You might be offered stomach cancer chemotherapy as a treatment for your tumor. This may be given either before surgery to shrink it or after to help prevent it from coming back.
Doctors use complex terms for these types of therapies, but you will commonly here the terms neoadjuvant drugs, which means the treatment is being given before surgery, and adjuvant meaning it is being given after stomach cancer surgery to help prevent recurrence.
The options for you really depend on your oncologist and what is available in your local area.
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There is no doubt, this form of therapy has revolutionized the treatment of a lot of different tumors.
Often referred to as chemo, it is the administration of a drug that is designed to damage and destroy cancer cells.
The drugs are commonly referred to as cytotoxics – cyto meaning cell and toxic meaning that it is poisonous to the malignant cells.
Whilst the researcher’s ideal is to try to develop drugs that only have an effect on malignant tumors, in reality this is very difficult to achieve.
Side effects do occur through damage to non-cancer cells and when embarking on this type of therapy, it is important to discuss what these are fully with your specialist or oncologist.
It is important that you have a good performance status before embarking on this treatment.
The drugs used in stomach cancer chemotherapy are administered usually intravenously in to a large vein near the heart or in some cases as a tablet or injection.
Often combinations of drugs are given and you might be offered these different ways of administering them.
The reason for these different ways of delivering them is usually because of their toxic effects on the gut or as a consequence of poor absorption of the medicine if given by mouth.
Central lines are commonly used as a route of administration for your stomach cancer chemotherapy and other drugs such as antibiotics or even to help feed you in some cases.
They are used as the drugs are often unsuitable to be given in a “peripheral” vein due to the damage it can cause to smaller veins. This damage is known as phlebitis and is much less likely in larger veins.
A central line is often referred to as a Hickman line, a specific manufacturing type of line. They are long fine tubes that are inserted under the skin and “tunnelled” through to the large vein at the base of your neck called the subclavian vein which connects to the superior vena cava or great vein which is attached to the right side of your heart.
You can see an example of this in the diagram below:
These lines are placed by an experienced practitioner, usually a doctor or cancer specialist nurse under sterile conditions to help prevent introducing infection before you have your stomach cancer chemotherapy.
Your skin will be cleansed with an antiseptic and drapes will then be placed around your neck and chest.
A local anesthetic to numb your skin will be administered via needle. A small cut or incision will be made in your skin both at the level of your neck (near your collar bone) and also on your chest.
The line is introduced through the incision in the neck and then “tunnelled” through to the incision made in your chest where it will come out on to your skin.
They are usually placed on the right side of your chest although this can vary depending on your anatomy and availability of the vein.
After the central line is inserted, you will need a chest x-ray to make sure that the line is in the correct position and to ensure that a pneumothorax hasn't occurred (collapsed lung).
Unfortunately, placement of these central lines is not without risk although they are a necessity in a lot of cases. You can see a table of complications that can occur whilst inserting them and also latter on below:
An alternative although less commonly used line for stomach cancer chemotherapy is a PICC line or percutaneous inserted central catheter.
This is placed through the largest vein in your arm instead of the neck and chest. It is said to have less risk of infection, but other complications are similar to the central lines in general.
Choice of line depends on the unit you attend and the expertise available.
As previously mentioned, side effects can occur with drug treatment. These occur due to either the direct toxicity of the drug or due to the damage that they can inflict on normal human tissues.
Whilst every care is taken to help prevent these effects through rigorous laboratory or clinical trials, all drugs have the potential to cause problems and drugs used in stomach cancer are not immune to this.
The actual side-effects you may experience really depends on the stomach cancer chemotherapy you are offered. You can learn more about these by looking at the specific drug information.
Some of the commonly experienced side effects include:
This is a common side effect of a lot of drugs and chemotherapy is no different.
This can be due to the drug itself and to the toxicity it exerts on the stomach directly.
Rashes are quite a common side effect and can vary from dryness of the skin through to very severe changes in the skin with “exfoliation and desquamation” or skin breakdown.
Chemotherapy drugs can sometimes make you more prone to the effects of sunlight so your clinician will be able to advise you about this although it is wise to cover yourself up when in direct sunlight.
