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Understand Stomach Cancer Staging: TNM Classification


Stomach cancer staging helps to determine the disease prognosis, and to select an appropriate treatment strategy.

TNM is the most commonly used staging system for breast cancer. “T” stands for “Tumor Size”, “N” for “Lymph Nodes”, and “M” for “Metastasis”. Numbers and/or letters after T (is, 1a, 1b, 2, and 3), N (0, 1, 2, and 3), and M (0 and 1) provide more details about each of these factors. Higher the number means higher the severity of the disease.

Once T, N, and M categories are determined, this information is combined to assign an overall stage (from 0 to IV).

t staging stomach cancer infographic
Stomach Cancer - T Staging
N and M staging of stomach cancer
Stomach Cancer - N and M Staging

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Before discussing the staging, we will understand the NORMAL ANATOMY OF STOMACH.

Following table describes the characteristics of gastric cancer according to different stages:

STAGE TNM DESCRIPTION
0 Tis N0 M0 Pre-cancerous or cancer cells present only in the epithelium of gastric mucosa
IA T1 N0 M0 Tumor invades mucosa or submucosa.
IB T2 N0 M0 Tumor invades the muscular layer (muscularis propria)
OR
T1 N1 M0 Tumor invades mucosa or submucosa; and has spread to 1 or 2 nearby lymph nodes
IIA T3 N0 M0 Tumor invades in the subserosal connective tissue layer
OR
T2 N1 M0 Tumor invades the muscular layer (muscularis propria); and has spread to 1 or 2 nearby lymph nodes
OR
T1 N2 M0 Tumor invades mucosa or submucosa; and has spread to 3 to 6 nearby lymph nodes
IIB T3 N1 M0 Tumor invades in the subserosal connective tissue layer and has spread to 1 or 2 nearby lymph nodes
OR
T2 N2 M0 Tumor invades the muscular layer (muscularis propria); and has spread to 3 to 6 nearby lymph nodes
OR
T1 N3a M0 Tumor invades mucosa or submucosa; and has spread to 7 to 15 nearby lymph nodes
OR
T4a N0 M0 Tumor invades the outermost serosa layer without affecting any nearby lymph node
IIIA T4b N0 M0 Tumor invades adjacent structure/organs without affecting any nearby lymph node
OR
T4a N1/2 M0 Tumor invades up to the outermost serosa layer and has spread to 1 to 6 nearby lymph nodes
OR
T3 N2 M0 Tumor invades in the subserosal connective tissue layer and has spread to 3 to 6 nearby lymph nodes
OR
T2 N3a M0 Tumor invades the muscular layer (muscularis propria); and has spread to 7 to 15 nearby lymph nodes
IIIB T4b N1-2 M0 Tumor invades adjacent structure/organs and has affected </=6 nearby lymph nodes
OR
T3-4a N3a M0 Tumor has invaded into subserosal connective tissue or serosa, and has spread to 7 to 15 nearby lymph nodes
OR
T1-2 N3b M0 Tumor has invaded up to the muscular layer (muscularis propria) and has spread to >/=16 nearby lymph nodes
IIIC T4b N3a-3b M0 Tumor invades adjacent structure/organs and has affected >/=7 lymph nodes
OR
T3-4a N3b M0 Tumor has invaded into subserosal connective tissue or serosa and has spread to >/=16 nearby lymph nodes
IV Any T Any N M1 Tumor has spread to the distant organs such as lungs, bones, brain, etc

Watch the video below where Cancerbro explains the TNM STAGING OF STOMACH CANCER.

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