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Staging

Criteria for TNM Clinical Staging
Physical examination and history; pathologic examination of biopsy specimen to establish a diagnosis of cancer, endoscopies and imaging procedures, surgical exploration of primary site.

Criteria for TNM Pathologic Staging
Examination of surgically resected specimen and lymph nodes.

Notes on TNM Staging for Stomach

Tumor that involves the gastrocolic or gastrohepatic ligaments or penetrates into the greater or lesser omentum without perforating the visceral peritoneum covering these structures is coded T2. Any perforation of the visceral peritoneum covering the gastric ligaments or omentum is classified T3.

Extension of tumor along the stomach wall into the duodenum or esophagus is classified by the greatest depth of invasion at any of these sites, including the stomach.

Adjacent structures of the stomach are the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum.

Brief Summaries of 6th Edition Categories

Esophagus

TNM Classification Histological/Clinical Features
T1 Lamina propria or submucosa
T2 Muscularis propria
T3 Adventitia
T4 Adjacent structures
N1 Regional lymph node metastases
Lower thoracic esophagus
TNM Classification Histological/Clinical Features
M1a Celiac lymph nodes
M1b Other distant metastasis
Upper thoracic esophagus  
M1a Cervical lymph nodes
M1b Other distant metastases
Mid-thoracic esophagus
TNM Classification Histological/Clinical Features
M1a Not applicable
M1b Non-regional lymph nodes or other distant metastases

Small Intestine

TNM Classification Histological/Clinical Features
T1 Lamina propria or submucosa
T2 Muscularis propria
T3 Subserosa, non-peritonealized perimuscular tissues (mesentery, retroperitoneum) = 2 cm
T4 Visceral peritoneum, other organs/structures (including mesentery, retroperitoneum) > 2 cm
N1 Regional lymph node metastases
M1 Distant metastasis

Stomach

TNM Classification Histological/Clinical Features
T1 Lamina propria or submucosa
T2 Muscularis propria or subserosa
T2a Tumor invades muscularis propria
T2b Tumor invades subserosa
T3 Penetrates serosa
T4 Adjacent structures
N1 1 - 6 nodes
N2 7 - 15 nodes
N3 > 15 nodes
M1 Distant metastasis

Collaborative Stage Elements

For more details on Collaborative Stage, see the Intro to Collaborative Staging module.