Systemic Chemotherapy

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Systemic chemotherapy uses powerful drugs via the bloodstream to target and destroy cancer cells throughout the body. Unlike localized surgery, it reaches microscopic cells spread beyond the primary tumor, making it a cornerstone for treating abdominal cancers.

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What is Chemotherapy?

Chemotherapy (also commonly referred to as "chemo") is the use of cell-killing (cytotoxic) drugs designed to destroy cancer cells or prevent them from multiplying throughout the body. Unlike surgery or radiation, which target a specific area, systemic chemotherapy travels through the bloodstream so it can reach cancer cells that have spread beyond the original tumor. [1,2]

Chemotherapy is a common treatment option used to fight abdominal cancers. Though surgical treatment (such as CRS with or without regional chemotherapies like HIPEC or PIPAC) is a critical tool to treat nearly all abdominal cancers and peritoneal metastases, systemic chemotherapy is called for in current treatment guidelines for a majority of patients. [11]

Why Use Chemotherapy?

Depending on your situation, chemo may be used to [3]:

Shrink a tumor before surgery to make it easier to remove (neoadjuvant)
Kill remaining cancer cells after surgery to reduce the risk of recurrence (adjuvant)
Control the disease when surgery isn't an option, slowing growth and prolonging life
Relieve symptoms caused by tumors pressing on organs (palliative)

How Does Chemotherapy Work?

Chemo drugs target cells that divide rapidly – a defining trait of cancer cells. They damage the cancer cell's DNA or interfere with its ability to multiply, eventually causing it to die. Because some healthy cells (hair follicles, gut lining, bone marrow) also divide quickly, they can be affected too – which is why many side effects occur. Most healthy cells recover; cancer cells, being mutated, are less able to repair themselves. [2]

Chemotherapy as Part of Your Treatment Plan

Chemo may be given on its own or as one piece of a combined treatment plan alongside other modalities such as surgery, radiation therapy, immunotherapy, or targeted therapy. For many types of abdominal cancers, a multimodal approach – combining two or more treatments – offers the best chance of long-term control. Your oncology team will tailor the combination and sequence based on tumor type, stage, and your overall health. [3,4]

How is Chemotherapy Used with a Surgical Treatment Plan?

Chemo is delivered in cycles – typically a treatment day (or several days) followed by 1–3 weeks of rest to let your body recover. A full course usually runs 3 to 6 months total, though it can be shorter or longer depending on the cancer and how you tolerate treatment. [5-7]

Neoadjuvant

WHEN: Before Surgery
PURPOSE: Shrink the tumor and address microscopic spread early
TYPICAL LENGTH: A few weeks up to a few months (commonly 2-4 months); surgery usually follows within ~4 weeks of finishing

Adjuvant

WHEN: After Surgery
PURPOSE: Eliminate any cancer cells left behind to lower recurrence risk
TYPICAL LENGTH: Usually 3-6 months, started within ~6-8 weeks after surgery once you've healed

In many abdominal cancers, you may receive both – known as perioperative chemotherapy – for a combined total of roughly 6 months of treatment, split before and after surgery.

Chemotherapy as a Standalone or Palliative Treatment

Not every patient has surgery as part of their plan. When cancer has spread, when surgery isn't safe, or when the tumor can't be fully removed, chemo may be used as the primary treatment to control the disease for as long as possible. In this setting it is often called palliative chemotherapy – the aim isn't to cure, but to shrink tumors, slow their growth, ease symptoms (such as pain, nausea, or blockage from a tumor pressing on the bowel or bile duct), and improve quality of life. Treatment may continue as long as it's working and well-tolerated, with regular scans every few months to reassess; if one regimen stops working, your care team may switch to a different combination. [8]

When is Chemotherapy Used for Peritoneal Metastases?

When cancer cells spread to the lining of the abdomen – called the peritoneum – current guidelines still recommend systemic chemotherapy at some point in the majority of patients. These guidelines often call for using the same regimens given for other forms of metastatic cancer (typically platinum- and fluoropyrimidine-based combinations, sometimes with targeted agents or immunotherapy agents).

