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Gastric Cancer Treatment (PDQ®)

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Stage Information for Gastric Cancer

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
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.
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.b
T3 Tumor penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures.c,d
T4 Tumor invades serosa (visceral peritoneum) or adjacent structures.c,d
T4a Tumor invades serosa (visceral peritoneum).
T4b Tumor invades adjacent structures.
Table 2. Regional Lymph Nodes (N)a
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.
NX Regional lymph node(s) cannot be assessed.
N0 No regional lymph node metastasis.b
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.
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.
M0 No distant metastasis.
M1 Distant 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.
0 Tis N0 M0
IA T1 N0 M0
IB T2 N0 M0
T1 N1 M0
IIA T3 N0 M0
T2 N1 M0
T1 N2 M0
IIB T4a N0 M0
T3 N1 M0
T2 N2 M0
T1 N3 M0
IIIA T4a N1 M0
T3 N2 M0
T2 N3 M0
IIIB T4b N0 M0
T4b N1 M0
T4a N2 M0
T3 N3 M0
IIIC T4b N2 M0
T4b N3 M0
T4a N3 M0
IV Any T Any N M1

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]
  • Updated: April 23, 2015