Carcinoma of the Stomach

In the TNM classification of gastric cancer1-3 (Table 52), depth of invasion is the main criterion, as in esophageal carcinoma. The current T staging system is illustrated in Figure 5-1.

The classification presents some limitations. The T1 designation does not distinguish mucosal and submu-cosal invasion. In the definition of a T2 cancer, no distinction is made as to whether the muscularis propria is merely invaded or there is extension to involve the sub-serosa. Invasion of the serosa is the main criterion of a T3 cancer.

The Japanese Research Society for Gastric Cancer has used a detailed classification based on meticulous surgical and pathologic findings,15 mostly translatable to the TNM system, providing an anatomic basis for systematic lymph node dissection in the surgical treatment of gastric cancer.

There is a distinct correlation between the T stage

Table 5-2. TNM Clinical Classification System for Staging Gastric Carcinoma

Primary tumor (T) TX TO Tis

Regional lymph nodes (N) NX NO

Distant metastasis (M) MX MO Ml

Primary tumor cannot be assessed No evidence of primary tumor

Carcinoma in situ: intraepithelial tumor, without invasion of lamina propria Tumor invades lamina propria or sub mucosa Tumor invades muscularis propria or subserosa

Tumor penetrates serosa (visceral peritoneum) without invasion of adjacent structures Tumor invades adjacent structures

Regional lymph nodes cannot be assessed No regional lymph node metastasis Metastasis in 1—6 regional lymph nodes Metastasis in 7—15 regional lymph nodes Metastasis in >15 regional lymph nodes

Presence of distant metastasis cannot be assessed No distant metastasis Distant metastasis

Stage II

Distant metastasis (M) MX MO Ml

Presence of distant metastasis cannot be assessed No distant metastasis Distant metastasis

Stage II

grouping

0

Tis

NO

IA

T1

NO

IB

T1

N1

T2

NO

II

T1

N2

T2

Nt

T3

NO

IIIA

T2

N2

T3

N1

T4

NO

HIB

T3

N2

IV

T4

Nl

T1

N3

T2

N3

T3

N3

T4

N2

T4

N3

Any T

Any N

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO Ml and the number and sites of invaded lymph nodes.16 Increases in either the number of positive nodes or the extent of nodal involvement adversely influence survival.17

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