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Table 1. Primary Tumor (T)a

TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisCarcinoma in situ: intraepithelial tumor without invasion of the lamina propria.
T1Tumor invades lamina propria, muscularis mucosae, or submucosa.
T1aTumor invades lamina propria or muscularis mucosae.
T1bTumor invades submucosa.
T2Tumor invades muscularis propria.b
T3Tumor penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures.c,d
T4Tumor invades serosa (visceral peritoneum) or adjacent structures.c,d
T4aTumor invades serosa (visceral peritoneum).
T4bTumor invades adjacent structures.

aReprinted with permission from AJCC: Stomach. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 117-26.
bA tumor may penetrate the muscularis propria with extension into the gastrocolic or gastrohepatic ligaments, or into the greater or lesser omentum, without perforation of the visceral peritoneum covering these structures. In this case, the tumor is classified T3. If there is perforation of the visceral peritoneum covering the gastric ligaments or the omentum, the tumor should be classified T4.
cThe adjacent structures of the stomach include the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum.
dIntramural extension to the duodenum or esophagus is classified by the depth of the greatest invasion in any of these sites, including the stomach.