TNM 7 classification
TNM 6 classification
1. Rules for ClassificationThe 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
- Cardia (and gastroesophageal junction) (C16.0)
- Fundus (C16.1)
- Corpus (C16.2)
- Antrum (C16.3) and pylorus (C16.4)
3. Regional Lymph NodesThe 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 Classification4.1. 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 ClassificationThe 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 GradingSee definitions here
7. Stage Grouping