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Chemotherapy (chemo) is treatment with certain kinds of drugs that destroy cancer cells. The drugs travel through the bloodstream to reach cancer cells in most parts of the body.

Most people will get chemo as part of their treatment for stomach cancer (also known as gastric cancer). It might be used by itself, or it might be given along with other types of medicines or with radiation therapy.

When is chemo used for stomach cancer?

Chemo might be used at different times to help treat stomach cancer:

If surgery is an option to treat the cancer, chemo is often given (with other medicines) both before and after surgery to try to improve the chances of getting rid of the cancer completely. This is known as perioperative treatment or perioperative therapy.

If surgery is done first, chemo may be given after surgery to kill any areas of cancer that may have been left behind but are too small to see. This is called adjuvant treatment or adjuvant therapy.

Chemo is often given with radiation therapy after surgery (known as chemoradiation). This may be especially helpful for cancers that couldn’t be removed completely by surgery, or if not enough lymph nodes were removed.

For cancers that aren’t resectable by surgery but haven’t spread, chemotherapy might be part of the first treatment, often along with other medicines or with radiation therapy. If the cancer shrinks enough, surgery might then be an option for some people.

Chemo may be given as part of the primary (main) treatment if the cancer has spread (metastasized) to distant parts of the body. Chemo may help shrink the cancer or slow its growth, which can relieve symptoms and help people live longer.

Which chemo drugs are used for stomach cancer?

Different chemo drugs can be used to treat stomach cancer, including:

• 5-fluorouracil (5-FU), typically given along with leucovorin (folinic acid)
• Capecitabine
• Carboplatin
• Cisplatin
• Docetaxel
• Irinotecan
• Oxaliplatin
• Paclitaxel
• Trifluridine and tipiracil (Lonsurf), a combination drug in pill form

Most often, 2 or more of these drugs are combined (sometimes along with a targeted therapy drug and/or immunotherapy drug as well). But this depends on factors such as the stage of the cancer, a person’s overall health, and if the cancer cells have certain gene or protein changes. Combinations with more drugs 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, drug combinations that might be used before and/or after surgery include:

• FLOT (5-FU/leucovorin, oxaliplatin, and docetaxel)
• Oxaliplatin plus 5-FU/leucovorin (FOLFOX), or oxaliplatin plus capecitabine (CAPOX)
• Docetaxel or paclitaxel plus either 5-FU/leucovorin or capecitabine
• Cisplatin plus either 5-FU/leucovorin or capecitabine
• Paclitaxel and carboplatin

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:

• Oxaliplatin plus 5-FU/leucovorin (FOLFOX), or oxaliplatin plus capecitabine (CAPOX)
• Cisplatin plus either 5-FU/leucovorin or capecitabine
• Irinotecan plus 5-FU/leucovorin (FOLFIRI)
• Paclitaxel plus either cisplatin or carboplatin
• Docetaxel plus cisplatin
• Docetaxel, 5-FU/leucovorin, and either cisplatin, carboplatin, or oxaliplatin

If a person isn’t healthy enough to get a combination of chemo drugs, a single drug, such as 5-FU/leucovorin, 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.

How is chemotherapy given?

Chemo drugs for stomach cancer are typically given into a vein (using an IV or central line), either as an injection over a few minutes or as an infusion over a longer period. Some drugs are taken by mouth. All these drugs enter your bloodstream and reach most areas of your body. These drugs can be given in a doctor’s office, infusion center, or in a hospital.

Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 to 4 weeks long. The schedule varies depending on the drugs used. Some drugs might be given only on the first day of the cycle, while others might be given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

For earlier-stage stomach cancer, chemo is often given for a total of 3 to 6 months, depending on the drugs used. The length of treatment for advanced stomach cancer depends on how well it’s working and what side effects you’re having.

Side effects of chemo

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:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• Diarrhea or constipation
• Mouth sores

Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:

• Increased chance of infection (from a shortage of white blood cells)
• Easy bleeding or bruising (from a shortage of platelets)
• Fatigue and shortness of breath (from a shortage of red blood cells)

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.

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, call uses, 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 of 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.