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Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs work by disrupting the growth and division of these cells.
Even when the tumour itself and the local lymph nodes have been removed by surgery, there is a risk that tiny amounts of the cancer (micro-metastases) have been left behind or have spread. These are too small to be seen on a scan and can make the cancer come back later on.
Some research studies have suggested that giving chemotherapy after surgery (known as adjuvant therapy), might lower the risk of the cancer coming back and can help some people to live longer, but this has not been found in other studies. For this reason, chemotherapy is not a standard treatment in this situation.
Chemotherapy may also sometimes be given before the surgery. Giving the chemotherapy in this way may help to reduce the chances of the cancer coming back. A recent research trial (the ‘MAGIC’ study) showed that giving chemotherapy both before and after surgery helped make the surgery more successful and reduced the chance of the cancer coming back.
Occasionally, if the cancer has not spread beyond the stomach but it cannot be removed by surgery, doctors may use chemotherapy to try and shrink the cancer. Sometimes this makes it possible for the surgeon to remove the tumour. Chemotherapy given before surgery is called neo-adjuvant therapy.
Chemotherapy is also used when the cancer has spread beyond the stomach. In this situation, it can help to shrink and control the cancer for a period of time. This is known as palliative treatment.
Chemotherapy drugs can be given as tablets, or by injection into a vein (intravenously). Intravenous chemotherapy is given as injections or drips (infusions) into a vein. The drugs can be given through a small tube (cannula) in your arm or through a plastic tube called a central line or PICC line.
The central line can be put into a vein in your chest under a general or local anaesthetic.
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).
Some chemotherapy is given by using a small portable pump. This gives a continuous low dose of the chemotherapy drugs over a few weeks or months (known as a continuous infusion). If you are having this type of chemotherapy you will be given detailed information about how to use the pump by your doctors or nurses.
Chemotherapy is sometimes given to you as an outpatient, but at other times it will mean a short stay in hospital.
Chemotherapy can cause unpleasant side effects, but these can often be well controlled with medicines. The main side effects are described here, along with some ways of avoiding or reducing them.
While the drugs are acting on the cancer cells in your body, they also temporarily reduce the number of normal cells in your blood. When these cells are reduced, you are more likely to get an infection and you may tire easily.
During chemotherapy your blood will be tested regularly. If necessary, you will be given antibiotics to treat any infection. You may also be given injections of proteins called growth factors to stimulate the production of white blood cells by your bone marrow.
If your temperature goes above 38°C (100.5°F), or you suddenly feel ill, even with a normal temperature, contact your doctor or the hospital straight away.
Some of the drugs used to treat stomach cancer may make you feel sick (nauseous) and possibly make you vomit. There are now very effective anti-sickness drugs (anti-emetics) to prevent or greatly reduce nausea and vomiting. Your doctor will prescribe these for you.
Some chemotherapy drugs can make your mouth sore and cause small ulcers. Regular mouthwashes are important and your nurse will show you how to do these properly. 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.
If the level of red blood cells (haemoglobin) in your blood is low you will become very tired and lethargic. You may also be breathless. These are all symptoms of anaemia – a low level of haemoglobin in the blood. Anaemia can be very successfully treated by blood transfusions. You will feel more energetic and the breathlessness will be eased.
Platelets are a type of cell that help to clot the blood. If the number of platelets in your blood is low you will bruise very easily, may develop blood spots in the skin (petechiae) or rashes (purpura), 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.
Unfortunately, some of the drugs can make your hair fall out. Ask your doctor if the drugs you are taking are likely to cause hair loss or other specific side effects. You could also ask about the possibility of scalp cooling or cold cap treatment, which is a method of trying to reduce hair loss from chemotherapy. People whose hair falls out often cover up by wearing wigs, hats or scarves. Hospital inpatients are entitled to a free wig from the NHS and your nurse or doctor will be able to arrange for a wig specialist to visit you. People being treated as outpatients however, usually have to pay for their wigs. If your hair falls out as a result of chemotherapy, it should grow back over a period of 3–6 months. We have a section on hair loss, which you may find helpful.
It is important to remember that chemotherapy affects different people in different ways. Some people find that they are able to lead a fairly normal life during their treatment, but many find that they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it. We have information on coping with cancer-related fatigue.
Some of the chemotherapy drugs used to treat stomach cancer can cause diarrhoea. This often starts several days after the treatment. If you are taking chemotherapy tablets or capsules at home, it is important that you let your doctor or nurse know that you have diarrhoea as your treatment may need to be stopped.
Although they may be hard to bear at the time, these side effects will disappear once treatment is over.
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, replacement hormones (HRT) can be given to replace those 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 is 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 during sex within the first 48 hours after chemotherapy to protect your partner from any of the drug that may be present in semen or vaginal fluid.
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