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NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016

NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016


Cancer staging

TNM scores


Cancer staging

TNM scores

N = Node

Lymph drains from stomach tissue into vessels that

transport lymph to the bloodstream. As lymph travels,

it passes through small structures called lymph

nodes. Lymph nodes remove germs from lymph. As

shown in

Figure 5

, lymph nodes and vessels are

found throughout the body. The N category reflects

the number of lymph nodes with stomach cancer.


means that the lymph nodes can’t be



means that there is no cancer within

nearby lymph nodes.


means 1 or 2 nearby nodes have cancer.


means 3 to 6 nearby nodes have cancer.


means 7 to 15 nearby lymph nodes have



means 16 or more nearby lymph nodes

have cancer.

M = Metastasis

The M category tells you if there are metastases to

sites not in direct contact with the stomach. Such sites

include distant lymph nodes.


means that there is no growth to distant



means that the cancer has spread to

distant sites.

Figure 5.

Lymph nodes near the


Throughout your body is a network

of vessels that transport lymph to

the bloodstream. Lymph is a clear

fluid that contains germ-fighting

blood cells. As lymph travels in

vessels, it passes through lymph

nodes, which remove germs

from lymph. Stomach cancer first

spreads to lymph nodes next to the

stomach and then beyond.

Illustration Copyright © 2016 Nucleus Medical Media, All rights reserved.

In 2010, at age 59, I was diagnosed with metastatic Stage IV gastric adenocarcinoma (T4bN3bM1).

My prognosis was bad, and I thought that I was a hopeless case. Fortunately, I have been treated at

a National Comprehensive Cancer Network Hospital. Five years later, I am, much to my amazement,

alive and feeling well, with no evidence of disease.

My treatment has included partial gastrectomy, oral and IV chemotherapy, radiation therapy and

targeted therapy. My tumor expressed the HER-2 antigen, leading to my being treated with the

targeted treatment trastuzumab (Herceptin). Trastuzumab had been approved for treatment of HER-

2+ breast cancer since 1997, but was approved for HER-2+ stomach cancer only a few weeks before

I was diagnosed. I am continuing to receive infusions of it every three weeks and continue to be

followed up at my NCCN hospital.

During my treatment, I have had most of the possible side effects, particularly nausea. I have received

most of the possible medications for side effects and eventually found treatments that alleviated my

side effects. Although the side effects were serious, I now, of course, consider them a small price to

have had to pay.

Being diagnosed with stomach cancer is a terrible thing, but it is no longer a death sentence. I am

very, very glad that you will have access, like I did, to the full range of treatments now available. I

am also very, very happy that you have access to this wonderful booklet to help you understand the

diagnosis and treatment of this disease.

Randy Hillard

Stage IV Cancer Survivor

Founder, East Michigan

Chapter of Debbie's Dream Foundation