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