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In April 2008, I was 40 years old, the mother of three children, a practicing attorney, and married to a

physician. Life changed dramatically when I was diagnosed with stage IV, inoperable and incurable

stomach cancer; was told I would need chemotherapy for the rest of my life; and my chance of being

alive in five years was only four percent. There were very few treatment options for advanced stomach

cancer because it is not a common cancer in the United States.

I began to educate myself and to seek the best available care. I was told that I only had a few weeks

to live, so my first thought was that my three-year-old daughter would not remember me, and my

10-year-old twins would go through their teenage years without a mother. I could not imagine missing

out on my children’s lives. I was determined to live to celebrate milestones with them that every mom

waits for. The possibility of not seeing them grow up was not an option.

I have had eight recurrences and remain in treatment to this day. I have been treated with several

different chemotherapy regimens and three rounds of radiation.

I currently live in Florida with my husband and children. My family has helped me to get through a very

difficult time in life. Now, being with my children and husband is my main priority and every birthday,

talent show, soccer game, karate tournament, and recital I can attend is a blessing. There were no

resources available to me when I was diagnosed, so I am very happy that this guide is available to you

as a resource to help you on your journey.

Debbie Zelman

Stage IV Cancer Survivor

Founder, Debbie's Dream Foundation:

Curing Stomach Cancer



NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016

NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016


Overview of cancer treatments Radiation therapy


Overview of cancer treatments Radiation therapy

are added to the radiation machine. Radiation beams

are aimed at the tumor with help from ink marks on

the skin or marker seeds in the tumor.

Receiving radiation

Do not eat a heavy meal 3 hours before treatment.

During treatment, you will lie on a table in the same

position as done for simulation. Devices may be used

to keep you from moving so that the radiation targets

the tumor.

You will be alone while the technician operates the

machine from a nearby room. He or she will be able

to see, hear, and speak with you at all times. As

treatment is given, you may hear noises. One session

can take less than 10 minutes.

There are multiple types of EBRT. For stomach

cancer, 3D-CRT (










herapy) is strongly advised. In 3D-CRT, the

radiation beams match the shape of your tumor to

avoid healthy tissues.

Sometimes vital organs may be within the field of

the radiation beam if 3D-CRT is used. Vital organs

include the heart, lungs, liver, and kidneys. In these

cases, IMRT (









may be used. IMRT is a more precise type of 3D-CRT

that may be used to avoid giving radiation to vital

organs. The radiation beam is divided into smaller

beams, and the strength of each beam can vary.

Side effects of radiation

Radiation therapy is likely to cause changes in your

skin. Skin that was exposed to radiation will look and

feel as if it has been sunburned. It will likely become

red and may also become dry, sore, and feel painful

when touched.

Radiation therapy to a stomach tumor may also cause

GI symptoms. You may feel nauseated, vomit, and

have diarrhea. You may have pain in the area. Other

reactions may include extreme tiredness despite

sleep (fatigue) and loss of appetite.

Not all side effects of radiation therapy 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.