NCCN Guidelines for Patients
Stomach Cancer, Version 1.2016
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
• 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:
• Paclitaxel and carboplatin,
• Cisplatin and 5-FU (or capecitabine),
• Oxaliplatin and 5-FU (or capecitabine), and
• 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
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,