Stomach cancer staging

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]

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Staging

The American Joint Committee on Cancer has designated staging by TNM classification to define gastric cancer Definitions of TNM

Primary tumor

• TX: Primary tumor cannot be assessed.

• T0: No evidence of primary tumor.

• Tis: Carcinoma in situ: intraepithelial tumor without invasion of the lamina propria.

• T1: Tumor invades lamina propria, muscularis mucosae, or submucosa.

• T1a: Tumor invades lamina propria or muscularis mucosae.

• T1b: Tumor invades submucosa.

• T2: Tumor invades muscularis propria

• T3: Tumor penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures

• T4: Tumor invades serosa (visceral peritoneum) or adjacent structures

• T4a: Tumor invades serosa (visceral peritoneum)

• T4b: Tumor invades adjacent structures.

Regional Lymph Nodes

• NX: Regional lymph node(s) cannot be assessed

• N0: No regional lymph node metastasis

• N1: Metastases in 1–2 regional lymph nodes.

• N2: Metastases in 3–6 regional lymph nodes.

• N3: Metastases in ≥7 regional lymph nodes.

• N3a: Metastases in 7–15 regional lymph nodes.

• N3b: Metastases in ≥16 regional lymph nodes.

Distant Metastasis

• M0: No distant metastasis.

• M1: Distant metastasis.

AJCC Stage Groupings

Stage 0

• Tis, N0, M0

Stage IA

• T1, N0, M0

Stage IB

• T2, N0, M0

• T1, N1, M0

Stage IIA

• T3, N0, M0

• T2, N1, M0

• T1, N2, M0

Stage IIB

• T4a, N0, M0

• T3, N1, M0

• T2, N2, M0

• T1, N3, M0

Stage IIIA

• T4a, N1, M0

• T3, N2, M0

• T2, N3, M0

Stage IIIB

• T4b, N0, M0

• T4b, N1, M0

• T4a, N2, M0

• T3, N3, M0

Stage IIIC

• T4b, N2, M0

• T4b, N3, M0

• T4a, N3, M0

Stage IV

• Any T, Any N, M1