Gastric Cancer Staging 

Updated: Feb 27, 2018
  • Author: Shamudheen Rafiyath, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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TNM Classification for Gastric Cancer

The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classification and staging systems for gastric cancer are provided below. [1] Post-neoadjuvant treatment staging classifications and overall survival data are also provided. [2]

Table 1. TNM classification for gastric cancer (Open Table in a new window)

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

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 seven or more regional lymph nodes

N3a

Metastasis in 7-15 regional lymph nodes

N3b

Metastasis in 16 or more regional lymph nodes

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

Table 2. Clinical stage/prognostic groups (cTNM) (Open Table in a new window)

Stage

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

T2 N0 M0
IIA T1 N1, N2, N3 M0
T2 N1, N2, N3

IIB

T3

N0

M0

T4a

N0

M0

III T3 N1, N2, N3 M0
T4a N1, N2, N3 M0

IVA

Any T

Any N

M0

IVB Any T Any N M1

 

Table 3. Pathological stage (pTNM) (Open Table in a new window)

Stage  T N M
 0 Tis N0 M0
 IA T1 N0 M0
IB T1 N1 M0
T2 N0 M0
 II A T1 N2 M0
T2 N1 M0
T3 N0 M0
II B T1 N3 M0
T2 N2 M0
T3 N1 M0
T4a N0
M0
III A T2 N3a M0
T3 N2, N1 M0
T4a N2 M0
T4b N0 M0
III B T1, T2 N3b M0
T3 N3a M0
T4b N1, N2 M0
III C T3, T4a N3b M0
T4b N3a, N3b M0
IV Any T Any N

M1

 

 

 

Table.4 Post-neoadjuvant therapy staging and overall survival (ypTNM) (Open Table in a new window)

Stage T N M

3-year survival (%)

5-year survival (%)
I T1, T2 N0 M0 81.4 76.5
T1 N1 M0
II T1 N2, N3 M0 54.8 46.3
T2 N1, N2 M0
T3 N0, N1 M0
T4a N0 M0
III T2 N3 M0 28.8 18.3
T3 N2, N3 M0
T4a N1, N2, N3 M0
T4b N0,N1,N2,N3 M0
IV Any T Any N M1 10.2 5.7