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13

NCCN Guidelines for Patients

®

Stomach Cancer, Version 1.2016

12

NCCN Guidelines for Patients

®

Stomach Cancer, Version 1.2016

2

Cancer staging

12 TNM scores

16 The 5 stages

18 Review

2

Cancer staging

TNM scores

T = Tumor

The T score tells into which tissues the primary tumor

has grown. Stomach cancers grow through the wall of

the stomach and then into nearby structures. T scores

for stomach cancer include:

Tis

means the tumor hasn’t grown beyond the

epithelium.

T1

tumors have invaded the lamina propria,

muscularis mucosae, or submucosa.

o T1a tumors have invaded the lamina

propria or muscularis mucosae.

o T1b tumors have invaded the

submucosa.

T2

tumors have invaded the muscularis

propria.

T3

tumors have invaded the subserosa.

T4

tumors have invaded the serosa or nearby

tissues.

o

T4a

tumors have invaded the

serosa.

o

T4b

tumors have invaded the

nearby structures. These structures

include the diaphragm, liver,

spleen, pancreas, adrenal gland,

kidney, colon, small intestine, and

abdominal wall.

See Figure 4

.

Figure 4.

Areas of T4b growth

The primary tumor may grow

through the stomach wall and into

nearby structures. Tumors that

have grown into nearby structures

are rated T4b. The structures that

may be affected are partly based

on where the tumor started in the

stomach.

Illustration Copyright © 2016 Nucleus Medical Media, All rights reserved.

www.nucleusinc.com

Cancer staging is a rating by your

doctors of how far the cancer has

grown and spread. The rating is

based on test results. Doctors plan

additional tests and treatment based

on how much the cancer has grown.

In Part 2, the scoring system used for

cancer staging is explained.

TNM scores

The AJCC (

A

merican

J

oint

C

ommittee on

C

ancer)

staging system is used to stage stomach cancer.

Tumors that occur in the EGJ are staged according to

esophageal cancers. Read the

NCCN Guidelines for

Patients: Esophageal Cancer

for more information.

In the AJCC system, the letters T, N, and M describe

a different location of cancer growth. Your doctors

will assign a score to each letter. TNM scores will

be combined to assign the cancer a stage. The

cancer stage is used to assess the prognosis of the

cancer and to decide what treatments will be used. A

prognosis is the outlook (prediction) of the pattern and

outcome of a disease.

diaphragm

liver

spleen

pancreas

adrenal gland

kidney

colon

small intestine

abdominal wall