Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy can be used on its own or with other anti-cancer treatments such as surgery or radiotherapy. It may be used to reduce the risk of cancer coming back after surgery, or to try to slow down the cancer and improve quality of life if an operation isn’t possible.

You may be given chemotherapy as an outpatient (which means you can go home on the same day), or as an inpatient which includes a short stay in hospital.

Chemotherapy drugs commonly used to treat stomach cancer include cisplatin, epirubicin, and fluorouracil (also called 5FU). These drugs may be given together as the ECF regimen. Sometimes a tablet form of 5FU called capecitabine (Xeloda®) is used in place of 5FU. The combination is then known as the ECX regimen. Another combination is called EOX and uses the drugs epirubicin, oxaliplatin and capecitabine.

If you are having surgery to remove a stomach cancer, chemotherapy may be given before the operation to help reduce the chance of the cancer coming back. It may also be given if your doctors think the tumour is too large to be removed by surgery, as chemotherapy can sometimes shrink the cancer and make it easier to remove.

Your doctors may plan to give you chemotherapy both before and after surgery. This is called perioperative chemotherapy and has been shown to help make surgery more successful and to reduce the chance of the cancer coming back. 

Sometimes chemotherapy is given after surgery if it wasn’t possible to remove all of the tumour during the operation, or if there is a high risk that it may come back. Chemotherapy given after surgery is known as adjuvant therapy.

If the cancer has spread to other parts of the body, chemotherapy may be used as the main treatment. It is given to try to shrink the cancer, reduce symptoms and to help you to feel better for longer. In some people the chemotherapy will work well. Unfortunately, for other people the chemotherapy won’t shrink the cancer and they will have the side effects of the treatment with little benefit.

It’s helpful to discuss with your cancer specialist the benefits and side effects of chemotherapy in your particular situation. If you have a cancer that has spread, and you decide that you don’t want to have chemotherapy, your doctor can still prescribe medicines to help to control symptoms caused by the cancer.

Chemotherapy drugs can be taken as tablets, or given into a vein (intravenously) as injections or drips (infusions).

Intravenous chemotherapy can be given through a small tube (cannula) in your arm or through a soft plastic tube called a central line or PICC line.

The central line is put into a vein in your chest under a general or local anaesthetic.

If you’re having this type Instead of a central line, a tube may be put into a vein in the bend of your arm: this is known as a PICC line (see below).

Chemotherapy pumps

The chemotherapy drug fluorouracil – or 5FU – may be given continuously through a central line or a PICC line attached to a small pump. The pump allows a low dose of the drug to be given day and night, while you are at home. The pump can be carried round in a small bag strapped around the waist or over the shoulder.

If you’re having this type of chemotherapy your doctors or nurses will explain how to use the pump.

Chemotherapy is given in cycles of treatment. A cycle often takes three weeks. On the first day of each cycle you will usually be given chemotherapy by injection or infusion. This is often followed by a continuous infusion of chemotherapy or chemotherapy tablets to take at home.

Your doctor or nurse will tell you how many cycles of treatment are planned for you and explain exactly how you will be given your chemotherapy.

Chemotherapy can cause unpleasant side effects, but these can usually be well controlled with medicines. The main side effects are described here, along with some ways to avoid or reduce them. We can send you information on some of the side effects mentioned in this section.

Lowered resistance to infections (neutropenia)

While the drugs are acting on the cancer cells in your body, they also temporarily reduce the number of normal white cells in your blood. When these cells are reduced, you’re more likely to get an infection and you may tire easily. Your blood will be tested regularly during chemotherapy and, if necessary, you’ll be given antibiotics to treat any infection. You may also be given injections called growth factors to stimulate your body to make more white blood cells.

If your temperature goes above 38°C (100.4°F) or you suddenly feel unwell, even with a normal temperature, you may have an infection. Contact your chemotherapy nurse or doctor at the hospital straight away. We can send you a factsheet about how to avoid infections.

