Radiation Oncology/Stomach/Staging

Current Staging AJCC 7th Edition (2009) Staging applies only to carcinomas. Lymphomas, sarcomas, and carcinoids not included. Note: tumors of the esophagogastric junction or arising in the stomach <= 5 cm from the EGJ and crossing the EGJ are staged as Esophageal cancers T-stage: Tis - in situ; no invasion of lamina propria T1 - (mucosal invasion) invades lamina propria, muscularis mucosae, or submucosa T1a - invades lamina propria or muscular mucosae T1b - invades submucosa T2 - (wall invasion) invades muscularis propria T3 - penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures T4 - invades serosa (visceral peritoneum) or adjacent structures T4a - invades serosa (visceral peritoneum) T4b - invades adjacent structures adjacent structures include: spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum note: intramural extension to the duodenum or esophagus is classified by the depth of greatest invasion N-stage: (should include 10-15 nodes for analysis) N0 - no nodes N1 - 1-2 nodes N2 - 3-6 nodes N3 - 7 or more nodes N3a - 7-15 nodes N3b - 16 or more nodes Regional nodes include: Greater curvature: greater curvature, greater omental, gastroduodenal, gastroepiploic, pyloric, pancreaticoduodenal Pancreatic and splenic area: pancreaticolienal, peripancreatic, splenic Lesser curvature: lesser curvature, lesser omental, left gastric, cardioesophageal, common hepatic, celiac, hepatoduodenal* (see note below) Involvement of other nodal groups (retropancreatic, para-aortic, portal, retroperitoneal, and mesenteric) are considered distant metastases. Positive peritoneal cytology is classified as metastatic disease. * (note)The manual states "Involvement of other intra-abdominal lymph nodes, such as the hepatoduodenal ... is classified as distant metastasis." (Confusing. It lists hepatoduodenal nodes are both metastatic and regional) M-stage: M0 - no M1 - yes Stage grouping: IA - (add to 1) T1N0 IB - (add to 2) T1N1 or T2N0 IIA - (add to 3) T1N2, T2N1, T3N0 IIB - (add to 4) T1N3, T2N2, T3N1, T4aN0 IIIA - (add to 5) T2N3, T3N2, T4aN1 IIIB - (add to 6 or T4b) T3N3, T4a N2, T4b N1, T4b N0 IIIC - T4aN3, T4b N2-3 IV - Any M1 Changes from 6th edition: Cancers of the GE junction and proximal 5 cm of stomach are classified as esophageal cancers Subdivision of T1 into T1a/b Redefined T2 (same as old T2a). Also, T2 is no longer subdivided. Redefined T3 (same as old T2b). Redefined and subdivided T4. T4a is same as old T3. T4b is same as old T4. Changed # lymph nodes involved to define N1/2/3 Redefined stage groupings Older staging editions AJCC 6th Edition (2002) T-stage: Tis - in situ; no invasion of lamina propria T1 - (mucosal invasion) invades lamina propria or submucosa T2 - (wall invasion) invades muscularis propria or subserosa T2a - muscularis propria T2b - subserosa T3 - penetrates serosa (visceral peritoneum) without invasion of adjacent structures T4 - invades adjacent structures N-stage: (should include 10-15 nodes for analysis) N0 - no nodes N1 - 1-6 nodes N2 - 7-15 nodes N3 - more than 15 nodes Stage grouping: IA - (add to 1) T1N0 IB - (add to 2) T1N1 or T2N0 II - (add to 3) T1N2, T2N1, T3N0 IIIA - (add to 4) T2N2, T3N1, T4N0 IIIB - (add to 5) T3N2 IV - Any T4N+, Any N3, or M1 Changes in 6th edition: divided T2 into T2a and T2b AJCC 5th Edition (1997) No subdivision of T2 into T2a and T2b. Changed N-staging AJCC 4th edition (1992) N1: positive node located with 3cm of primary. N2: located more than 3 cm of primary. Japanese Staging Japanese Classification, 3rd English Edition (2011)