Pathologic stage of gastric cancer

E. Strong (ed.). Gastric cancer. Principles and practice. Springer (2015)

The American Joint Committee on Cancer Staging (AJCC) periodically updates their guidelines for staging cancer spread according to the size of the tumor (T-stage), amount of nodal metastasis (N-stage) and the presence or absence of extraorgan metastasis (M-stage). The most recent update occurred in 2010 (Table 4.3) [85].

Gastric cancer. Principles and practice (2015) 4.12

Fig. 4.12. Intraoperative diagnosis of margin status. a Diffuse type gastric adenocarcinoma causes thickened gastric wall (left) without histologic abnormalities at the mucosal surface. An immunostain of cytokeratin demonstrates transmural infiltration of tumor cells in the gastric wall (right). b) The tumor cells infiltrate between muscular fibers (arrows). c) The tumor cells infiltrates within fibrous septae in subserosal fat (arrows). d) The tumor cells are commonly present at the serosal surface (arrows). e, f) At intraoperative evaluation of the margin status, the tumor may be present in the deep gastric wall as scatted cluster or individual cells, which are better appreciated on an immunostain for cytokeratin

Table 4.3. Gastric cancer TNM staging [85]

Primary tumor (T) Stage grouping
TX Primary tumor cannot be assessed Stage 0 Tis N0 M0
T0 No evidence of primary tumor Stage IA T1 N1 M0
Tis Carcinoma in situ: intraepithelial tumor without invasion of the lamina propria (i.e., high grade dysplasia) Stage IB T2 N0 M0
T1 Tumor invades lamina propria (T1a), muscularis mucosae (T1a), or submucosa (T1b) T1 N1 M0
T2 Tumor invades muscularis propria Stage IIA T3 N0 M0
T3 Tumor penetrates submucosal serosa without invasion of visceral peritoneum or adjacent structures T2 N1 M0
T4 Tumor invades serosa (visceral peritoneum) (T4a) or adjacent structures (T4b) T1 N2 M0
Regional lymph nodes (N) Stage IIB T4a N0 M0
NX Regional lymph node(s) cannot be assessed T3 N1 M0
N0 No regional lymph node metastasis T2 N2 M0
N1 Metastasis in 1 to 2 regional lymph nodes T1 N3 M0
N2 Metastasis in 3 to 6 regional lymph nodes Stage IIIA T4a N1 M0
N3 Metastasis in 7 or more regional lymph nodes T3 N2 M0
Distal metastasis (M) T2 N3 M0
M0 No distant metastasis Stage IIIB T4b N0 M0
M1 Distant metastasis T4b N1 M0
T4a N2 M0
T3 N3 M0
Stage IIIC T4b N2 M0
T4b N3 M0
T4a N3 M0
Stage IV Any T Any N M1

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer Science + Business Media

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