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NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016

NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016


Overview of cancer treatments Radiation therapy

Radiation therapy

Radiation therapy uses high-energy rays to treat

cancer. The rays damage DNA. This either kills the

cancer cells or stops new cancer cells from being

made. For stomach cancer, radiation therapy is

often given with chemotherapy. Chemotherapy may

improve how well radiation works. This combined

treatment is called chemoradiation.









herapy) is the

method used to treat stomach cancer. This method

delivers radiation from outside your body using a

large machine.

See Figure 12

. The radiation passes

through your skin and other tissue to reach the tumor.

Simulation session

To receive radiation therapy, you first must have a

planning (simulation) session. Do not eat a heavy

meal 3 hours beforehand. A 3D image of the tumor

will be made with a CT scan. Contrast may be used to

enhance images.

Images are taken after your body is moved into the

position needed for treatment. It is advised that you

lie on your back and be kept from moving with an

immobilization device. For some people, 4D-CT

planning and other methods to control movement may

be used.

Using the scans, your treatment team will plan the

best radiation dose, number and shape of radiation

beams, and number of treatment sessions. Beams

are shaped with computer software and hardware that

Figure 12.

External beam

radiation therapy

Radiation therapy is often delivered

from a large machine. The rays

pass through skin and travel

to the tumor. Healthy tissue is

protected by using modern types of



Overview of cancer treatments Surgical treatment

Lymph node dissection

During the gastrectomy, some lymph nodes near to

your stomach will be removed, too. This is called a

lymph node dissection. Removal of at least 15 lymph

nodes is advised.

A D1 dissection removes lymph nodes right next to

the stomach. A D2 dissection removes D1 nodes as

well as lymph nodes next to nearby arteries and your

spleen. A pathologist will test your lymph nodes for

cancer so your surgeon knows if more tissue should

be removed.

Surgical methods

Surgery removes tissue from your body through cuts

(incisions) made with a surgical knife. Gastrectomy

can be performed by three methods. An open

gastrectomy is one method that removes tissue

through a large cut in your belly area.

Laparoscopic or robotic gastrectomy removes tissue

with small tools that are inserted through small cuts.

Because small cuts are used, doctors describe these

methods as “minimally invasive.” Laparoscopic or

robotic gastrectomy is appropriate for some but not

all stomach cancers. Your surgeon will discuss with

you whether your stomach cancer can be removed by

these methods.

After the cancer is removed, your remaining organs

will be attached. For a total gastrectomy, your small

intestine will be attached to your esophagus. For

a subtotal or distal gastrectomy, your remaining

stomach will be attached to your intestine or


The entire surgery can take 2 to 3 hours to complete.

Most people stay in the hospital about one week to

recover. As you heal from surgery, you will receive

nutrition through a needle placed in your vein or

receive food through a feeding tube.

Side effects of surgery

Surgery causes pain, swelling, and scars. Pain and

swelling often fade away in the weeks following

surgery. As with any surgery, there is a chance of

infection, heart attack, or a blood clot.

Side effects of a gastrectomy differ between people.

You may have few or many side effects. Side effects

of a gastrectomy include nausea, vomiting, and

diarrhea. You may lose weight or not absorb enough

vitamins. Gastrectomy can cause heartburn (acid

reflux). Long-term leakage of stomach acid can scar

and constrict your esophagus. Less often, food may

leak from your stomach into your chest and cause


Not all side effects of surgery are listed here. Please

ask your treatment team for a complete list of

common and rare side effects. If a side effect bothers

you, tell your treatment team. There may be ways to

help you feel better.