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Glossary


Stages of stomach cancer

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. The most common staging system for stomach cancer is the TNM system. The International Union Against Cancer (UICC) uses the TNM system to describe the extent of many solid tumour cancers

 

The staging system described below is for adenocarcinoma tumours, the most common type of stomach cancer.

TNM

TNM stands for tumour, nodes, metastasis. TNM staging describes:

  • the size of the primary tumour
  • the number and location of any regional lymph nodes that have cancer cells in them
  • whether the cancer has spread or metastasized to another part of the body

 

Primary tumour (T)

TX

Primary tumour cannot be assessed.

T0

No evidence of primary tumour.

Tis

Carcinoma in situ – The tumour is only in the inside lining of the stomach (mucosa). Also called high-grade gastric epithelial dysplasia.

T1

The tumour has grown into the mucosa, the muscle layer of the mucosa (muscularis mucosae) or the submucosa.

T1a – The tumour has invaded the mucosa or muscularis mucosae.

T1b – The tumour has invaded the submucosa.

T2

The tumour has grown into the main muscle of the stomach (muscularis propria).

T3

The tumour has invaded the tissues just below the covering of the stomach (subserosa).

or

A tumour that has grown into the ligaments of the stomach or into the omentum without growing into the peritoneum.

T4

The tumour has grown through the covering of the stomach (serosa) or invades organs near the stomach.

T4a – The tumour has grown through the serosa.

T4b – The tumour has spread to any organ near the stomach, including the spleen, colon, liver, diaphragm, pancreas, kidney, adrenal gland, small intestine, abdominal wall, area behind the peritoneum (retroperitoneum) or esophagus.

Note: Tumours that are centred within 5 cm of the area where the stomach and the esophagus join (gastroesophageal junction or GE junction) are classified and staged as tumours of the esophagus. Tumours that are more than 5 cm from the GE junction or that grow up from the stomach into the esophagus are classified and staged as stomach (gastric) tumours.

 

Regional lymph nodes (N)

NX

Regional lymph nodes 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 or more regional lymph nodes.

N3a – Metastasis in 7–15 regional lymph nodes.

N3b – Metastasis in 16 or more regional lymph nodes.

Note: Sixteen or more lymph nodes are usually removed for staging. If a pathologist examines fewer than 16 lymph nodes, and they are negative, they are classified as pN0.

 

Distant metastasis (M)

M0

No distant metastasis.

M1

Distant metastasis.

Note: Distant metastasis includes tumours that have grown into the peritoneum or a tumour in the omentum that is not part of the original tumour or cancer cells found in the fluid in the abdomen.

Stage grouping for stomach cancer

The UICC further groups the TNM data into the stages listed in the table below.

 

UICC staging – stomach cancer

UICC stage

TNM

Explanation

stage 0

Tis

N0

M0

Carcinoma in situ – The tumour is only in the mucosa.

 

The cancer has not spread to the lymph nodes or to distant parts of the body.

stage IA

T1

N0

M0

The tumour has grown into the submucosa.

 

The cancer has not spread to the lymph nodes or to distant parts of the body.

stage IB

T2

N0

M0

The tumour has grown into the muscularis propria.

 

The cancer has not spread to the lymph nodes or to distant parts of the body.

T1

N1

M0

The tumour has grown into the mucosa, the muscularis mucosae or the submucosa.

 

The cancer has spread to 1–2 regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

stage IIA

T3

N0

M0

The tumour has grown into the submucosa.

 

The cancer has not spread to the lymph nodes or to distant parts of the body.

T2

N1

M0

The tumour has grown into the muscularis propria.

 

The cancer has spread to 1–2 regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

T1

N2

M0

The tumour has grown into the mucosa, the muscularis mucosae or the submucosa.

 

The cancer has spread to 3–6 regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

stage IIB

T4a

N0

M0

The tumour has grown through the serosa.

 

The cancer has not spread to any lymph nodes or to distant parts of the body.

T3

N1

M0

The tumour has grown into the submucosa.

 

The cancer has spread to 1–2 regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

T2

N2

M0

The tumour has grown into the muscularis propria.

 

The cancer has spread to 3–6 regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

stage IIIA

T4a

N1

M0

The tumour has grown through the serosa.

 

The cancer has spread to 1–2 regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

T3

N2

M0

The tumour has grown into the submucosa.

 

The cancer has spread to 3–6 regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

T2

N3

M0

The tumour has grown into the muscularis propria.

 

The cancer has spread to 7 or more regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

stage IIIB

T4b

N0, N1

M0

The tumour has spread to any organ near the stomach, including the spleen, colon, liver, diaphragm, pancreas, kidney, adrenal gland, small intestine, abdominal wall, area behind the peritoneum (retroperitoneum) or esophagus.

 

The cancer has not spread to the lymph nodes, or it has spread to 1–2 regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

T4a

N2

M0

The tumour has grown through the serosa.

 

The cancer has spread to 3–6 regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

T3

N3

M0

The tumour has grown into the submucosa.

 

The cancer has spread to 7 or more regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

stage IIIC

T4a

N3

M0

The tumour has grown through the serosa.

 

The cancer has spread to 7 or more regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

T4b

N2, N3

M0

The tumour has spread to any organ near the stomach, including the spleen, colon, liver, diaphragm, pancreas, kidney, adrenal gland, small intestine, abdominal wall, area behind the peritoneum (retroperitoneum) or esophagus.

 

The cancer has spread to 3–6 regional lymph nodes, or more than 7 regional lymph nodes.

 

The cancer has not spread to distant parts of the body.

stage IV

The cancer has spread to distant parts of the body.

Recurrent stomach cancer

Recurrent stomach cancer means that the cancer has come back after it has been treated. It may recur in the same location as the original cancer or it may recur in another part of the body (metastatic stomach cancer).

 

Gastroesophageal junction tumours

The UICC or the AJCC classification systems may be used to classify adenocarcinoma tumours that develop within 5 cm of the area where the stomach and the esophagus join (gastroesophageal or GE junction). The Siewart classification system is rarely used in Canada for GE junction tumours.

References

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