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Cancer Health Center

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Gastric Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Gastric Cancer

Definitions of TNM

The American Joint Committee on Cancer has designated staging by TNM classification to define gastric cancer.[1,2,3]

Table 1. Primary Tumor (T)a

a Reprinted with permission from AJCC: Stomach. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 117-26.
b A tumor may penetrate the muscularis propria with extension into the gastrocolic or gastrohepatic ligaments, or into the greater or lesser omentum, without perforation of the visceral peritoneum covering these structures. In this case, the tumor is classified T3. If there is perforation of the visceral peritoneum covering the gastric ligaments or the omentum, the tumor should be classified T4.
c The adjacent structures of the stomach include the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum.
d Intramural extension to the duodenum or esophagus is classified by the depth of the greatest invasion in any of these sites, including the stomach.
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.b
T3 Tumor penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures.c,d
T4 Tumor invades serosa (visceral peritoneum) or adjacent structures.c,d
T4a Tumor invades serosa (visceral peritoneum).
T4b Tumor invades adjacent structures.

Table 2. Regional Lymph Nodes (N)a

a Reprinted with permission from AJCC: Stomach. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 117-26.
b A designation of pN0 should be used if all examined lymph nodes are negative, regardless of the total number removed and examined.
NX Regional lymph node(s) cannot be assessed.
N0 No regional lymph node metastasis.b
N1 Metastases in 1-2 regional lymph nodes.
N2 Metastases in 3-6 regional lymph nodes.
N3 Metastases in ≥7 regional lymph nodes.
N3a Metastases in 7-15 regional lymph nodes.
N3b Metastases in ≥16 regional lymph nodes.
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