Chemotherapy for stomach cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. Treatment that reaches the whole body in this way is called a systemic treatment.

You might have chemotherapy before or after surgery for stomach cancer. If you have advanced cancer, you might also have chemotherapy to relieve symptoms and improve your quality of life.

When you have it

Before and after surgery

You’re likely to have chemotherapy before and after surgery unless you have a very early stage cancer (stage 1A). This is called perioperative chemotherapy. It aims to:

  • reduce the size of the cancer so it’s easier for your surgeon to remove 
  • lower the risk of the cancer coming back

After surgery 

If you haven't had chemotherapy before surgery then you might have:

  • chemotherapy on its own after surgery
  • rarely you might have chemotherapy combined with radiotherapy (chemoradiotherapy) after surgery 

Advanced cancer

You might have chemotherapy as your main treatment if you have advanced stomach cancer. It can’t cure your cancer, but it might:
•    relieve symptoms
•    control the growth of the cancer
•    improve your quality of life

How often do you have it?

You usually have chemotherapy every 3 weeks. Each 3 week period is called a cycle. Your doctor will tell you how many cycles you are going to have.

Types of chemotherapy

Usually you have a combination of 2 or 3 drugs (in a regimen). Your oncologist will explain which regimen they think is best for you. The most common types include:

  • fluorouracil, folinic acid, oxaliplatin and docetaxel (FLOT) 
  • epirubicin, cisplatin and fluorouracil (ECF)
  • oxaliplatin, fluorouracil, and folinic acid (FOLFOX)

If you have advanced cancer you might also have some other chemotherapy drugs. You might have them on their own or in a combination. These include:

  • cisplatin
  • capecitabine
  • paclitaxel
  • carboplatin
  • docetaxel
  • irinotecan
  • oxaliplatin
  • fluorouracil
  • trifluridine and tipiracil (Lonsurf)

Targeted and immunotherapy cancer drugs

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. These are called immunotherapy. 

You might have targeted or immunotherapy cancer drugs with chemotherapy as part of your treatment for advanced stomach cancer. This might include:

  • trastuzumab, cisplatin and capecitabine (HCX)
  • nivolumab, oxaliplatin, fluorouracil and folinic acid (nivolumab-FOLFOX)

First and second line treatment

You might hear the terms first line and second line treatment. The first course of chemotherapy you have is the first line treatment. Your doctor might offer you second line treatment if first line treatment isn't working or your cancer starts to grow again.

How you have it

You have most of the chemotherapy drugs for stomach cancer into your bloodstream (intravenously). Capecitabine is a tablet.

Into your bloodstream

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.

Diagram showing a central line


You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test. 

Before your first chemotherapy, your doctor will explain what drugs you need, how you have them, and what the side effects are. You’ll sign a consent form. This is a good time to ask any questions you might have.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • increased risk of getting an infection
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.

Dietary or herbal supplements and chemotherapy

Let your doctors know if you:

  • take any supplements
  • have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

When you go home

Chemotherapy for stomach cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

  • Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up 
    F Lordick and others 
    Annals of Oncology, 2022

  • Gastric Cancer                                                                                                                     
    E Smyth and others                                                                                  
    The Lancet, 2020. Volume 396, Pages 635-648

  • Systemic treatment oesophageal and gastric cancer guidelines
    London Cancer Alliance, July 2014

  • Oesophago-gastric cancer: assessment and management in adults
    National Institute for Health and Care Excellence (NICE), 2018

  • National Oesophago-Gastric Cancer Audit
    The Royal College of Surgeons of England, 2021

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
06 Sep 2022
Next review due: 
05 Sep 2025

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