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The stages of stomach cancer

Men and woman discussing stomach cancer

This page tells you about the stages of stomach cancer, and the different systems of staging. There is information on

 

A quick guide to what's on this page

The stages of stomach cancer

The stage of a cancer tells the doctor the size of the tumour and whether it has spread. It is important because treatment is often decided according to the stage of a cancer. Doctors mainly use the TNM staging system and the number staging system.

The TNM stages of stomach cancer

The TNM system is the system most commonly used in cancer. TNM stands for Tumour, Node, Metastasis. This system describes the size of the primary tumour (T), whether or not there is cancer in the nearby lymph nodes (N), and if the cancer has spread to another area of the body (M).

Number stages of stomach cancer

The number staging system uses information from the TNM staging system to divide stomach cancer into one of 5 main groups - stages 0 to 4. There are details of the TNM and number stages of stomach cancer further down this page. 
 

CR PDF Icon You can view and print the quick guides for all the pages in the treating stomach cancer section.

 

 

What staging is

The stage of a cancer tells the doctor the size of the tumour and whether it has spread. The tests and scans you have when diagnosing your cancer give some information about the stage. It is important because treatment is often decided according to the stage of a cancer. But your doctor may not be able to tell you the exact stage of cancer in your stomach until you have surgery.

There are different ways of staging cancers. The two main ways are the TNM system and the number system. There is more general information about staging cancers in the section about cancer.

 

TNM stages of stomach cancer

TNM stands for Tumour, Node, Metastasis. The system describes

The size and spread of the stomach tumour (T)

  • TX means the main tumour (primary) cannot be assessed.
  •  T1 means the tumour has started to grow into the wall of the stomach. T1 is further divided into T1a and T1b. T1a means the tumour is within the inner layers of the stomach (the mucosa). And T1b means the tumour has grown through the mucosa and into a layer of supportive tissue called the submucosa.
  • T2 means the tumour has grown into the muscle layer of the stomach.
  • T3 means the tumour has grown into the outer lining of the stomach.
  • T4 means the tumour has grown right through the outer lining of the stomach.  It is further divided into T4a and T4b. T4a means the tumour has broken through the outer lining of the stomach wall. And T4b means it has grown through the stomach wall and into other organs or body structures nearby such as the liver, foodpipe (oesophagus) or abdominal wall.

Diagram showing the T stages of stomach cancer

Whether cancer cells have spread to lymph nodes (N)

  • NX means that the lymph nodes cannot be assessed.
  • N0 means that there are no lymph nodes containing cancer cells
  • N1 means that there are cancer cells in 1 to 2 lymph nodes near to the stomach
  • N2 means there are cancer cells in 3 to 6 nearby lymph nodes
  • N3a means there are cancer cells in 7 to 15 nearby lymph nodes
  • N3b means there are cancer cells in 16 or more nearby lymph nodes

Diagram showing stomach cancer cells in the lymph nodes

Whether the cancer has spread to a different part of the body (M)

  • MX means that spread of the cancer cannot be assessed.
  • M0 means the cancer has not spread to other organs
  • M1 means the cancer has spread to other parts of the body

Diagram showing secondary stomach cancer in the lungs

 

Number stages of stomach cancer

There are five main stages in this system - stages 0 to 4.

Stage 0 or carcinoma in situ (CIS) - also sometimes called TIS

If you are told you have CIS or stage 0 stomach cancer, you have a very early stage of stomach cancer. There are cancer cells in your stomach lining. But they are completely contained within the innermost layer of the lining. So there is very little risk of any cancer cells having spread. It is not usual for stomach cancer to be diagnosed this early.

Stage 1

This is the earliest stage of cancer. It is divided into 1a and 1b.

Stage 1a means the cancer has grown no further than the lining of the stomach, with no cancer in the lymph nodes (T1, N0, M0).

Stage 1b means either that

  • The cancer is still within the stomach lining, but nearby lymph nodes contain cancer cells (T1, N1, M0) OR
  • There are no cancer cells in the lymph nodes, but the cancer has grown into the muscle of the stomach wall (T2, N0, M0)

Stage 2

Stage 2 is also divided into a and b

Stage 2a means that 

  • The cancer is still within the lining of the stomach, but between 3 and 6 nearby lymph nodes contain cancer cells (T1, N2, M0) OR
  • The cancer has grown into the muscle layer of the stomach wall and is also in 1 or 2 nearby lymph nodes (T2, N1, M0) OR
  • The cancer has grown into the outer layers of the stomach but there are no cancer cells in the lymph nodes (T3, N0, M0)

Stage 2b means that 

  • The cancer is within the lining of the stomach wall but 7 or more lymph nodes contain cancer cells (T1, N3, M0) OR
  • The cancer has grown into the muscle layer of the stomach and between 3 and 6 lymph nodes contain cancer cells (T2, N2, M0) OR
  • The cancer has grown into the outer layer of the stomach and is also in 1 or 2 nearby lymph nodes (T3, N1, M0) OR
  • The cancer has grown through the outer lining but there are no cancer cells in nearby lymph nodes (T4a, N0, M0)

Stage 3

Stage 3 is divided into a, b and c.

Stage 3a means that the cancer has grown

  • Into the muscle layer of the stomach and 7 or more nearby lymph nodes contain cancer cells (T2, N3, M0) OR
  • Into the outer lining of the stomach and between 3 and 6 nearby lymph nodes contain cancer cells (T3, N2, M0) OR
  • Through the stomach wall and 1 to 2 nearby lymph nodes contain cancer cells (T4a, N1, M0)

In stage 3b the cancer has grown

  • Into the outer lining of the stomach and more than 7 nearby lymph nodes contain cancer cells (T3, N3, M0) OR
  • Right through the stomach wall and between 3 and 6 lymph nodes contain cancer (T4a, N2, M0) OR
  • Right through the stomach wall into nearby tissues and organs, and the nearby lymph nodes may contain cancer (T4b, N0 to 1, M0)

In stage 3c the cancer has 

  • Grown right through the stomach wall and more than 7 nearby lymph nodes contain cancer (T4a, N3, M0) OR
  • Grown right through the stomach wall into nearby tissues and organs, and the lymph nodes contain cancer (T4b, N2 to 3, M0)

Stage 4

This means your cancer is advanced and has spread to body organs further away from the stomach, such as the lungs, brain or bones (any T, any N, M1).

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Updated: 13 February 2014