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TNM staging

Tumour, node and metastasis (TNM) staging is the most common way that doctors stage stomach cancer.

Doctors may also use the number staging system. 

The stage of a cancer tells you how big it is and how far it’s spread. It helps your doctor decide which treatment you need.

Your scans will give some information about the stage of your cancer, but your doctor may not be able to tell you the exact stage until you have surgery.

Tumour (T)

Tumour describes the size of the tumour.

There are 4 main stages of tumour size in stomach cancer.

T1 means the tumour has started to grow into the wall of the stomach. It’s divided into T1a and T1b:

  • T1a means the tumour is within the inner layers of the stomach (the mucosa)
  • 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 that the tumour has grown through the outer lining of the stomach. It’s divided into T4a and T4b:

  • T4a means the tumour has broken through the outer lining of the stomach wall
  • T4b means the tumour has grown through the stomach wall and into other organs or body structures nearby such as the liver, food pipe (oeosphagus) or abdominal wall
Diagram showing stage T1-T4a stomach cancer

T4b

tnm stages 1.png

Node (N)

Node (N) describes whether the cancer has spread to the lymph nodes. Lymph nodes are a network of glands throughout the body, for example in your armpits, neck and groins. They drain away waste fluid, waste products and damaged cells, and contain cells that fight infection.

There are 4 possible stages describing whether cancer cells are in the lymph nodes – N0, N1, N2 and N3:

N0 means there are no lymph nodes containing cancer cells.

N1 means 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. 

N3 is split into N3a and N3b: 

  • 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
tnm stages 2.png

Metastasis (M)

Metastasis describes whether the cancer has spread to a different part of the body.

There are 2 stages of metastasis:

  • M0 means the cancer has not spread to other organs
  • M1 means the cancer has spread to other parts of the body
tnm stages3.png

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 might include:

  • surgery - to remove part or all your stomach
  • chemotherapy
  • radiotherapy
  • targeted cancer drugs, for example trastuzumab (Herceptin)
  • symptom control treatment

Chemotherapy in combination with radiotherapy (chemoradiotherapy) is sometimes a treatment to shrink stomach cancer. It is not a common treatment.

You may have treatment as part of a clinical trial.

Last reviewed: 
20 Dec 2019
  • 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

  • Guidelines for the management of oesophageal and gastric cancer
    Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, the British Society of Gastroenterology and the British Association of Surgical Oncology
    Allum (and others)
    Gut 2011;60:1449-1472

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

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