One important limitation to be aware of: because the peritoneum has a relatively poor blood supply, IV (intravenous) and oral chemotherapy drugs don't penetrate it as effectively as they reach other sites throughout the body - in other words, chemotherapy many not reach those tumors effectively, which means it can be less effective at killing the cancer cells. This can make peritoneal disease harder to control with systemic chemo alone. For carefully selected patients, your team may discuss adding local approaches – such as cytoreductive surgery with HIPEC or PIPAC — alongside systemic treatment; these are considered in specialized centers and depend on the type of cancer, extent of peritoneal spread, and your overall condition. [11]

When considering a plan of care that may include systemic chemotherapy for an abdominal cancer diagnosis, talk with your doctor about the recommended treatment and its effectiveness in reaching the cancer and treating your diagnosis.

How is Chemotherapy Administered?

Chemotherapies are most commonly given in one of two ways [9]:

Intravenous (IV)

Drugs are infused directly into a vein, usually through a port or PICC line, at an infusion center or hospital. IV delivery is rapid, fully supervised, and reaches the bloodstream immediately — often preferred for more advanced or aggressive disease.

Oral

Pills, capsules, or liquids (such as capecitabine) taken at home on a set schedule. Oral chemo offers more flexibility and fewer clinic visits, but requires strict adherence – missing doses can reduce effectiveness. Oral chemo is not automatically weaker than IV; modern oral agents can be equally effective for certain cancers.

Some regimens combine the two modalities – IV and oral.

What It's Like to Receive

For IV infusions: You'll arrive at an infusion suite, have your blood drawn, and meet briefly with your team before the medicine is connected to your port. Sessions can last from 30 minutes to several hours; some regimens use a portable pump you take home for a few days. You'll receive pre-medications (anti-nausea drugs, steroids) before the chemo starts. Many people read, nap, or use devices during infusion. Some teams suggest ice mittens or compression gloves to reduce numbness in hands and feet.

For oral chemo: You take the medication at home according to a precise schedule — usually with food restrictions and careful handling instructions.

After treatment: Side effects often peak 2–5 days after a cycle and gradually improve before the next one. Plan for lighter activity during those days. [1,2]

What are Possible Side Effects of Chemotherapy?

Not everyone experiences every side effect, and your team will work to manage them [10]. Common side effects of systemic chemotherapy include:

Nausea and vomiting – usually well-controlled with anti-nausea medications
Loss of appetite and weight loss
Diarrhea or constipation
Sore mouth and throat (mucositis)
Fatigue, low energy levels – main and most common side effect
Low blood counts – increasing risk of infection, bleeding, or anemia
Hair thinning or loss (depends on the regimen)
Peripheral neuropathy – tingling or numbness in hands and feet, especially with platinum-based drugs
"Hand-foot syndrome" – redness, peeling, soreness on palms and soles (common with capecitabine and 5-FU)

Most side effects fade once treatment ends, though some (like neuropathy) may linger longer.

When to call your team right away

Fever of 100.4°F (38°C) or higher
Uncontrolled vomiting or diarrhea
Signs of infection, unusual bruising, or bleeding
Chest pain, shortness of breath, or new severe pain

Questions to Ask Your Oncologist

Coming to your appointment with a written list of questions can help you make the most of your time and feel more in control of your care. Consider asking:

What is the goal of this chemotherapy – to prepare me for surgery, treat residual disease after surgery, or manage unresectable disease?
Am I a candidate for surgery, including CRS/HIPEC for peritoneal metastases, now or potentially in the future?
What regimen*are you recommending, and why is it the best fit for my specific cancer type?
What are the most likely side effects with this specific regimen, and how will we manage them?
How will we measure whether chemotherapy is working, and on what timeline?
If I don't respond to this regimen, what are the next options?

Resources

Gentle Yoga for Recovery & Stretching

https://youtu.be/n-y-cUkWLrY

A gentle, slow yoga sequence designed specifically for abdominal surgery recovery, focusing on gentle stretches and mindful movement. These practices are meant to be gentle and appropriate for recovery when approved by your care team.

https://youtu.be/MmFZ_aqNX90

A very slow, beginner-level practice for early post-surgery healing that encourages gentle joint mobility and light movement.
Yoga for Recovery Stretch (12 min) – A short, gentle session focused on restorative stretching that can help ease stiffness and promote circulation.
Note: Many channels like Yoga With Joy offer playlists broken into phased post-surgery sequences, which can be helpful as you progress through recovery.

