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Chemotherapy treatment

When, where and how you have chemotherapy for stomach cancer, and the possible side effects.

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

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.

Before surgery

You’re likely to have chemotherapy before surgery if you're going to have surgery aiming to cure the cancer. This is called neo adjuvant treatment. 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

Before and after surgery

You may have chemotherapy before and after surgery (peri operative chemotherapy).

Having chemotherapy after surgery might reduce the chance of your cancer coming back

After surgery with radiotherapy (chemoradiotherapy)

If you don't have chemotherapy before surgery, you then might have chemoradiotherapy after surgery. Chemoradiotherapy is having chemotherapy and radiotherapy together. 

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)

Advanced cancer

You may also have chemotherapy if you have advanced stomach cancer..

How you have chemotherapy

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 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.

Before you start chemotherapy

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.

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.

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 any signs of infection such as a temperature higher than 37.5C 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–ESSO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    T Waddell and others
    Annals of oncology, 2013. Vol 24, Supplement 6, 157-163

  • 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

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