Staging (clinical and pathologic)

Author: Elliot Weisenberg, M.D. (see Authors page)

Revised: 19 December 2016, last major update July 2012

Copyright: (c) 2003-2016,, Inc.

PubMed Search: staging stomach
Cite this page: Staging (clinical and pathologic). website. Accessed July 23rd, 2018.
Definition / general
  • Only applies to carcinomas
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

  • Notes:
    • A 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 liagments or the omentum, the tumor should be classified T4
    • The adjacent structures of the stomach include the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine and retroperitoneum
    • Intramural extension to the duodenum or esophagus is classified by the depth of the greatest invasion in any of these sites, including the stomach
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 7+ regional lymph nodes
  • N3a: Metastasis in 7 - 15 regional lymph nodes
  • N3b: Metastasis in 16+ regional lymph nodes

  • Note: pN0 means all examined lymph nodes are negative, regardless of the total number removed / examined
Distant metastasis (M)
  • M0: No distant metastasis
  • M1: Distant metastasis
Anatomic stage / prognostic groups
  • Stage 0: Tis N0 M0
  • Stage IA: T1 N0 M0
  • Stage IB: T2 N0 M0 or T1 N1 M0
  • Stage IIA: T3 N0 M0 or T2 N1 M0 or T1 N2 M0
  • Stage IIB: T4a N0 M0 or T3 N1 M0 or T2 N2 M0 or T1 N3 M0
  • Stage IIIA: T4a N1 M0 or T3 N2 M0 or T2 N3 M0
  • Stage IIIB: T4b N0-1 M0 or T4a N2 M0 or T3 N3 M0
  • Stage IIIC: T4b N2-3 M0 or T4a N3 M0
  • Stage IV: Any T any N M1