The lining of the gut has trillions of cells on it as well as bacteria within the gut, all of which are helpful in the digestion of your food.
Stomach cancer chemotherapy drugs can have a profound effect on both, resulting in diarrhea as well as reducing your immunity. As a consequence of this, you are more prone to getting gut infections.
Losing your appetite is common in patients. Compounded with this is the effect of the drugs themselves which can equally exert this effect.
You can also lose your sense of taste in your mouth as well as your sense of smell. It can also give you a sore mouth too.
It is important to try and maintain a good calorie intake which will help the healing process, improve your immune state and also your sense of well being.
Sometimes, you will be advised to have nutritional supplements when on stomach cancer chemotherapy and may even need to be fed through your central line with artificial feeds. A dietician can be very helpful in this situation.
An extremely common side-effect, tiredness can occur either as a direct effect or as a result of anemia too.
Chemotherapy agents not only destroy cells, but they can also suppress the production of your blood cells. Also, stomach cancers can bleed directly resulting in further anemia problems.
You might require iron supplements or may even require blood transfusions. Your doctor will be able to advise you on this.
I have already mentioned that these drugs can have an effect on your blood cell production. Some of these cells are involved in fighting off infection, particularly neutrophils and lymphocytes.
Low immunity is common in stomach cancer and it is important that you have your vaccinations prior to treatment if possible.
Low neutrophils can occur with a lot of different regimens and is known as neutropenia, usually occuring seven to ten days after chemo.
It can result in very severe infection resulting in hospital admission for intravenous antibiotics and care.
Monitoring of your blood counts and checking for fevers are important. Your doctor will be able to help and advise you further on this.
In the bone marrow, your platelet cells are produced. These are involved in clotting if you bleed and chemotherapy can lower their levels. If this happens, you are more susceptible to bleeding and bruising.
Your liver produces the clotting factors required to stop bleeding. If your liver is inflamed by the drugs you can have problems with bleeding.
Vitamin K is also required to produce your clotting factors. If you are malnourished, you may have low levels requiring supplements often given intravenously.
Finally, stomach cancer chemotherapy can make your small blood vessels more fragile and susceptible to bleeding.
It is important to be aware of this and to take precautions to make sure you don’t cut yourself or expose yourself to any risk of bleeding.
Blood monitoring by your doctor will help to prevent issues with your platelet count being low.
Neuropathy is where the stomach cancer chemotherapy drugs have an effect on the nerves, usually the one’s that provide sensation in your hands and feet.
Your feet can become numb and sometimes sore. You may also notice altered sensation in your hands too.
Both these problems can make you more clumsy as well as increasing your risk of falls and also introducing infections as you may become unaware that you have damaged your skin (a common ‘portal’ for infections to get in.
It’s important to exercise the up most caution with this and be aware of the potential problems that can occur.
Make sure you wear sensible footwear and regularly check your skin for any developing issues.
Hair loss is always a worrying side effect of chemotherapy. However on certain drugs cause this and your oncologist or cancer specialist will be able to advise you about this.
It’s not only hair loss though; your nails can also become very brittle and distorted too.
All body hair can be affected including eyebrows, eyelashes and pubic hair.
Whilst this form of cancer is usually a disease that affects older people, it can sometimes occur in the young.
Any menstruating women having stomach cancer chemotherapy should be made aware that these drugs can cause harm to the unborn baby and that they should be advised against becoming pregnant whilst on treatment.
The length of treatment does vary and is dependant on how well you tolerate the therapy as well as the response.
It is given in cycles, normally over three weeks and will go on for several months.
It maybe changed depending on your response which will be monitored whilst you are on it.
Your oncologist will be able to guide you in this matter, but the average
The type of stomach cancer chemotherapy regimen for gastric cancer depends on your local hospital.
For more information on these, take a look at the stomach cancer treatment page.
Chemotherapy alone is not usually enough to cure your stomach cancer. It is normally used as part of a treatment plan with the aim of giving you the best chance of long term survival.
The drugs are either used as a pre-op way in 'mopping up' cancer cells or as palliative treatment to prolong life or help reduce symptoms from the tumor.