Stomach cancer staging

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2] Mohammed Abdelwahed M.D [3]

Overview

According to the American Joint Committee on Cancer, there are 4 stages of stomach cancer based on the tumor spread

There are two major classification systems currently in use for gastric cancer; the Japanese classification. The other and more widely used staging system is the American Joint Committee on Cancer has designated staging by TNM classification to define gastric cancer:^[1]

**Stomach cancer TNM staging**
Stage	Description
TX	Primary tumor cannot be assessed
Tis	Carcinoma in situ: intraepithelial tumor without invasion of the lamina propria
T0	No evidence of primary tumor
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
T3	Tumor penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures
T4	T4: Tumor invades serosa (visceral peritoneum) or adjacent structures T4a: Tumor invades serosa (visceral peritoneum) T4b: Tumor invades adjacent structures

**Regional Lymph Nodes (N)**
Stage	Description
NX	Regional lymph node cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in 1-2 regional lymph nodes
N2	Metastasis in 3-6 regional lymph nodes
N3	Metastasis in seven or more regional lymph nodes N3a: Metastasis in 7-15 regional lymph nodes N3b: Metastasis in 16 or more regional lymph nodes

**Distant Metastasis (M)**
Stage	Description
M0	No distant metastasis
M1	Distant metastasis

**Anatomic Stage/Prognostic Groups**
Stage		T	N	M
Stage 0		Tis	N0	M0
I	Stage IA	T1	N0	M0
	Stage IB	T2	N0	M0
	Stage IB	T1	N1	M0
II	Stage IIA	T3	N0	M0
		T2	N1	M0
		T1	N2	M0
	Stage IIB	T4a	N0	M0
		T3	N1	M0
		T2	N2	M0
III	Stage IIIA	T1	N1	M0
	Stage IIIB	T4b	N0	M0
		T4b	N1	M0
		T4a	N2	M0
		T3	N3	M0
	Stage IIIC	T4b	N2	M0
		T4b	N3	M0
		T4a	N3	M0
IV		Any T	Any N	M1