NCCN Guidelines for Patients
Stomach Cancer, Version 1.2016
lists options for initial treatment of very
early cancers. These cancers have not grown beyond
the first layer of the stomach wall (mucosa).There is
no proof of cancer in nearby lymph nodes or distant
sites. The TMN scores for very early cancers are
Tis, N0, M0 (stage 0) and T1a, N0, M0 (stage IA).
Treatment options are based on whether you are
healthy enough for surgery. Your willingness to have
surgery is also a factor. Your doctors will assess if you
are able to undergo surgery by testing your lungs,
heart, and nutritional intake.
For all very early cancers, options include EMR and
ESD. If you are able to have surgery, gastrectomy
with lymph node dissection is another option. In
centers with experts in ESD, it is preferred over other
options for initial treatment of very early cancer.
After EMR or ESD, test results may suggest a
higher-risk cancer. Higher-risk cancers are more
likely to have spread to the lymph nodes. Signs
of higher risk include cancer cells that look very
different than normal cells (poorly differentiated) and
tumor growth into the second layer of the stomach
wall (submucosa). In this case, you may receive a
gastrectomy with lymph node removal.
lists options for the next treatment after
surgery. The results of surgery are used to decide if
more treatment is needed. Surgery results include,
1) no cancer is in the surgical margin or lymph
nodes; 2) cancer is in the surgical margin; 3) not all
the cancer that the surgeon could see in or near the
stomach was removed, and 4) cancer was found in
distant sites (M1 score).
Your surgeon may have been able to remove all the
cancer and a cancer-free surgical margin. In this
case, no more treatment is needed if the lymph nodes
are cancer-free. The next step is to start follow-up
If cancer is found in the surgical margin,
chemoradiation or another surgery is advised.
Chemoradiation will treat any cancer that may
remain in your body. Likewise, if your surgeon
wasn’t able to remove all the cancer in or near your
stomach, chemoradiation is one of two options. In
these cases, chemotherapy with infusional 5-FU or
capecitabine before and after fluoropyrimidine-based
chemoradiation is advised.
You may receive supportive care. It is a second option
when cancer remains in or near your stomach after
surgery. It is also advised if M1 cancer is found during
surgery. Supportive care is addressed in the section,
Very early cancer