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Gastrointestinal Stromal Tumors Treatment (PDQ®)

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Last Modified: 08/26/2014

Stage Information for Gastrointestinal Stromal Tumors

Definitions of TNM (for GIST at All Sites)

A formal staging system for gastrointestinal stromal tumors (GIST) appeared for the first time in the 7th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual.[1] Because of the limited availability of mutation testing, mutation status is not included in the AJCC system. In addition, since nodal involvement is so rare, and nodal dissection is not indicated, the designation N0/pN0 should be used in the absence of information about the regional nodes. Note that treatment decisions may not be based strictly on the stage of disease.[2-4]

Definitions of TNM (for GIST at All Sites)

This staging system for GIST is new for the 7th edition of the AJCC Cancer Staging Manual.[1]

Table 2. Primary Tumor (T)a
aReprinted with permission from AJCC: Gastrointestinal stromal tumor. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 181-9.
TXPrimary tumor cannot be assessed.
T0No evidence for primary tumor.
T1Tumor ≤2 cm.
T2Tumor >2 cm but not >5 cm.
T3Tumor >5 cm but not >10 cm.
T4Tumor >10 cm in greatest dimension.

Table 3. Regional Lymph Nodes (N)a
aReprinted with permission from AJCC: Gastrointestinal stromal tumor. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 181-9.
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Regional lymph node metastasis.

Table 4. Distant Metastasis (M)a
aReprinted with permission from AJCC: Gastrointestinal stromal tumor. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 181-9.
M0No distant metastasis.
M1Distant metastasis.

Table 5. Anatomic Stage/Prognostic Groupsa
Gastric GIST b
Group T N M Mitotic Rate
Stage IAT1 or T2N0M0Low
Stage IBT3N0M0Low
Stage IIT1N0M0High
T2N0M0High
T4N0M0Low
Stage IIIAT3N0M0High
Stage IIIBT4N0M0High
Stage IVAny TN1M0Any rate
Any TAny NM1Any rate
Small Intestinal GIST c
Group T N M Mitotic rate
Stage IT1 or T2N0M0Low
Stage IIT3N0M0Low
Stage IIIAT1N0M0High
T4N0M0Low
Stage IIIBT2N0M0High
T3N0M0High
T4N0M0High
Stage IVAny TN1M0Any rate
Any TAny NM1Any rate

gist = gastrointestinal stromal tumors.
aReprinted with permission from AJCC: Gastrointestinal stromal tumor. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 181-9.
bAlso to be used for omentum.
cAlso to be used for esophagus, colorectal, mesentery, and peritoneum.

References
  1. Gastrointestinal stromal tumor. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 175-80. 

  2. Demetri GD: Gastrointestinal stromal tumor. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1060-73. 

  3. Demetri GD, Benjamin RS, Blanke CD, et al.: NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)--update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw 5 (Suppl 2): S1-29; quiz S30, 2007.  [PUBMED Abstract]

  4. Casali PG, Jost L, Reichardt P, et al.: Gastrointestinal stromal tumors: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 19 (Suppl 2): ii35-8, 2008.  [PUBMED Abstract]