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Staging of stomach cancer

The TNM classification system is used for staging stomach cancer. TNM assesses the tumor (T), lymph nodes (N), and metastases (M) at the time of diagnosis. To assess the grade of lymph node spreading, at least 15 lymph nodes must be examined microscopically. 

Primary Tumor (T)

  • Tis  Carcinoma in situ: intraepithelial tumor without infiltration of the lamina propria
  • T1   Tumor invades lamina propria or submucosa
  • T2   Tumor invades muscularis propria or subserosa
  • T3   Tumor penetrates serosa (viscerale peritoneum), without invasion of adjacent organs/structures 
  • T4   Tumor invades adjacent organs/structures

 

Regional Lymph Nodes (N)

  • NX   Regional lymph nodes cannot be assessed
  • N0   No regional lymph node metastases
  • N1   Metastases in 1–6 regional lymph nodes 
  • N2   Metastases in 7–15 regional lymph nodes
  • N3   Metastases to at least 16 regional lymph nodes

 
The perigastric nodes along the minor curvature (1) and major curvature (2).
 
Lymph nodes along the left gastric artery (1), common hepatic artery (2), lienalis artery (3) celiac trunk (4) and the hepatoduodenal lymph nodes (5).

Distant Metastasis (M)

  • MX   Distant metastases cannot be assessed
  • M0   No disant metastases 
  • M1   Distant metastases 
Stage Division TNM
Stage T N M
0/IA Tis, T1 N0 M0
IA/IB T1 N0, N1 M0
II

 T1, T2, T3

 N2, N1, N0

M0

IIIA

T2, T3, T4

N2, N1, N0

M0

IIIB T3 N2 M0
IV

T1, T2, T3, T4

N0, N1

M1

 (1)

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