Stomach
Miscellaneous
TNM staging of stomach carcinomas (AJCC 8th edition)

Author: Raul S. Gonzalez, M.D.
Editor-in-Chief Review: Debra Zynger, M.D.

Revised: 2 October 2018, last major update August 2018

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Gastric carcinoma[title] staging [title]
Cite this page: Gonzalez, R.S. TNM staging of stomach carcinomas (AJCC 8th edition). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/stomachstagingcarcinomas.html. Accessed November 12th, 2018.
Pathologic TNM staging of carcinomas of the stomach, AJCC 8th edition
Definition / general
  • Includes gastric carcinoma, gastric neuroendocrine carcinoma, gastroesophageal junction carcinoma with an epicenter more than 2 cm into the stomach, cardia carcinoma
Essential features
ICD-10 coding
  • C16.9: Malignant neoplasm of stomach, unspecified
Primary tumor (pT)
  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Carcinoma in situ: intraepithelial tumor without invasion of the lamina propria; high grade dysplasia
  • T1: Tumor invades the lamina propria, muscularis mucosae or submucosa
    • T1a: Tumor invades the lamina propria or muscularis mucosae
    • T1b: Tumor invades the submucosa
  • T2: Tumor invades the muscularis propria
  • T3: Tumor penetrates the subserosal connective tissue without invasion of the visceral peritoneum or adjacent structures
  • T4: Tumor invades the serosa (visceral peritoneum) or adjacent structures
    • T4a: Tumor invades the serosa (visceral peritoneum)
    • T4b: Tumor invades adjacent structures/organs
Regional lymph nodes (pN)
  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • N1: Metastasis in one or two regional lymph nodes
  • N2: Metastasis in three to six regional lymph nodes
  • N3: Metastasis in seven or more regional lymph nodes
    • N3a: Metastasis in seven to 15 regional lymph nodes
    • N3b: Metastasis in 16 or more regional lymph nodes

Note:
  • Regional lymph nodes include the greater curvature, greater omental, lesser curvature, lesser omental, right and left peracardial (cardioesophageal), suprapyloric, gastroduodenal, infrapyloric, gastroepiploic, left gastric artery, celiac artery, common hepatic artery, hepatoduodenal, portal, splenic artery, and splenic hilum nodes
Distant metastasis (pM)
  • M0: No distant metastasis
  • M1: Distant metastasis
Prefixes
  • y: preoperative radiotherapy or chemotherapy
Stage grouping
Clinical staging
Stage 0: Tis N0 M0
Stage I: T1-2 N0 M0
Stage IIA: T1-2 N1-3 M0
Stage IIB: T3-4a N0 M0
Stage III: T3-4a N1-3 M0
Stage IVA: T4b N1-3 M0
Stage IVB: any T any N M1


Pathologic staging
Stage 0: Tis N0 M0
Stage IA: T1 N0 M0
Stage IB: T1 N1 M0
T2 N0 M0
Stage IIA: T1 N2 M0
T2 N1 M0
T3 N0 M0
Stage IIB: T1 N3a M0
T2 N2 M0
T3 N1 M0
T4a N0 M0
Stage IIIA: T2 N3a M0
T3 N2 M0
T4a N1-2 M0
T4b N0 M0
Stage IIIB: T1-2 N3b M0
T3-4a N3a M0
T4b N1-2 M0
Stage IIIC: T3-4a N3b M0
T4b N3a-3b M0
Stage IV: any T any N M1


Pathologic staging following neoadjuvant therapy
Stage I: T1-2 N0 M0
T1 N1 M0
Stage II: T3-4a N0 M0
T2-3 N1 M0
T1-2 N2 M0
T1 N3 M0
Stage III: T4b N0 M0
T4a-4b N1 M0
T3, 4a, 4b N2 M0
T2, 3, 4a, 4b N3 M0
Stage IV: any T any N M1
Registry data collection variables
  • Tumor location
  • Serum CEA
  • Serum CA 19-9
  • Clinical staging modalities (endoscopy and biopsy, EUS, EUS-FNA, CT, PET/CT)
  • Tumor length
  • Depth of invasion
  • Number of suspicious malignant lymph nodes on baseline radiologic images
  • Number of suspicious malignant lymph nodes by EUS assessment
  • Location of suspicious nodes (clinical)
  • Location of suspicious nodes (pathological)
  • Number of tumor deposits
  • Lymphovascular invasion
  • Neural invasion
  • Extranodal extension
  • HER2 status (positive or negative)
  • Microsatellite instability (MSI) status
  • Surgical margin (negative, microscopic, macroscopic)
  • Sites of metastasis, if applicable
  • Type of surgery
Histologic grade
  • GX: Grade cannot be assessed
  • G1: Well differentiated
  • G2: Moderately differentiated
  • G3: Poorly differentiated
Histopathologic type
  • Intraepithelial neoplasia (dysplasia), high grade
  • Adenocarcinoma, NOS
  • Adenocarcinoma, intestinal type
  • Carcinoma, diffuse type
  • Papillary adenocarcinoma
  • Tubular adenocarcinoma
  • Mucinous adenocarcinoma
  • Parietal cell carcinoma
  • Signet ring cell carcinoma
  • Mixed adenocarcinoma
  • Adenosquamous carcinoma
  • Carcinoma with lymphoid stroma (medullary carcinoma)
  • Hepatoid adenocarcinoma
  • Squamous cell carcinoma, NOS
  • Lymphoepithelial carcinoma
  • Medullary carcinoma, NOS
  • Undifferentiated carcinoma
  • Neuroendocrine carcinoma (NEC)
  • Large cell neuroendocrine carcinoma (NEC)
  • Small cell neuroendocrine carcinoma (NEC)
  • Mixed adenoneuroendocrine carcinoma
Board review question #1
    Based on AJCC 8th edition criteria, a tumor located within the gastric cardia but involving the gastroesophageal junction would be staged as an esophageal carcinoma if its epicenter is no more than what distance from the gastroesophageal junction?

  1. 2 cm
  2. 3 cm
  3. 4 cm
  4. 5 cm
Board review answer #1
A. 2 cm

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