- How is stomach cancer treated?
- Surgery for stomach cancer
- Chemotherapy for stomach cancer
- Targeted therapies for stomach cancer
- Radiation therapy for stomach cancer
- Clinical trials for stomach cancer
- Complementary and alternative therapies for stomach cancer
- Treatment choices by type and stage of stomach cancer
- More treatment information for stomach cancer
Chemotherapy for stomach cancer
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 where it started.
Chemo can be used in different ways to help treat stomach cancer:
- Chemo can 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, chemo is then given again after surgery.
- Chemo may be given after surgery to remove the cancer. This is called adjuvant treatment. The goal of adjuvant chemo is to kill any cancer cells that may have been left behind but are too small to see. This can help keep the cancer from coming back. Often, for stomach cancer, chemo is given with radiation therapy after surgery. This combination is called chemoradiation. This may be especially helpful for cancers that could not be removed completely by surgery.
- Chemo may be given as the primary (main) treatment for stomach cancer that has spread (metastasized) to distant organs. It may help shrink the cancer or slow its growth, which can relieve symptoms for some patients and help them live longer.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each cycle typically lasts for a few weeks.
A number of chemo drugs can be used to treat stomach cancer, including:
- 5-FU (fluorouracil), often given along with leucovorin (folinic acid)
- Capecitabine (Xeloda®)
- Docetaxel (Taxotere®)
- Epirubicin (Ellence®)
- Irinotecan (Camptosar®)
- Oxaliplatin (Eloxatin®)
- Paclitaxel (Taxol®)
Depending on the situation (including the stage of the cancer, the person’s overall health, and whether chemo is combined with radiation therapy), these drugs may be used alone or combined with other chemotherapy or targeted drugs.
Some common drug combinations used when surgery is planned include:
- ECF (epirubicin, cisplatin, and 5-FU),which may be given before and after surgery
- 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
- Paclitaxel and carboplatin, 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 other combinations may also be helpful. Some of these include:
- DCF (docetaxel, cisplatin and 5-FU)
- Irinotecan plus cisplatin
- Irinotecan plus 5-FU or capecitabine
- Oxaliplatin plus 5-FU or capecitabine
Many doctors prefer to use combinations of 2 chemo drugs to treat advanced stomach cancer. Three-drug combinations can have more side effects, so they are usually reserved for people who are in very good health and who can be followed closely by their doctor.
Side effects of chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells can also be affected by chemo, which can lead to side effects. The type of side effect 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
- Mouth sores
- Increased chance of infection (from a shortage of white blood cells)
- Bleeding or bruising after minor cuts or injuries (from a shortage of platelets)
- Fatigue and shortness of breath (from a shortage of red blood cells)
These side effects are usually short-term and go away once treatment is finished. For example, hair will usually grow back after treatment ends. 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.
Some chemotherapy drugs have specific side effects. You should be given specific information about each drug you are receiving and you should review it before you start treatment.
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 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 to monitor heart function. Treatment with these drugs is stopped at the first sign of heart damage.
Low blood cell counts: This is a very common side effect of chemo.
Having a low white blood cell count can increase your risk of serious infection. If your white blood cell counts are very low during treatment, you can 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 before 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 be given drugs known as growth factors, such as G-CSF (Neupogen®) and GM-CSF (Leukine®), to increase your white blood cell count and thus reduce the chance of infection while you are on chemo. 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 might 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.
To learn more about chemotherapy, you can read our document Understanding Chemotherapy: A Guide for Patients and Families online, or call us for a free copy.
Last Medical Review: 02/15/2013
Last Revised: 02/11/2014