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Chemotherapy for advanced cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. Find out about chemotherapy for advanced stomach cancer.

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

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Chemotherapy for advanced stomach cancer can relieve the symptoms. It can also control the cancer and improve your quality of life for a time. But it can’t cure the disease.

The drugs circulate throughout the body in the bloodstream. They can reach the cancer cells wherever they are in the body.

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. 
Usually you 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)
  • paclitaxal and carboplatin

Other drugs you may have include:

  • docetaxel
  • irinotecan

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

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

Trastuzumab is a type of biological therapy. 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. 
 

You have most of these drugs into your bloodstream through a drip into your arm. A nurse puts a small tube into one of your veins and connects the drip to it.

Or you might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

You have capecitabine and Lonsurf as tablets.

You must take your tablets 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, no more, no less. Never stop taking a cancer drug without talking to your specialist first.

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.

When you have it

You usually have chemotherapy every 3 weeks. Each 3 week period is called a cycle. You may have between 3 and 6 cycles of 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.

Side effects

Common chemotherapy side effects include:
  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infection
  • bleeding and bruising easily
Contact the doctor or nurse immediately if you have any signs of infection such as a temperature higher than 38C or generally feeling unwell. Some infections can be life threatening.
Side effects depend on:
  • which drug you have
  • how much of each drug you have
  • how you react

Most side effects only last for the few days that you’re having the drugs. The team caring for you can help reduce your side effects.

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: 
05 Jul 2016
  • Cancer and its Management (6th edition)
    Tobias, J and Hochauser D
    Wiley Blackwell, 2010

  • 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, Issue 4.

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

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