Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth as pills. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread to organs beyond the stomach.
Chemo may be given as the primary (main) treatment for stomach cancer that has spread to distant organs. It may help relieve symptoms for some patients, especially those whose cancer has spread (metastasized) to other areas of the body. It may also help some patients live longer.
Chemo may also be given after surgery to remove the cancer. This is called adjuvant treatment. Adjuvant treatment is meant to kill any cancer cells that may have been left behind but are too small to see. The goal is to keep the cancer from coming back. Often, for stomach cancer, chemo is given with radiation therapy after surgery. This combination is called chemoradiation. It may delay the cancer coming back (known as recurrence) and extend the life span of people with less advanced stomach cancer. This may be especially helpful for cancers that could not be removed completely by surgery.
Chemo can also be given before surgery for stomach cancer. This, known as neoadjuvant treatment, can shrink the tumor and possibly make surgery easier. It may also help keep the cancer from coming back and help patients live longer. For some stages of stomach cancer, neoadjuvant chemo is one of the standard treatment options. Often, treatment with chemo starts again after surgery (adjuvant chemotherapy).
A number of drugs are used to treat stomach cancer, including 5-FU (fluorouracil), doxorubicin (Adriamycin®), methotrexate, epirubicin (Ellence®), etoposide (VP-16), cisplatin docetaxel (Taxotere®), paclitaxel (Taxol®), irinotecan (Camptosar®, CPT-11), capecitabine (Xeloda®), and oxaliplatin. 5-FU is often given with a vitamin-like drug called leucovorin (or folinic acid) which helps it work better.
These drugs are often given in combination. Some common combinations used when surgery is planned include:
- ECF (epirubicin, cisplatin, and 5-FU),which may be given before and after
- Docetaxel or paclitaxel plus either 5-FU or capecitabine combined with radiation as treatment before surgery
- Cisplatin plus either 5-FU or capecitabine combined with radiation as treatment before surgery
When chemo is given with radiation after surgery, a single drug such as 5-FU or capecitabine may be used.
To treat advanced stomach cancer, ECF may also be used, but some other combinations may also be helpful. They include:
- DCF (Docetaxel, cisplatin and 5-FU)
- Irinotecan plus cisplatin
- Irinotecan plus 5-FU or capecitabine
- Oxaliplatin plus 5-FU or capecitabine
Other combinations may also be helpful in treating stomach cancer.
Side effects of chemotherapy
Chemotherapy drugs kill cancer cells but also damage some normal cells, which can lead to side effects. The type of side effects depends on the type of drugs, the amount taken, and the length of treatment. Short-term side effects common to most chemotherapy drugs can include:
- Nausea and vomiting
- Loss of appetite
- Hair loss
- Diarrhea
- Mouth sores
- Low blood cell counts
Because chemotherapy can damage the bone marrow, where new blood cells are made, your blood cell counts might become low. This can result in:
- Increased chance of infection (a shortage of white blood cells)
- Bleeding or bruising after minor cuts or injuries (a shortage of platelets)
- Fatigue and shortness of breath (low red blood cell counts)
These side effects are usually short-term and go away once treatment is finished. For example, hair will usually grow back after treatment ends.
Some chemotherapy drugs have specific side effects:
Neuropathy: Cisplatin, oxaliplatin, docetaxel, and paclitaxel can damage nerves outside the brain and spinal cord. This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases this goes away once treatment is stopped, but it may be long-lasting in some patients. Oxaliplatin can also affect nerves in the throat, causing throat pain that is much worse when trying to eat or drink cold liquids or foods. This pain can lead to trouble swallowing or even breathing, and can last a few days after treatment.
Heart damage: Doxorubicin, epirubicin, and some other drugs may cause permanent heart damage if used for a long time or in high doses. For this reason, doctors carefully control the doses and use heart tests such as echocardiograms or MUGA scans (a procedure that lets the doctor see how well your heart is pumping) to monitor heart function. Treatment with these drugs is stopped at the first sign of heart damage.
Low blood counts: This is a very common side effect of chemo. Low white blood cell counts can increase your risk of serious infection. G-CSF (Neupogen®) and GM-CSF (Leukine®) are drugs known as growth factors. One of these may be given to increase your white blood cell counts and thus reduce the chance of infection while you are on chemo. If your white blood cell counts are very low during treatment, you can also reduce your risk of infection by avoiding exposure to germs. During this time, your doctor may suggest that you:
- Wash your hands often.
- Avoid fresh, uncooked fruits and vegetables and other foods that might carry germs.
- Avoid fresh flowers and plants because they may carry mold.
- Make sure other people wash their hands when they come in contact with you.
- Avoid large crowds and people who are sick (wearing a surgical mask offers some protection in these situations).
You might also be given antibiotics before you have signs of infection or at the earliest sign that an infection may be developing.
If your platelet counts are low, you may be given drugs or platelet transfusions to help protect against bleeding. Likewise, shortness of breath and extreme fatigue caused by low red blood cell counts may be treated with drugs or with red blood cell transfusions.
You should be given specific information about each drug you are receiving and you should review it before you start treatment.
Be sure to tell your cancer care team about any side effects you have because there are often ways to lessen them. For example, you can be given drugs to prevent or reduce nausea and vomiting.
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