Linitis plastica staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]


According to the American Joint Committee on Cancer, there are 4 stages of stomach cancer based on the tumor spread. Staging can be done via EUS, CT, MRI or laparoscopy, which has the advantage of directly visualizing liver, peritoneum and local lymph nodes.


There are two major classification systems currently in use for gastric cancer; the Japanese classification. The other and more widely used staging system is the American Joint Committee on Cancer has designated staging by TNM classification to define gastric cancer:[1]

Definitions of TNM

Stomach cancer TNM staging
Stage Description
TX Primary tumor cannot be assessed
Tis Carcinoma in situ: intraepithelial tumor without invasion of the lamina propria
T0 No evidence of primary tumor
T1 Tumor invades lamina propria, muscularis mucosae, or submucosa

T1a: Tumor invades lamina propria or muscularis mucosae

T1b: Tumor invades submucosa

T2 Tumor invades muscularis propria
T3 Tumor penetrates subserosal connective tissue without invasion of visceral peritoneum or adjacent structures
T4 T4: Tumor invades serosa (visceral peritoneum) or adjacent structures

T4a: Tumor invades serosa (visceral peritoneum)

T4b: Tumor invades adjacent structures

Regional Lymph Nodes (N)
Stage Description
NX Regional lymph node cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in 1-2 regional lymph nodes
N2 Metastasis in 3-6 regional lymph nodes
N3 Metastasis in seven or more regional lymph nodes

N3a: Metastasis in 7-15 regional lymph nodes

N3b: Metastasis in 16 or more regional lymph nodes

Distant Metastasis (M)
Stage Description
M0 No distant metastasis
M1 Distant metastasis
Anatomic Stage/Prognostic Groups
Stage T N M

Stage 0

Tis N0 M0
I Stage IA T1 N0 M0
Stage IB T2 N0 M0
T1 N1 M0
II Stage IIA T3 N0 M0
T2 N1 M0
T1 N2 M0
Stage IIB T4a N0 M0
T3 N1 M0
T2 N2 M0
III Stage IIIA T1 N1 M0
Stage IIIB T4b N0 M0
T4b N1 M0
T4a N2 M0
T3 N3 M0
Stage IIIC T4b N2 M0
T4b N3 M0
T4a N3 M0
IV Any T Any N M1
Diagram showing the T stages of stomach cancer, source:


  1. In H, Solsky I, Palis B, Langdon-Embry M, Ajani J, Sano T (2017). "Validation of the 8th Edition of the AJCC TNM Staging System for Gastric Cancer using the National Cancer Database". Ann Surg Oncol. 24 (12): 3683–3691. doi:10.1245/s10434-017-6078-x. PMID 28895113.

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