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NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016

NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016



Treatment guide

Locoregional cancer

Guide 6. Initial treatment

Surgery status

Clinical stage

What are my options?

You are approved and agree to surgery

T1a, N1–N3, M0

T1b, Any N, M0 • Surgery

T2, Any N, M0

T3, Any N, M0

T4, Any N, M0

• Surgery,

• Chemotherapy before and after surgery, or

• Chemoradiation before surgery

You may be approved for surgery


• Chemoradiation ± surgery, or

• Chemotherapy ± surgery

You are not approved or decline surgery Any

• Chemoradiation, or

• Supportive care


Treatment guide

Locoregional cancer

Guide 6

lists options for initial treatment of

locoregional cancer. These cancers have grown

beyond the first layer of the stomach wall (mucosa).

There may be cancer in nearby Iymph nodes but

not in distant sites. A list of clinical stages that are

locoregional cancers is included in Guide 6.

Surgery may be a treatment option for these cancers.

Your doctors will assess if you are able to undergo

surgery by testing your lungs, heart, and nutritional

intake. Your doctors will also assess if chemotherapy

or chemoradiation would do more help than harm.

Approved and agree to surgery

If you are approved and agree to surgery, your initial

treatment may be surgery only. However, for most

people, surgery alone is not enough. As such, there

are two more options if the tumor has grown beyond

the second layer of the stomach wall. These tumors

include those scored T2, T3, or T4.

The second option is to receive chemotherapy

before and after surgery. This is called perioperative

chemotherapy. The third option is chemoradiation

before surgery (preoperative) but more research is

needed to know how well it works.

The recommended regimens for perioperative

chemotherapy are:

• 5-FU and cisplatin,

• ECF (epirubicin, cisplatin, and fluorouracil),

• Epirubicin, oxaliplatin, and fluorouracil,

• Epirubicin, cisplatin, and capecitabine, and

• Epirubicin, oxaliplatin, and capecitabine.

The recommended chemotherapy regimens for

preoperative chemoradiation are:

Preferred regimens

• Paclitaxel and carboplatin,

• Cisplatin and 5-FU (or capecitabine),

• Oxaliplatin and 5-FU (or capecitabine), and

Other regimens

• Paclitaxel and 5-FU (or capecitabine).

May be approved for surgery

You may be approved for surgery if the cancer is

widespread around your stomach. Other treatments

may shrink the cancer enough for surgery.

Fluoropyrimidine- or taxane-based chemoradiation

may shrink the cancer. A second option is to shrink

the cancer with only chemotherapy.

The cancer will be re-staged to assess if the cancer

shrunk. Staging should be done with a CT scan, CBC,

and a comprehensive chemistry profile. CT should

be of your chest, abdomen, and pelvis. Contrast will

be injected into your vein and you will be given as a

liquid to drink. You may receive PET/CT if needed.

If the tumor shrunk a lot, you may be approved for

surgery. Another option is to start follow-up care.

If the tumor didn't shrink enough, supportive care is

an option. Supportive care is addressed in the next


Metastatic cancer


Not approved or decline surgery

If you are not approved for or decline surgery,

chemoradiation to try to cure the cancer is an option.

Doctors call this type of chemoradiation “definitive

chemoradiation.” Fluoropyrimidine- or taxane-based

chemotherapy should be used.

A second option is supportive care. Supportive care is

addressed in the next section,

Metastatic cancer


Locoregional cancer