About chemotherapy for stomach cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body.

For stomach cancer, you may have chemotherapy

• Before or after surgery (or both before and after)
• To reduce or control symptoms in advanced cancer
• To slow an advanced cancer down

You might have your chemotherapy for stomach cancer

• As an injection
• Through a drip into the arm
• Through a pump as a slow continuous infusion
• As tablets

How you have your chemotherapy will depend on the particular drug or combination of drugs you are having. You may have a combination of drip, injections and tablets. There is information about the drugs used to treat stomach cancer in the next page of this section.

You might have chemotherapy before surgery to try to shrink the cancer so it can be operated on more easily. This is known as neoadjuvant therapy. Or you might have it after surgery to try to stop the cancer coming back. This is called adjuvant therapy. Chemotherapy does have side effects, and not everyone is fit enough to have it. Your doctor will assess you carefully to make sure you are fit enough before starting any chemotherapy treatment.

A large trial called MAGIC looked into chemotherapy before and after surgery for stomach cancer. Results have been encouraging and show that chemotherapy made it easier to remove the cancer, and helped stop the cancer from coming back. There is more information about the results of this trial in the what's new in stomach cancer section.

A new trial is looking at adding a biological therapy called bevacizumab (Avastin) to chemotherapy for advanced stomach cancer. Another trial for advanced stomach cancer is looking at adding another type of biological therapy called panitumumab (Vectibix) to chemotherapy. These trials hope to find out whether biological therapies can slow the growth of advanced stomach cancer and help to reduce symptoms. If you are interested in taking part in a clinical trial, visit our searchable database of clinical trials in the UK and choose stomach from the drop down menu.

Some research has looked into using chemotherapy and radiotherapy together after surgery to remove stomach cancer. This isn't standard treatment in the UK, as doctors here don't believe there is enough evidence that it works. The side effects can also be more severe. If you have this treatment, it should be as part of a clinical trial.

If your cancer is thought to be too large to remove completely, your doctor may suggest chemotherapy to try to shrink it. Or you might have chemotherapy after surgery if your surgeon could not remove the whole tumour. Chemotherapy might shrink the cancer that was left behind after the operation. This treatment is to try to slow the growth of the cancer. Even if the chemotherapy shrinks a tumour completely, there is a high risk of the cancer coming back at some time in the future.

If you have advanced stomach cancer, your doctor might suggest chemotherapy to try to shrink the cancer, slow it down, or relieve any symptoms that you have. This type of treatment is called palliative chemotherapy. It is usually given through a drip or chemotherapy pump and you may also have chemotherapy tablets.

You may be asked to take part in a clinical trial. It is important for doctors to find out which treatments work best. As the aim of the treatment is to make you feel better, it is important that the chemotherapy itself does not make you feel ill and that you do not have to make too many trips to the hospital. So doctors design trials to look at the side effects of treatment, ways of giving outpatient treatment, and how the treatment makes you feel, as well as trying to find the treatment that works best.

This way of giving chemotherapy for stomach cancer is not done very often. It may be used when there are signs that cancer cells have spread onto the inside of the abdominal wall and are making your abdomen swell with fluid (ascites). A small cut is made in the wall of your abdomen and a tube called a catheter is put through. The fluid in the abdomen is drained out and a chemotherapy infusion put into the abdominal cavity through the catheter. With most of these chemotherapy drugs you need anti-sickness medicines, and a drip to flush the chemo out of your system.

If you have cancer that has spread to your liver, in rare situations your doctor may offer you an experimental treatment called hepatic artery infusion. You have a general anaesthetic so that a small tube can be put into your abdomen. The tube is threaded into one of the main blood vessels to the liver. This blood vessel is called the hepatic artery. A pump can then be attached to this tube to give you chemotherapy directly into your liver. Continuous chemotherapy is given through the pump. Your doctor will decide exactly how long you should have the treatment for. The drug used is usually fluorouracil. This is not standard treatment for stomach cancer.

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed them by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section of CancerHelp UK.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

For detailed information about chemotherapy look at the main chemotherapy section in CancerHelp UK. It explains

• What chemotherapy involves
• How chemotherapy works
• General side effects
• Living with chemotherapy

If you would like more information about chemotherapy, contact cancer information nurses. They would be happy to help.

If you would like more information about anything to do with chemotherapy, contact one of the stomach cancer organisations. They will be happy to help. They often have free factsheets and booklets that they can send to you.