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Gastric Cancer Treatment (PDQ®)

  • Last Modified: 02/27/2014

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Stage Information for Gastric Cancer

Definitions of TNM



Definitions of TNM

The American Joint Committee on Cancer has designated staging by TNM classification to define gastric cancer.[1-3]

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.

Table 2. Regional Lymph Nodes (N)a
NXRegional lymph node(s) cannot be assessed.
N0No regional lymph node metastasis.b
N1Metastases in 1–2 regional lymph nodes.
N2Metastases in 3–6 regional lymph nodes.
N3Metastases in ≥7 regional lymph nodes.
N3aMetastases in 7–15 regional lymph nodes.
N3bMetastases in ≥16 regional lymph nodes.

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 designation of pN0 should be used if all examined lymph nodes are negative, regardless of the total number removed and examined.

Table 3. Distant Metastasisa
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.
M0No distant metastasis.
M1Distant metastasis.

Table 4. Anatomic Stage/Prognostic Groupsa
Stage T N M 
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.
0TisN0M0
IAT1N0M0
IBT2N0M0
T1N1M0
IIAT3N0M0
T2N1M0
T1N2M0
IIBT4aN0M0
T3N1M0
T2N2M0
T1N3M0
IIIAT4aN1M0
T3N2M0
T2N3M0
IIIBT4bN0M0
T4bN1M0
T4aN2M0
T3N3M0
IIICT4bN2M0
T4bN3M0
T4aN3M0
IVAny TAny NM1

References
  1. Stomach. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, p 120. 

  2. Roder JD, Böttcher K, Busch R, et al.: Classification of regional lymph node metastasis from gastric carcinoma. German Gastric Cancer Study Group. Cancer 82 (4): 621-31, 1998.  [PUBMED Abstract]

  3. Ichikura T, Tomimatsu S, Uefuji K, et al.: Evaluation of the New American Joint Committee on Cancer/International Union against cancer classification of lymph node metastasis from gastric carcinoma in comparison with the Japanese classification. Cancer 86 (4): 553-8, 1999.  [PUBMED Abstract]