Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein (through an IV line or central venous catheter) 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 might be used at different times to help treat stomach cancer:
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.
Many different chemo drugs can be used to treat stomach cancer, including:
Most often, 2 or 3 of these drugs are combined (sometimes along with a targeted drug as well). But this depends on factors such as the stage of the cancer, the person’s overall health, and whether chemo is combined with radiation therapy. 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.
For earlier stage cancers, some common drug combinations used before and/or after surgery include:
When chemo is given with radiation after surgery, a single drug such as 5-FU or capecitabine may be used.
For advanced stomach cancer, many of the same combinations of drugs can be used, although doctors often prefer combinations of 2 drugs rather than 3 to try to reduce side effects. Some of the most commonly used combinations include:
If a person isn’t healthy enough to get a combination of chemo drugs, a single drug, such as 5-FU, capecitabine, docetaxel, or paclitaxel, might be used instead.
If one of these combinations (or a single drug) is no longer helpful, another drug or combination of drugs might be tried.
Chemo drugs attack cells in the body that are dividing quickly, which can lead to side effects. These depend on the type and dose of drugs, and the length of treatment. Side effects from chemo can include:
These side effects usually 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 help with them. For example, you can be given drugs to prevent or reduce nausea and vomiting.
Some chemo drugs have specific side effects. Your treatment team can help you know which of these you might need to look out for.
Nerve damage (neuropathy): Cisplatin, oxaliplatin, docetaxel, and paclitaxel can damage nerves. 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 people. Oxaliplatin can also affect nerves in the throat, causing throat pain that is worse when trying to eat or drink cold liquids or foods.
Heart damage: Epirubicin and some other drugs can damage the heart 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.
Hand-foot syndrome can occur during treatment with capecitabine or 5-FU (when given as an infusion). This starts out as redness in the hands and feet, which can then progress to pain and sensitivity in the palms and soles. If it worsens, blistering, calluses, or skin peeling can occur, sometimes leading to painful sores. The best way to prevent severe hand-foot syndrome is to tell your doctor if you have early symptoms, such as redness or sensitivity, so that steps can be taken to keep things from getting worse.
Diarrhea is a common side effect with many chemo drugs, but it can be particularly bad with irinotecan. It needs to be treated right away — at the first sign of loose stools — to prevent severe dehydration. If you are getting a chemo drug that is likely to cause diarrhea, your doctor will give you instructions on what drugs to take and how often to take them to control this symptom.
Some chemo drugs can cause other side effects. Talk with your treatment team about what types of side effects you should watch for.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Last Revised: January 22, 2021