Now, after discussing the different layers of the stomach wall, let’s discuss the T-staging of the stomach cancer.
First is the Tis of carcinoma in situ. This is not considered as malignant and is localized to the epithelium.
Infiltration of lamina propria or muscularis mucosa is called as T1a disease.
Infiltration into the submucosa is called as T1b. Muscularis propria infiltration is called as T2.
Infiltration of subserosa is called as T3. And infiltration of the tumor into the serosa is called as T4a disease.
When the tumor extends through the stomach walls to involve the adjacent structures it is called as T4b.
In this figure, the tumor extends to involve the colon. And here it infiltrates the pancreas. And here the tumor infiltrates into the spleen. And here it invades the kidney. It may also infiltrate into the liver or the diaphragm.
This finishes the stomach cancer staging T, now next comes the N staging or the nodal staging.
The regional nodes which drain the stomach are different in different part of the stomach.
These nodes drain the lesser curvature of the stomach. And these drain the upper part of the greater curvature of the stomach. And these the lower part.
These nodes drain the pyloric antrum. All the nodes draining the different part of the stomach, ultimately drain into these nodes which are called the coeliac nodes.
M staging refers to the distance spread of the tumor to different parts of the body.
DistanT metastasis may be seen to the liver. The peritoneum in form of multiple peritoneal deposits.
To the lungs in form of multiple nodular deposits. Rarely, it may spread to the left supraclavicular lymph node which presents as nodular deposits in the left side of the neck.
Or a nodular deposit in the periumbilical region called as sister Mary Joseph Nodule.
It may also present as pelvic deposits in the rectovesical pouch or pouch of Douglas.
Or as nodular deposits in one or both the ovaries, called as Krukenberg’s tumor. Very rarely, it may also spread to brain or bones.
This finishes the TNM for stomach cancer staging.
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