Gastric Cancer Staging
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The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classification and staging systems for gastric cancer are provided below. [1] Post-neoadjuvant treatment staging classifications and overall survival data are also provided. [2]
Table 1. TNM classification for gastric cancer (Open Table in a new window)
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, 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
Tumor invades serosa (visceral peritoneum) or adjacent structures
T4a
Tumor invades serosa (visceral peritoneum)
T4b
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 1-2 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)
M0
No distant metastasis
M1
Distant metastasis
Table 2. Clinical stage/prognostic groups (cTNM) (Open Table in a new window)
Stage
T
N
M
0
Tis
N0
M0
I
T1
N0
M0
IIB
T3
M0
T4a
N0
M0
IVA
Any T
Any N
M0
Table 3. Pathological stage (pTNM) (Open Table in a new window)
M1
Table.4 Post-neoadjuvant therapy staging and overall survival (ypTNM) (Open Table in a new window)
3-year survival (%)
American Joint Committee on Cancer. Digestive System. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, et al, eds. AJCC Cancer Staging Manual. 8th edition. New York, NY: Springer; 2016.
In, H., Ravetch, E., Langdon-Embry, M. et al. The newly proposed clinical and post-neoadjuvant treatment staging classifications for gastric adenocarcinoma for the American Joint Committee on Cancer (AJCC) staging. Gastric Cancer. 2018, January. 21:1-9. [Medline]. [Full Text].
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, 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
Tumor invades serosa (visceral peritoneum) or adjacent structures
T4a
Tumor invades serosa (visceral peritoneum)
T4b
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 1-2 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)
M0
No distant metastasis
M1
Distant metastasis
Stage
T
N
M
0
Tis
N0
M0
I
T1
N0
M0
IIB
T3
M0
T4a
N0
M0
IVA
Any T
Any N
M0
M1
3-year survival (%)
Shamudheen Rafiyath, MD Hematologist/Oncologist, Arizona Oncology
Shamudheen Rafiyath, MD is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital; Medical Director, Deaconess Hospital Outpatient Infusion Centers; Chairman, Deaconess Hospital Cancer Committee
Christopher D Braden, DO is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology
Disclosure: Nothing to disclose.
N Joseph Espat, MD, MS, FACS Harold J Wanebo Professor of Surgery, Assistant Dean of Clinical Affairs, Boston University School of Medicine; Chairman, Department of Surgery, Director, Adele R Decof Cancer Center, Roger Williams Medical Center
N Joseph Espat, MD, MS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Clinical Oncology, Americas Hepato-Pancreato-Biliary Association, Association for Academic Surgery, Central Surgical Association, Chicago Medical Society, International Hepato-Pancreato-Biliary Association, Pancreas Club, Sigma Xi, Society for Leukocyte Biology, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Surgical Oncology, Society of University Surgeons, Southeastern Surgical Congress, Southern Medical Association, Surgical Infection Society
Disclosure: Nothing to disclose.
Terence D Rhodes, MD, PhD Medical Oncologist, Intermountain Medical Group
Terence D Rhodes, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society of Clinical Oncology
Disclosure: Nothing to disclose.
Gastric Cancer Staging
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