnant or father a child may be affected by some of the chemotherapy drugs used to treat stomach cancer. It’s important to discuss fertility with your doctor or nurse before starting treatment.

We have more information about ways of preserving fertility|.

Early menopause Back to top

Some women may find that chemotherapy treatment causes an early menopause. They may have signs of the menopause such as hot flushes and sweats. Hormone replacement therapy (HRT) can often be given to replace hormones that are no longer being produced. You may find it helpful to talk this through with your doctor or with another support organisation|.

Contraception Back to top

It’s not advisable to become pregnant or father a child while taking any of the chemotherapy drugs used to treat stomach cancer, as they may harm the developing baby. It’s important to use effective contraception during your treatment and for a few months afterwards. You can discuss this with your doctor or nurse.

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 semen or vaginal fluid.