If you get diagnosed with stomach cancer, your healthcare team will run tests. These tests determine the cancer’s spread, known as staging. Staging shows how much the cancer has grown inside you. It helps choose the best treatment and know your outlook. The main staging system is the AJCC TNM system for stomach cancer. It was updated in 2018.

This system works for most stomach cancers, not those near the gastroesophageal junction. Different types like GISTs and lymphomas have their own staging methods.

Staging is key with stomach cancer. It shows how severe your cancer is. It helps doctors plan the best treatment. They also use the cancer stage when talking about your chances of surviving.

Introduction to Gastric Cancer Staging

Each cancer journey is unique. But, cancers with the same stages often have similar outlooks. They also get treated in similar ways. For stomach or gastric cancer, the American Joint Committee on Cancer (AJCC) TNM system is commonly used. This system was last updated in 2018.

Importance of Cancer Staging

The AJCC TNM system focuses on three main things. It looks at the main tumor’s size, spread to nearby lymph nodes, and distant spread. Knowing these details helps doctors plan the right treatment and give a more accurate prognosis for those with gastric cancer.

Staging Systems for Gastric Cancer

Staging for gastric cancer can happen at various points. It might start with clinical staging. Later, it could include pathological staging after someone has surgery. The stages go from 0 (where there’s no spread) to IV (the cancer has spread to other parts). Lower numbers mean the cancer has spread less.

The TNM Staging System

The TNM system for stomach cancer uses three main facts: the T category, the N category, and the M category. It helps choose the right treatment and outlook for those with gastric cancer.

T Category: Extent of the Primary Tumor

The T category shows the size of the main tumor in the stomach. It looks at how deep it goes and if it’s reached other parts too. Tumors are classified from T1 to T4. A T4 tumor is divided into T4a and T4b by how much it has invaded.

N Category: Lymph Node Involvement

The N category tells us if cancer has spread to lymph nodes close to the stomach. It goes from N0 (no spread) to N3 for major spread.

M Category: Metastasis

The M category looks at if the cancer has spread to far areas like the liver. It’s either M0 (no spread) or M1 (has spread).

Putting T, N, and M together, we get the cancer’s overall stage (from 0 to IV). This system helps doctors plan the best treatment and give an accurate idea of what to expect.

Layers of the Stomach Wall

The stomach wall has four layers. Each layer is critical for gastric cancer growth. Knowing these layers helps understand how stomach cancer spreads.


The mucosa is the stomach wall’s inner layer, where most cancers start. It has epithelial cells, lamina propria, and a muscle layer called muscularis mucosa


Below the mucosa is the submucosa, which supports the stomach wall’s structure.

Muscularis Propria

The muscularis propria is a thick muscle layer. It moves and mixes stomach contents.


The serosa is the stomach wall’s outer layer. It protects the stomach. Advanced cancer can reach these outer layers.


Stage 0: Carcinoma in Situ

Stage 0 gastric cancer is in the very early phase. Abnormal cells appear in the stomach’s inner layer, called mucosa. These cells might turn into cancer and spread to healthy tissues. This phase includes high-grade dysplasia, which means changes in the lining that might become cancerous. The cancer hasn’t reached the deeper stomach layers or other parts like lymph nodes or organs yet.

This early stage, or carcinoma in situ, is like a warning. It shows that cancer may start but hasn’t moved deeper yet. Catching this early and treating it can stop a bigger problem. With quick action, it’s often completely curable. It’s key to preventing more serious types of gastric cancer.

Understanding the stage of cancer is crucial for the right treatment. Also, it helps predict how well the patient might do. Keeping a close eye on stage 0 cancer and treating it early is vital. This gives the best chance for a good outcome.

Stage I Gastric Cancer

Stomach cancer staging helps decide on the right treatment and outlook for each case. The American Joint Committee on Cancer (AJCC) TNM system, last updated in 2018, guides us. It looks at the primary tumor (T), lymph node involvement (N), and distant spread (M).

Stage IA

In stage IA, the tumor starts in the stomach’s inner layer, the mucosa, and might reach the submucosa. It’s still early, with no spread to lymph nodes or distant parts. This means a better chance for those with stage IA gastric cancer.

Stage IB

Stage IB involves two situations. First, the cancer is in the mucosa, maybe in the submucosa, and has moved to 1 or 2 nearby lymph nodes. Or, it’s in the mucosa and reached the stomach muscle. Even with this spread, stage IB has a good prognosis compared to more advanced stages.

