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