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.

Chemotherapy 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 (metastases) to other areas of the body. It may also help some patients live longer.

Chemotherapy 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 along 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.

Chemotherapy is also being studied for use before surgery. The goal of this type of treatment, known as neoadjuvant chemotherapy, is to shrink the tumor and possibly make surgery easier. It may also help keep the cancer from coming back, like adjuvant treatment does. Right now, it is not clear if neoadjuvant chemotherapy is any better than adjuvant chemotherapy, but studies are ongoing. The standard treatment at this point remains adjuvant chemoradiation given after surgery to try to decrease the chance of the cancer coming back.

Chemotherapy for stomach cancer may use one drug such as 5-fluorouracil (5-FU), which is often combined with radiation therapy. Or chemotherapy may use several drugs combined. The most commonly used drugs are 5-FU (fluorouracil), doxorubicin (Adriamycin^®), methotrexate, epirubicin (Ellence^®), etoposide (VP-16), and cisplatin. 5-FU is often given with a vitamin-like drug called leucovorin (or folinic acid) which helps it work better. Other drugs that may be helpful are docetaxel (Taxotere^®), paclitaxel (Taxol^®), irinotecan (Camptosar^®, CPT-11), capecitabine (Xeloda^®), and oxaliplatin. It is not yet clear which drugs or combinations of drugs work best against 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 (due to a shortage of white blood cells)
• bleeding or bruising after minor cuts or injuries (due to a shortage of platelets)
• fatigue and shortness of breath (due to 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.

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.

You should be given specific information about each drug you are receiving and you should review it before you start treatment.

Be sure to talk with 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.

Drugs known as growth factors G-CSF (Neupogen) and GM-CSF (Leukine), for example are sometimes given to increase your white blood cell counts and thus reduce the chance of infection. If your white blood 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 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 there are 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.

Targeted therapies

Newer drugs that target specific parts of cancer cells are now being tested against stomach cancer. Some of these are discussed in more detail in the section "What's new in stomach cancer research and treatment?"

Last Medical Review: 11/03/2009
Last Revised: 11/03/2009