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Chemotherapy for advanced cancer

You might have chemotherapy if you have advanced stomach cancer. Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells.  The drugs circulate throughout your body in the bloodstream. 

Advanced stomach cancer is a cancer that began in the stomach and has spread to another part of the body.

Diagram showing advanced cancer

When do you have chemotherapy?

You might have chemotherapy for advanced cancer if your doctor thinks you might benefit from the treatment and you are well enough.

Chemotherapy for advanced stomach cancer can relieve symptoms. It can also control the cancer and improve your quality of life for a time. But it can’t cure the disease. Your doctor or specialist nurse can talk with you about the benefits and possible side effects. 

You usually have chemotherapy every 2 or 3 weeks depending on what drugs you have. Each 3 week period is called a cycle. Your doctor will tell you how many cycles they plan to give you.

Types of chemotherapy

Your doctor will make a plan for your treatment. How often you have treatment depends on this plan. Your doctor might change what chemotherapy you have depending on your side effects. 

There are different chemotherapy drugs that you might have for advanced stomach cancer. You usually have a combination of 2 or 3 drugs. The most common types are:

  • cisplatin and capecitabine (XP) 
  • epirubicin, cisplatin and capecitabine (ECX) 
  • epirubicin,cisplatin,fluorouracil (ECF) 
  • epirubicin, oxaliplatin and capecitabine (EOX)
  • epirubicin, carboplatin, capecitabine (ECarboX)
  • fluorouracil, folinic acid, oxaliplatin and docetaxel (FLOT)

Other drugs you may have include:

  • paclitaxal
  • carboplatin
  • docetaxel
  • irinotecan

You might hear the terms first line and second line treatment. The first course of chemotherapy you have is the first line treatment. Your doctor might offer you second line treatment if your cancer starts to grow again or first line treatment isn't working. 

Targeted cancer drugs

For advanced stomach cancer with HER2 protein, you might have:

  • trastuzumab (Herceptin) and XP (cisplatin and capecitabine)
  • trastuzumab (Herceptin) and cisplatin and 5-FU

Trastuzumab is a type of targeted cancer drugs. These treatments interfere with the way cells work. They can boost the body's immune system to help fight off or destroy cancer cells, or they can block signals telling cells to grow. 

How you have chemotherapy

You have most of the chemotherapy drugs for stomach cancer into your bloodstream (intravenously). Capecitabine is a tablet.

Into your bloodstream

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

Diagram showing a central line

Taking tablets

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start your treatment. You have these either a few days before or on the day your treatment begins. You have blood tests before each round or cycle of treatment.

Before your first chemotherapy, your doctor will explain what drugs you need, how you have them, and what the side effects are. You’ll sign a consent form. This is a good time to ask any questions you might have.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Low DPD levels don’t cause symptoms so you won’t know if you have a deficiency. Talk to your doctor if you are worried and about whether you need to have a test to check for it. 

Some people have severe side effects from capecitabine or fluorouracil even if they don't have low DPD levels. Contact your doctor or nurse if your side effects are severe.

When you go home

Chemotherapy for advanced stomach cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects you have. The nurse will give you telephone numbers to call if you have any problems at home.
 

Last reviewed: 
02 Sep 2019
  • Chemotherapy Algorithm for Locally Advanced Inoperable or Metastatic Gastric or Oesophageal Cancers
    St Lukes Cancer Alliance, 2014

  • LCA Oesophageal and Gastric Cancer Clinical Guidelines
    London Cancer Alliance, 2014

  • Molecular basis of 5-fluorouracil-related toxicity: lessons from clinical practice
    Papanastasopoulos P, Stebbing
    J Anticancer Research 2014. Vol 34

  • Ramucirumab for treating advanced gastric cancer or gastro–oesophageal junction adenocarcinoma previously treated with chemotherapy
    National Institute for Health and Care Excellence, 2016

  • Palliative management for people with oesophageal and gastric cancer
    NICE, January 2019 

  • Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up 
    E Smyth and others, 
    Annals of Oncology, 2016. Volume 27, Pages v38–v49

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