Feeling sick

Some of the drugs used to treat stomach cancer can make you feel, or be, sick (nausea and vomiting), but there are very effective anti-sickness drugs (anti-emetics) to prevent this. If the sickness is not controlled or continues, even with anti-sickness treatment, let your doctor know. They can prescribe other medicines that may be more effective. We have a factsheet about managing nausea and vomiting.

Diarrhoea

Some of the chemotherapy drugs used to treat stomach cancer can cause diarrhoea. This often starts several days after treatment. If you’re taking chemotherapy tablets or capsules at home, it’s important to let your doctor or nurse know if you have diarrhoea as your treatment may need to be interrupted.

Sore hands and feet

5FU or capecitabine may cause soreness of the palms of the hands or soles of the feet. This is known as palmar-plantar syndrome. A vitamin can be prescribed to help control it and non-perfumed moisturising creams can often help to relieve symptoms.  

Sore mouth

Some chemotherapy drugs can make your mouth sore and cause small ulcers. It’s important to rinse your mouth regularly to keep it clean. Using a soft bristle toothbrush can be helpful. If you don’t feel like eating during your treatment, you could try replacing some meals with nutritious drinks or a soft diet. Our section on diet and cancer has some useful tips on coping with eating problems.

Changes to your sense of taste

Chemotherapy can affect your sense of taste; food may taste more salty, bitter or metallic. Your normal sense of taste will come back after the chemotherapy treatment finishes. 

Anaemia

If the level of red blood cells in your blood is low this is called anaemia. It can make you feel very tired and lethargic and you may also become breathless. Anaemia can be treated by blood transfusions. These should help you to feel more energetic and ease the breathlessness. We have a factsheet about blood transfusions.

Bruising and bleeding

Platelets are blood cells that help the blood to clot. If the number of platelets in your blood is low you will bruise more easily and may bleed heavily from even minor cuts and grazes. If you develop any unexplained bruising or bleeding, contact your doctor or the hospital immediately.

Hair loss

Unfortunately, some chemotherapy drugs can cause hair loss. If you lose your hair it will start to grow back within three to six months of finishing your treatment. People who lose their hair often cover up by wearing wigs, bandanas, hats or scarves. If you’re having treatment as an inpatient, or you are on income support, you can get a free wig from the NHS. If not, you can still get a subsidised wig from the hospital. If your hair falls out it is important to protect your scalp from the sun. We have a section on hair loss, which you may find helpful.

Effects on the nerves

Some chemotherapy drugs can affect the nerves in your hands or feet. This can cause tingling or numbness, or a sensation of pins and needles. This is called peripheral neuropathy. It’s important to let your doctor know if this happens. They may need to change the chemotherapy drug if it gets worse. Usually, it gradually gets better when the chemotherapy treatment ends. Very occasionally it can damage the nerves permanently.

Tiredness

You may become very tired and have to take things more slowly. If you are tired do as much as you feel like and try not to overdo it. You might find it helpful to look at our section on coping with fatigue.

Your ability to become pregnant or father a child may be affected by taking some of the chemotherapy drugs used to treat stomach cancer. It is important to discuss fertility with your doctor or nurse before starting treatment.

Some women may find that the chemotherapy treatment brings on an early menopause, and they may have signs of the menopause such as hot flushes and sweats. In many women, hormone replacement therapy (HRT) can be given to replace hormones that are no longer being produced. You may find it helpful to talk this through with your doctor or a support organisation.

It is not advisable to become pregnant or father a child while taking any of the chemotherapy drugs used to treat stomach cancer, as they may harm the developing foetus. It’s important to use effective contraception during your treatment and for a few months afterwards. You can discuss this with your doctor or nurse.

Condoms should be used if you have sex within the first 48 hours after chemotherapy. This is to protect your partner from any of the drug that may be present in semen or vaginal fluid.