Coronavirus and cancer

We know it’s a worrying time for people with cancer, we have information to help. If you have symptoms of cancer contact your doctor.

Read our information about coronavirus and cancer

Decorative image

Stage 4

The stage of a cancer tells you how big it is and how far it’s spread. 

What is stage 4 stomach cancer?

Stage 4 stomach cancer means your cancer is advanced. Your cancer has spread through the outer lining of your stomach and into other nearby organs or body structures. Or it has spread to distant body parts. 

Staging systems

Doctors use different systems to stage stomach cancer. This page is about stage 4 cancer, which is part of the number staging system. This system has 5 stages, stage 0 to stage 4.

This page also tells you what stage 4 means in the TNM system. This system describes:

  • the size of the primary tumour (T)
  • whether the cancer has spread to the lymph nodes (N)
  • whether the cancer has spread to another part of the body (M)

How do doctors find out your stage?

There are different ways to find out your stage. Your doctor might use:

  • clinical staging before treatment and if you don't have surgery
  • pathological staging if you do have surgery
  • post neoadjuvant staging if you have chemotherapy before surgery

Clinical staging means the doctor stages you after examining you and looking at test and scan results. Doctors use clinical staging to plan your treatment. It’s also the best way to stage people who aren’t having surgery. You might see your clinical stage written as cTNM.

Pathological staging means the doctor stages you after examining the tissue that the surgeon removes during an operation. This is also called surgical staging. The doctors combine your clinical stage results with the surgical results. Pathological staging is generally a more precise way to find out how far your cancer has spread. Your pathological stage might be different to your clinical stage. You might see your pathological stage written as pTNM.

Post neoadjuvant staging means you have had chemotherapy before surgery (neoadjuvant treatment) and the doctor stages you again after surgery. You might see your post neoadjuvant stage written as ypTNM. 

For stomach cancer, the clinical, pathological, and post neoadjuvant staging are all different. In this section we describe the pathological and clinical stages.

What is stage 4 stomach cancer (clinical staging)?

In clinical staging, stage 4 stomach cancer is divided into 2 groups - stage 4A and stage 4B.

Stage 4A means your cancer has grown through the stomach wall and into nearby organs or tissues. It might have spread to nearby lymph nodes but it hasn’t spread to distant body parts.

In the TNM system, stage 4A is the same as:

  • T4b, any N, M0
Diagram showing stage 4A stomach cancer (clinical staging)

In the TNM system, stage 4B is the same as:

  • Any T, any N, M1
Diagram showing stomach cancer that has spread to distant body parts

What is stage 4 stomach cancer (pathological staging?)

Pathological staging means the doctor stages you after examining the tissue that the surgeon removes during an operation. 

In pathological staging, stage 4 stomach cancer means your cancer has spread to distant body parts.

In the TNM system, stage 4 is the same as:

  • Any T, any N, M1
Diagram showing stomach cancer that has spread to distant body parts

Treatment

The stage of your cancer helps your doctor to decide what treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is in your stomach
  • other health conditions

Treatment aims to control the cancer and maintain a good quality of life. You might have:

  • chemotherapy
  • radiotherapy
  • surgery to control symptoms
  • symptom control, for example treatment to help you swallow food
  • trastuzumab (Herceptin) targeted cancer drug for cancers that have the HER2 protein

About other stages

Last reviewed: 
26 Aug 2020
Next review due: 
25 Aug 2023
  • AJCC Cancer Staging Manual (8th Edition)
    M Amin and S Edge.
    Springer, 2017.

  • Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up 
    E Smyth and others, 
    Annals of Oncology, 2016. Volume 27, Pages v38–v49

  • Gastric cancer
    Custem EV. (and others)
    The Lancet, 2016. 5th May S0140-6736(16)30354-3

  • Recent Strategies for Treating Stage IV Gastric Cancer: Roles of Palliative Gastrectomy, Chemotherapy, and Radiotherapy
    Izuishi and Mori
    J Gastrointestin Liver Disease. 2016. March  Volume 25, Number 1/Article 13 [PMID: 27014758]

  • Trastuzumab for the treatment of HER2-positive metastatic gastric cancer
    NICE technology appraisal guidance [TA208]
    Published date: 24 November 2010

Information and help