Gastric cancer (TNM staging)

Last revised by Assoc Prof Frank Gaillard on 07 Jun 2022

Gastric cancer staging is routinely performed using the TNM staging system. This article is based on the 8th edition of the TNM classification of malignant tumors. This is technically the clinical TNM staging (cTNM).

cTNM staging (8th edition)

  • 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
    • T1a: tumor invades the lamina propria and or muscularis mucosae 
    • T1b: tumor invades submucosa 
  • T2: tumor invades muscularis propria 
  • T3: tumor penetrates the subserosal connective tissue without invasion of the visceral peritoneum or adjacent structures
  • T4
    • T4a: tumor invades the serosa (visceral peritoneum)
    • T4b: tumor invades adjacent structures
  • Nx: regional lymph node (s) cannot be assessed
  • N0: no regional nodal involvement
  • N1: metastases in 1 to 2 regional lymph nodes
  • N2: metastases in 3 to 6 regional lymph nodes
  • N3
    • N3a: metastases in 7 to 15 regional lymph nodes
    • N3b: metastases in more than 15 regional lymph nodes
  • M0: no distant metastases
  • M1: distant metastases

In this edition, pN3 is divided into pN3a and pN3b, and pT1N3b and pT2N3b are considered stage IIIB. Furthermore, pT3N3b is classified as stage IIIC, pT4bN0 and pT4aN2 are downstaged from stage IIIB into stage IIIA, and pT4aN3a and pT4bN2 from stage IIIC into stage IIIB 3.

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