Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
You might have chemotherapy before or after surgery for stomach cancer. Common chemotherapy drugs for stomach cancer are fluorouracil, docetaxel, oxaliplatin, capecitabine, cisplatin and epirubicin.
This page is about chemotherapy for stomach cancer that hasn’t spread to another part of the body.
When you have it
Before and after surgery
You’re likely to have chemotherapy before and after surgery unless you have a very early stage cancer (stage 1A). This is called perioperative chemotherapy. It aims to:
- reduce the size of the cancer so it’s easier for your surgeon to remove
- lower the risk of the cancer coming back
If you haven't had chemotherapy before surgery then you might have:
- chemotherapy combined with radiotherapy (chemoradiotherapy) after surgery, as part of a clinical trial
- chemotherapy on its own after surgery
You might have chemotherapy as your main treatment if you have advanced stomach cancer.
How often do 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.
Types of chemotherapy
Usually you have a combination of 2 or 3 drugs (in a regimen). The most common types are:
- epirubicin, cisplatin and capecitabine (ECX)
- epirubicin, cisplatin and fluorouracil (ECF)
- fluorouracil, folinic acid, oxaliplatin and docetaxel (FLOT)
Some other common combinations are:
- epirubicin, oxaliplatin and capecitabine (EOX)
- epirubicin, oxaliplatin and fluorouracil (EOF)
- oxaliplatin, fluorouracil, and folinic acid (FOLFOX)
How you have it
You have most of the chemotherapy drugs for stomach cancer into your bloodstream (intravenously). Capecitabine is a tablet.
Into your blood stream
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.
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.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
COVID swab test
Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.
To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.
At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.
This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.
Check with your team about when you’ll have the test as there are some differences between hospitals.
You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. 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.
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
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.
Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.
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.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you take any supplements or if you have been prescribed anything by alternative or complementary therapy practitioners.
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. They could be harmful.
When you go home
Chemotherapy for stomach cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.