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©2013 UpToDate ® Print Email American Joint Committee on cancer staging for gastric cancer Tumor (T) stage TX Primary tumor cannot be assessed T0 No evidence of primary tumor T1s Carcinoma in situ: intra-epithelial tumor without invasion of the lamina propia T1 Tumor invades lamina propria or submucosa T2 Tumor invades muscularis propria or subserosa T2a Tumor invades muscularis propria T2b Tumor invades subserosa T3 Tumor penetrates serosa (visceral peritoneum) without invasion of adjacent structures* T4 Tumor invades adjacent structures* Nodal (N) stage NX Regional lymph node(s) cannot be assessed N0 No regional lymph node metastasis N1 Metastasis in 1 to 6 regional lymph nodes N2 Metastasis in 7 to 15 regional lymph nodes N3 Metastasis in more than 15 regional lymph nodes Metastasis (M) stage Mx Presence of distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis Stage grouping Stage 0 Tis N0 M0 Stage 1A T1 N0 M0 Stage 1B T1 N1 M0 T2a/b N0 M0 Stage II T1 N2 M0 T2a/b N1 M0 T3 N0 M0 Stage IIIA T2a/b N2 M0 T3 N1 M0 T4 N0 M0 Stage IIIB T3 N2 M0 Stage IV T1-3 N3 M0 T4 N1-3 M0 Any T Any N M1 * 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 classified by the depth of the greatest invasion in amy of these sites, including the stomach. Used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, Inc.