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NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016

NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016


Preparing for treatment

Cancer tests


Preparing for treatment

Cancer tests

As part of the genetic risk assessment, your doctor

will ask about the medical history of your blood

relatives. It’s important to know who in your family has

had what diseases and at what ages the diseases

started. Your doctor may ask about the health of

your children and grandchildren, your siblings, your

parents and their siblings, and your grandparents.

No one in your family may have had stomach or

a related cancer. However, you still may have an

inherited syndrome that increased your chances of

getting stomach cancer. A syndrome is a group of

signs or symptoms that occur together and suggest

the presence of or risk for a disease. Inherited

syndromes related to stomach cancer include:

• HDGC (









• Lynch syndrome [HNPCC (











• Juvenile polyposis syndrome,

• Peutz-Jeghers syndrome,

• Classic or attenuated FAP (







• Ataxia- telangiectasia,

• Bloom syndrome,

• Hereditary breast and ovarian cancer


• Li-Fraumeni syndrome, and

• Xeroderma pigmentosum.

If your doctor thinks you have hereditary stomach

cancer, you should be referred to a genetic counselor.

A genetic counselor can talk with you about getting

tested for syndromes related to stomach cancer. To

be tested, you must provide a sample of blood. Using

the sample, a pathologist can test your genes for

abnormal changes that cause these syndromes.

For some syndromes, there may be health care

related to cancer that you can receive. Your doctor

may advise regular testing to screen for cancers.

Examples include breast and colon cancer screening.

There may also be treatments that can prevent

certain cancers.

Physical exam

Doctors often perform a physical exam along with

taking a medical history. A physical exam is a study of

your body for signs of disease. During this exam, your

doctor will listen to your lungs, heart, and gut.

Your doctor will also look at and feel parts of your

body. This is done to see if organs are of normal size,

are soft or hard, or cause pain when touched. Cancer

and other health conditions can cause organs to

become enlarged and hard.








ount) gives important

information about the parts of blood. One example

is the number of white blood cells, red blood cells,

and platelets. Your blood counts may be low because

the cancer has spread into your bones, the cancer

is causing bleeding, or because of another health


Comprehensive chemistry profile

Chemicals in your blood come from your liver, bone,

and other organs. A comprehensive chemistry profile

assesses if the chemicals in your blood are too low

or high. Abnormal levels can be caused by spread of

cancer or by other diseases.

I came upon an old photo recently, circa 1962, of my mother with my three brothers and me; a typical,

ordinary family of the time. Never would I have imagined that four of my five family members in the

photo were destined to become stomach cancer patients. In 1982, my mom (52) died shortly after

her stage IV stomach cancer diagnosis. Then 25 years later, in 2007, my oldest brother (56) received

the same diagnosis. These events led me on a quest for answers: could this stomach cancer be


I learned about Hereditary Diffuse Gastric Cancer (HDGC), a syndrome sometimes related to a CDH1

gene mutation. We did not meet genetic testing criteria, but gut instinct pushed us to pursue testing.

Yes, this was the culprit.

Our lives were forever changed – this was a family cancer diagnosis. My brother was undergoing the

challenges of cancer treatment while other family members were going through genetic counseling,

testing and prophylactic (preventive) total gastrectomy (PTG).

I was first in my family to undergo surgery, followed by my younger brother. Tragically, we lost my

oldest brother in February of 2009, 17 months following his diagnosis, and just weeks before his son’s

PTG was to take place. By 2015, five family members have undergone successful PTG, proactively

eliminating the high risk of developing stomach cancer – and in each case, pathology revealed the

presence of undetected cancer in our stomachs. What an incredible gift of knowledge to have!

Back in the 80’s there were no resources, and in 2007 resources were still sorely lacking, not only for

diagnosis and treatment, but also for awareness of hereditary risk.

I am thrilled that this guide is available to help you make informed decisions about your treatment, and

to reinforce the important role that genetic risk assessment plays in the prevention and treatment of

stomach cancer.

Karen Chelcun Schreiber

Founder, No Stomach For Cancer