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Staging (clinical and pathologic)

Reviewer: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 13 October 2012, last major update July 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● 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

● 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

Anatomic stage / prognostic groups

References: AJCC Cancer Staging Manual (7th ed), PDF for stomach, Form for staging T, Form for staging NM, Form for prognostic groups

End of Stomach > Miscellaneous > Staging (clinical and pathologic)

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