Stage II Gastric Cancer

Gastric cancer in stage II falls into either IIA or IIB. Doctors look at the tumor’s size and nearby lymph nodes. This tells them how to treat it and what might happen.

Stage IIA

For stage IIA cancer, the tumor might have spread to different areas. It could be in the stomach wall’s submucosa layer. Or it may have reached to 1 or 2 nearby lymph nodes. There’s also a chance it got to the subserosa layer without lymph node spread.

Stage IIB

Stage IIB shows more possibility. The cancer might be in the stomach wall’s submucosa. And it’s around 7 to 15 lymph nodes. Or it has moved to the muscle layer and 3 to 6 lymph nodes. It could even affect the subserosa layer and 1 or 2 lymph nodes. In rare cases, it goes through the serosa, the stomach’s outer layer.

Staging gastric cancer right is key. It helps in choosing the best treatment mix. This mix usually includes surgery, chemo, and sometimes radiation. Knowing about stage II cancer lets doctors and patients plan better. They aim for the best results together.

Stage III Gastric Cancer

Stage III gastric cancer is a more advanced form. At this stage, the cancer has spread a lot in the stomach and to nearby lymph nodes. It’s split into IIIA, IIIB, and IIIC, each affecting treatment and outlook differently.

Stage IIIA

In stage IIIA, cancer could have moved into the muscle layer or beyond of the stomach. It might have reached 7 to 15 nearby lymph nodes. Or it could have made it to the subserosa and impacted 3 to 6 nodes. Sometimes it extends to the serosa, affecting 1 to 6 nodes. It might also affect the spleen or pancreas.

Stage IIIB

IIIB stage sees the cancer getting farther, possibly to the submucosa or the muscle layer. It could involve 16 or more nearby nodes. Or, it might have reached the subserosa or serosa affecting 7 to 15 nodes. It may also spread to some organs and 1 to 6 nodes.

Stage IIIC

IIIC is the most serious in stage III. Here, it hits the subserosa or serosa and affects 16 or more nodes. It could have also spread to organs, involving 7 or more lymph nodes nearby.


As gastric cancer moves to later stages, it gets more complicated and severe. IIIA, IIIB, and IIIC often need a mix of treatments like surgery and chemo. The stage plays a big role in the treatment plan and outlook for each patient.

Stage IV Gastric Cancer: Metastatic Disease

In stage IV, gastric cancer spreads to the lungs, liver, and other parts. This stage is called metastatic stomach cancer. Cancer spreads when cells move from the tumor to other places in the body. The new tumor is the same cancer type as the first one.

Stage IV is the most advanced stage of stomach cancer. The cancer has spread far from the stomach. Treatment usually includes chemotherapy, radiation, and care to help with symptoms. New treatments like targeted therapy and immunotherapy are helping some patients.

Doctors use many treatments for stage IV gastric cancer. They might use chemotherapy and radiation. Sometimes, surgery helps by removing the main tumor. The best treatment plan depends on the patient’s health and cancer details.

Although stage IV cancer is hard, there’s hope in research and new treatments. By keeping up with the latest news on cancer care, patients can work with their doctors for the best solutions.

gastric cancer staging

Gastric cancer, or stomach cancer, is staged at different times during treatment. Doctors look at exam results, biopsies, and imaging. They find the initial stage this way.

Then, if a surgery happens, the surgical stage is known. This stage might differ from the first because surgery sees more. The cancer might have gone further than thought from the first tests.

Clinical Staging vs. Pathological Staging

The first stage, called the clinical stage, helps plan treatment. It’s based on exams and tests. But, the exact stage becomes clearer after surgery, from closer looks at the cancer and lymph nodes.

This more detailed view helps refine the treatment plan. It shows the real spread of the cancer more accurately.

Neoadjuvant Treatment and Restaging

Sometimes, before surgery, you might have chemo or radiation. This is neoadjuvant treatment. It aims to shrink the tumor. After this, doctors may restage the cancer to see its new state.

Knowing the stage at different times is key. It guides the best treatment plan for each person.

Recurrent Gastric Cancer

Recurrent stomach cancer means it has come back after treatment. It may appear in the stomach again, or spread to areas like the liver, lung, or bone. Doctors will do tests to find where the cancer is back. The treatment for this will depend on its location.

Research shows 42% of those treated for gastric adenocarcinoma saw the cancer return. Most recurrences happened within two years, with different patterns—like around the stomach (54%), in the belly (29%), or far away as metastases (51%).

