Stomach cancer TNM staging AJCC UICC 8th edition

Primary tumor (T)
T category	T criteria
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Carcinoma in situ: Intraepithelial tumor without invasion of the lamina propria, high-grade dysplasia
T1	Tumor invades the lamina propria, muscularis mucosae, or submucosa
T1a	Tumor invades the lamina propria or muscularis mucosae
T1b	Tumor invades the submucosa
T2	Tumor invades the muscularis propria*
T3	Tumor penetrates the subserosal connective tissue without invasion of the visceral peritoneum or adjacent structures^¶^Δ
T4	Tumor invades the serosa (visceral peritoneum) or adjacent structures^¶^Δ
T4a	Tumor invades the serosa (visceral peritoneum)
T4b	Tumor invades adjacent structures/organs
* A tumor may penetrate the muscularis propria with extension into the gastrocolic or gastrohepatic ligaments, or into the greater or lesser omentum, without perforation of the visceral peritoneum covering these structures. In this case, the tumor is classified as T3. If there is perforation of the visceral peritoneum covering the gastric ligaments or the omentum, the tumor should be classified as T4. ¶ The adjacent structures of the stomach include the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, and retroperitoneum. Δ Intramural extension to the duodenum or esophagus is not considered invasion of an adjacent structure, but is classified using the depth of the greatest invasion in any of these sites.
Regional lymph nodes (N)
N category	N criteria
NX	Regional lymph node(s) cannot be assessed
N0	No regional lymph node metastasis
N1	Metastases in 1 or 2 regional lymph nodes
N2	Metastases in 3 to 6 regional lymph nodes
N3	Metastases in 7 or more regional lymph nodes
N3a	Metastases in 7 to 15 regional lymph nodes
N3b	Metastases in 16 or more regional lymph nodes
Distant metastasis (M)
M category	M criteria
M0	No distant metastasis
M1	Distant metastasis
Prognostic stage groups
Clinical (cTNM)
When T is...	And N is...	And M is...	Then the stage group is...
Tis	N0	M0	0
T1	N0	M0	I
T2	N0	M0	I
T1	N1, N2, or N3	M0	IIA
T2	N1, N2, or N3	M0	IIA
T3	N0	M0	IIB
T4a	N0	M0	IIB
T3	N1, N2, or N3	M0	III
T4a	N1, N2, or N3	M0	III
T4b	Any N	M0	IVA
Any T	Any N	M1	IVB
Pathological (pTNM)
When T is...	And N is...	And M is...	Then the stage group is...
Tis	N0	M0	0
T1	N0	M0	IA
T1	N1	M0	IB
T2	N0	M0	IB
T1	N2	M0	IIA
T2	N1	M0	IIA
T3	N0	M0	IIA
T1	N3a	M0	IIB
T2	N2	M0	IIB
T3	N1	M0	IIB
T4a	N0	M0	IIB
T2	N3a	M0	IIIA
T3	N2	M0	IIIA
T4a	N1	M0	IIIA
T4a	N2	M0	IIIA
T4b	N0	M0	IIIA
T1	N3b	M0	IIIB
T2	N3b	M0	IIIB
T3	N3a	M0	IIIB
T4a	N3a	M0	IIIB
T4b	N1	M0	IIIB
T4b	N2	M0	IIIB
T3	N3b	M0	IIIC
T4a	N3b	M0	IIIC
T4b	N3a	M0	IIIC
T4b	N3b	M0	IIIC
Any T	Any N	M1	IV
Post-neoadjuvant therapy (ypTNM)
When T is...	And N is...	And M is...	Then the stage group is...
T1	N0	M0	I
T2	N0	M0	I
T1	N1	M0	I
T3	N0	M0	II
T2	N1	M0	II
T1	N2	M0	II
T4a	N0	M0	II
T3	N1	M0	II
T2	N2	M0	II
T1	N3	M0	II
T4a	N1	M0	III
T3	N2	M0	III
T2	N3	M0	III
T4b	N0	M0	III
T4b	N1	M0	III
T4a	N2	M0	III
T3	N3	M0	III
T4b	N2	M0	III
T4b	N3	M0	III
T4a	N3	M0	III
Any T	Any N	M1	IV

TNM: tumor, node, metastasis; AJCC: American Joint Committee on Cancer; UICC: Union for International Cancer Control.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing.

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Stomach cancer TNM staging AJCC UICC 8th edition