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56

57

NCCN Guidelines for Patients

®

Stomach Cancer, Version 1.2016

NCCN Guidelines for Patients

®

Stomach Cancer, Version 1.2016

5

Treatment guide

Locoregional cancer

Guide 7. Next treatment after surgery only

Surgical results

Pathologic stage

What are my options?

No cancer is in the surgical margin

T1b, N0, M0

• Start follow-up care

T2, N0, M0

• Start follow-up care, or

• Chemoradiation if cancer is likely to return

T1, N1–N3, M0

T2, N1–N3, M0

T3, Any N, M0

T4, Any N, M0

• Chemoradiation, or

• Chemotherapy if D2 lymph nodes removed

Cancer is in the surgical margin Any

• Chemoradiation

Some cancer remains in or near

your stomach

Any

• Chemoradiation, or

• Supportive care

Cancer is found in distant sites

Any

• Supportive care

5

Treatment guide

Locoregional cancer

Guide 7

lists options for the next treatment after

initial treatment with surgery only. The results of

surgery are used to decide if more treatment is

needed. Surgery results include, 1) no cancer is in the

surgical margin; 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).

When the surgical margin is cancer-free, options are

also based on the pathologic stage. That's the cancer

stage after surgery. No more treatment is needed if

the cancer is rated T1b, N0, M0 or T2, N0, M0. The

next step is to start follow-up care. Chemoradiation

is only advised for T2 tumors if the chances of the

cancer returning are high. The cancer is more likely to

return if:

• The cancer cells don’t look much like normal

cells,

• Cancer has spread to lymph vessels or

nerves,

• You are younger than 50 years of age, or

• D2 lymph nodes weren’t removed.

Even when the margin is cancer-free, cancers that

should receive more treatment include those rated

1) T1 or T2 with cancer in lymph nodes or 2) T3 or

T4 with or without cancer in lymph nodes. For these

cancers, chemoradiation is one option. Chemotherapy

with infusional 5-FU or capecitabine before and after

fluoropyrimidine-based chemoradiation is advised.

A second option for people who had D2 lymph nodes

removed is chemotherapy without radiation. D2 lymph

nodes include those next to nearby arteries and the

spleen. In this case, capecitabine with oxaliplatin or

cisplatin is advised.

If cancer is found in the surgical margin,

chemoradiation 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 next

section,

Metastatic cancer

.