For those with advanced cases, distant metastases was the most common recurrence. It affected 42.6% of patients, while 36.8% saw it in the peritoneum, and 33.8% near the stomach. Within 5 years, nearly all patients faced a recurrence.

Recurrence PatternPercentage of Patients
Distant Metastasis (DM)42.6%
Peritoneal Recurrence (PR)36.8%
Locoregional Recurrence (LR)33.8%

Key risk factors for recurrence are the surgery’s depth, cancer spread, and number of cancer-free lymph nodes. Multiple studies pinpoint different main risk factors, based on where the cancer recurs. For instance, LR’s risk rises with surgery’s breadth, while DM’s main risk is how far the cancer spread to lymph nodes.

Being fast in finding and treating recurrent gastric cancer is vital. Extra treatment and watching patients carefully are big helpers in fighting this disease effectively.


Symptoms and Risk Factors of Gastric Cancer

Early Signs and Symptoms

The first signals of gastric cancer are often light at the start. They could be simple things like having trouble digesting, or finding it hard to swallow. You might notice feeling full quickly after meals or shedding pounds without trying. These signs can be easy to miss in the beginning stages of the illness.

Risk Factors for Gastric Cancer

There are many things that can up your chances of getting gastric cancer. Having the Helicobacter pylori bacteria in your stomach, living off of mostly smoked, salted, and pickled foods, and smoking increases these risks.

If you also have pernicious anemia, a family history of stomach cancer, or suffer from long-term stomach inflammation, be extra cautious. Even a history of GERD can play a part. But, there’s good news. Things like eating well and staying active can lower your chances of getting this type of cancer.

Treatment Options for Gastric Cancer

Patients with gastric cancer are given several treatments to consider. Each has its own benefits. It’s important to understand these to create a plan with your healthcare team. This plan will match your needs and cancer stage.


Surgery is key in treating gastric cancer. The aim is to cut out the tumor and nearby lymph nodes. This method gives the best hope for a long life, mainly for earlier stages with less spread. Surgery might remove part (subtotal) or all (total) of the stomach.


Chemotherapy helps even without surgery. It includes drugs taken to shrink the tumor before surgery. Or it’s used after surgery to destroy any leftover cancer cells. Sometimes, it’s the main way to tackle the cancer if surgery isn’t an option.

Radiation Therapy

Radiation therapy uses high-energy waves to fight cancer. It’s often paired with chemo. Or used alone to improve symptoms in advanced cases. It can be before or after surgery, or when surgery isn’t an option.

Targeted Therapy

Targeted therapies focus on specific cancer cell changes. They are used when certain biomarkers are found. These treatments can be added to chemo or be a main treatment for late stages or recurring cancer.

Talking with your cancer specialists is crucial. They guide you in picking the best treatment for your cancer stage and health. They’ll keep an eye on your progress and change your plan if needed.


Gastric cancer staging helps decide the right treatment and outlook for each patient. The TNM system looks at the main tumor, nearby lymph nodes, and distant spread. Knowing the different stages of gastric cancer, from early to advanced, is key. It helps doctors and patients choose the best plan.

It’s important to keep up with new gastric cancer staging and treatments. This way, patients can work with their doctors for the top results. The latest rules provide better staging for all gastric cancers. They also know more about certain types of cancer, improving care.

Studies also looked at the impact of some cancer features, like free tumor cells and lymph nodes. They found the number of metastatic lymph nodes can affect survival. All this helps doctors make better and personalized treatment plans for those with gastric cancer.


What is the staging process for gastric cancer?

A: Stomach cancer (gastric cancer) diagnosis leads to staging. Doctors examine if cancer has spread. They check how far it has spread. Staging describes cancer’s extent and helps plan treatment.

What is the TNM staging system for gastric cancer?

The AJCC TNM system, updated in 2018, stages stomach cancer. It uses T, N, and M categories. T shows tumor size, N looks at lymph nodes, and M tracks distant metastasis.

What are the different stages of gastric cancer?

Stage 0 is cancer in place. Stages I and II spread slightly. Stage III cancers spread further. Stage IV means cancer has reached far places.

What are the early signs and symptoms of gastric cancer?

Gastric cancer’s signs include indigestion and trouble swallowing. Feeling full fast and losing weight without trying are also signs.

What are the risk factors for gastric cancer?

Infection with Helicobacter pylori and certain diets raise risk. Smoking and a type of anemia make risk higher.

What are the treatment options for gastric cancer?

Options include surgery, chemo, radiation, and targeted therapy. Surgeons aim to remove the entire tumor. Chemo and radiation support this, used before or after surgery.

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