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Chemotherapy treatment

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

After surgery 

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 

Advanced cancer

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.

Diagram showing a central line

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

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.

Blood tests

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.

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.

Most side effects only last for a few days or so. Your treatment team can help to manage 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.

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.

Last reviewed: 
03 Sep 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

  • Peri-operative chemotherapy +/- bevacizumab for resectable gastro-oesophageal adenocarcinoma: Results from the UK Medical Research Council randomised ST03 trial (ISRCTN 46020948)
    D Cunningham and others (2016)
    The Cochrane Collection John Wiley and Sons

  • Randomized prospective phase II study to compare the combination chemotherapy regimen epirubicin, cisplatin, and 5-fluorouracil with epirubicin, cisplatin, and capecitabine in patients with advanced or metastatic gastric cancer
    Ocvirk and others (2016)
    The Cochrane Collection John Wiley and Sons

  • Systemic treatment oesophageal and gastric cancer guidelines
    July 2014 London Cancer Alliance

  • Oesophago-gastric cancer: assessment and management in adults  [NG83]
    National Institute for Health and Clinical Excellence (NICE)
    Published January 2018

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