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Staging (Stomach)
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Staging (Stomach)
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Pathologic Staging (pTNM) AJCC 8th Edition
CAP Approved Gastrointestinal • Stomach 4.0.0.0
TNM Descriptors (required only if applicable) (select all that apply)
___ m (multiple primary tumors)
___ r (recurrent)
___ y (posttreatment)
Primary Tumor (pT)
___ pTX: Primary tumor cannot be assessed
___ pT0: No evidence of primary tumor
___ pTis: Carcinoma in situ: intraepithelial tumor without invasion of the lamina propria, high-grade dysplasia
___ pT1: Tumor invades the lamina propria, muscularis mucosae, or submucosa
___ pT1a: Tumor invades the lamina propria or muscularis mucosae
___ pT1b: Tumor invades the submucosa
___ pT2: Tumor invades the muscularis propria#
___ pT3: Tumor penetrates the subserosal connective tissue without invasion of the visceral peritoneum or adjacent structures##, ###
___ pT4: Tumor invades the serosa (visceral peritoneum) or adjacent structures##, ###
___ pT4a: Tumor invades the serosa (visceral peritoneum)
___ pT4b: Tumor invades adjacent structures/organs
# A tumor may penetrate the muscularis propria with extension into the gastrocolic or gastrohepatic ligaments, or into the greater or lesser omentum, without perforation of the visceral peritoneum covering these structures. In this case, the tumor is classified as T3. If there is perforation of the visceral peritoneum covering the gastric ligaments or the omentum, the tumor should be classified as T4.
## The adjacent structures of the stomach include the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum.
### Intramural extension to the duodenum or esophagus is not considered invasion of an adjacent structure, but is classified using the depth of the greatest invasion in any of these sites.
Regional Lymph Nodes (pN)#
___ pNX: Regional lymph node(s) cannot be assessed
___ pN0: No regional lymph node metastasis
___ pN1: Metastasis in one or two regional lymph nodes
___ pN2: Metastasis in three to six regional lymph nodes
___ pN3: Metastasis in seven or more regional lymph nodes
___ pN3a: Metastasis in seven to 15 regional lymph nodes
___ pN3b: Metastasis in 16 or more regional lymph nodes
# Note: Metastatic tumor deposits in the subserosal fat adjacent to a gastric carcinoma, without evidence of residual lymph node tissue, are considered regional lymph node metastases for purposes of gastric cancer staging.
Distant Metastasis (pM) (required only if confirmed pathologically in this case)
___ pM1: Distant metastasis
Specify site(s), if known: __________________________
Summary of changes AJCC 7th to 8th edition