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Cancer Staging Systems

Staging of Stomach Cancer

TNM definition

Primary tumor (T)

• 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 or submucosa
• T2: Tumor invades the muscularis propria or the subserosa
  • T2a: Tumor invades muscularis propria
  • T2b: Tumor invades subserosa
• T3: Tumor penetrates the serosa (visceral peritoneum) without invading adjacent structures
• T4: Tumor invades adjacent structures

Regional lymph nodes (N)

• NX: Regional lymph node(s) cannot be assessed
• N0: No regional lymph node metastasis
• N1: Metastasis in 1 to 6 regional lymph nodes
• N2: Metastasis in 7 to 15 regional lymph nodes
• N3: Metastasis in more than 15 regional lymph nodes

Distant metastasis (M)

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis

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Stage grouping

Stage 0

• Tis, N0, M0

Stage IA

• T1, N0, M0

Stage IB

• T1, N1, M0
• T2a, N0, M0
• T2b, N0, M0

Stage II

• T1, N2, M0
• T2a, N1, M0
• T2b, N1, M0
• T3, N0, M0

Stage IIIA

• T2a, N2, M0
• T2b, N2, M0
• T3, N1, M0
• T4, N0, M0

Stage IIIB

• T3, N2, M0

Stage IV

• T4, N1, M0
• T4, N2, M0
• T4, N3, M0
• T1, N3, M0
• T2, N3, M0
• T3, N3, M0
• Any T, any N, M1

References

1. Stomach. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 99-106.

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