Breathing & Calm Practices
These videos focus on breathing techniques and light movement to help reduce stress, improve relaxation, and support breathing comfort — especially helpful when pain or discomfort interferes with deep breaths:

Daily Pranayama Breathing Exercises (under 15 min) on YouTube – A guided series of breath exercises to support calm and lung function.
15‑Minute Pranayama Practice with Deep Breaths – A gentle session of multiple breathing exercises that can help with relaxation and stress relief.
4‑7‑8 Calm Breathing Exercise (10 min) – A specific breathing technique that can help promote relaxation and ease tension.
Yoga Breathing Exercises Playlist (Various Lengths) – A collection of breath-focused videos for stress relief, calm, and mindful breathing practices.
10 Minute Balancing Breathwork – A short breathwork session focused on balance and inner calm.

Safety Reminder

Before trying any yoga or breathing video:

Talk with your surgeon or care team to ensure it’s safe for your specific recovery stage.
Stop if any movement causes sharp pain, dizziness, or discomfort.
Listen to your body; breath work and gentle motion are for comfort and calm, not exertion.

References

1. American Cancer Society. Chemotherapy. 2025.

2. National Cancer Institute. Chemotherapy to treat cancer. U.S. Department of Health and Human Services.

3. National Cancer Institute. Types of cancer treatment. U.S. Department of Health and Human Services.

4. American Cancer Society. Living with advanced and metastatic cancer. 2017.

5. Ou, H., Zhuang, J., Jian, M., Zheng, X., Wu, T., Cheng, H., & Qian, R. (2025). Perioperative versus adjuvant chemotherapy for resectable gastric cancer: a meta-analysis of randomized controlled trials. Frontiers in oncology, 15, 1432596. https://doi.org/10.3389/fonc.2025.1432596

6. Cashin, P. H., Esquivel, J., Larsen, S. G., Liauw, W., Alzahrani, N. A., Morris, D. L., Kepenekian, V., Sourrouille, I., Dumont, F., Tuech, J. J., Ceribelli, C., Doussot, B., Sgarbura, O., Quenet, F., Glehen, O., Fisher, O. M., Peritoneal Surface Oncology Group International (PSOGI), Nordic Peritoneal Oncology Group (NPOG), American Society for Peritoneal Surface Malignancy (ASPSM), & BIG-RENAPE Groups (2022). Perioperative chemotherapy in colorectal cancer with peritoneal metastases: A global propensity score matched study. EClinicalMedicine, 55, 101746. https://doi.org/10.1016/j.eclinm.2022.101746

7. Brebu, D., Șelaru, M., Faur, I. F., Burta, M. C., Faur, I. A., Dobrescu, A., Duță, C., Braicu, V., Neamțu, A. A., & Răzvan, D. (2026). A Meta-Analysis on the Long-Term Impact of Cytoreductive Surgery Plus HIPEC for Ovarian Cancer with Peritoneal Metastasis: Are We on the Right Path?. Life (Basel, Switzerland), 16(2), 335. https://doi.org/10.3390/life16020335

8. Matsumoto, Y., Higuchi, A., Shiba, M., Sasaki, K., Saiki, T., Honma, Y., Kimura, K., Zhou, Q., & Saijo, Y. (2023). Termination of Palliative Chemotherapy Near the End of Life: A Retrospective Study of Gastrointestinal Cancer Patients. Palliative medicine reports, 4(1), 169–174. https://doi.org/10.1089/pmr.2023.0027

9. American Cancer Society. Getting chemo infusions or injections. 2025.

10. American Cancer Society. Chemotherapy side effects. 2025.

11. Foster JM, Zhang C, Rehman S, Sharma P, Alexander HR. Emerging therapeutic approaches for peritoneal metastases from gastrointestinal cancers. Annals of Surgical Oncology. 2024