Stomach

TNM 7 classification

TNM 6 classification

1. Rules for Classification

The classification applies only to carcinomas. There should be histological confirmation of the disease.

The following are the procedures for assessing T, N, and M categories.

T categories. Physical examination, imaging, endoscopy, and/or surgical exploration
N categories. Physical examination, imaging, and/or surgical exploration
M categories. Physical examination, imaging, and/or surgical exploration

2. Anatomical Subsites

1. Cardia (and gastroesophageal junction) (C16.0)
2. Fundus (C16.1)
3. Corpus (C16.2)
4. Antrum (C16.3) and pylorus (C16.4)

3. Regional Lymph Nodes

The regional lymph nodes of the stomach are the perigastric nodes along the lesser and greater curvatures, the nodes along the left gastric, common hepatic, splenic, and coeliac arteries, and the hepatoduodenal nodes. The regional lymph nodes of the gastroesophageal junction are the paracardial, left gastric, coeliac, diaphragmatic, and the lower mediastinal para-oesophageal.

Involvement of other intra-abdominal lymph nodes such as retropancreatic, mesenteric, and para-aortic is classified as distant metastasis.

4. TNM Clinical Classification

4.1. T - Primary Tumour

TX. Primary tumour cannot be assessed
T0. No evidence of primary tumour
Tis. Carcinoma in situ: intraepithelial tumour without invasion of the lamina propria
T1. Tumour invades lamina propria or submucosa
T2. Tumour invades muscularis propria or subserosa1
T2a. Tumour invades muscularis propria
T2b. Tumour invades subserosa
T3. Tumour penetrates serosa (visceral peritoneum) without invasion of adjacent structures
T4. Tumour invades adjacent structures

4.2. N - Regional Lymph Nodes

NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Metastasis in 1 to 6 regional lymph nodes
N2. Metastasis in 7 to 15 regional lymph nodes
N3. Metastasis in more than 15 regional lymph nodes

4.3. M - Distant Metastasis

MX. Distant metastasis cannot be assessed
M0. No distant metastasis
M1. Distant metastasis

5. pTNM Pathological Classification

The pT, pN, and pM categories correspond to the T, N, and M categories.

pN0. Histological examination of a regional lymphadenectomy specimen will ordinarily include 15 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.

6. G Histopathological Grading

See definitions here

7. Stage Grouping

Stage 0 Tis N0 M0 Stage IA T1 N0 M0 Stage IB T1 N1 M0 T2a/b N0 M0 Stage II T1 N2 M0 T2a/b N1 M0 T3 N0 M0 Stage IIIA T2a/b N2 M0 T3 N1 M0 T4 N0 M0 Stage IIIB T3 N2 M0 Stage IV T4 N1. N2. N3 M0 T1. T2. T3 N3 M0 Any T Any N M1

8. Summary

Stomach T1 Lamina propria, submucosa T2 Muscularis propria, subserosa T2a Muscularis propria T2b Subserosa T3 Penetrates serosa T4 Adjacent structures N1 1 to 6 nodes N2 7 to 15 nodes N3 >15 nodes