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Stomach Cancer: Stages

What does the stage of a cancer mean?

The stage of a cancer is how much and how far it has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is.

Scans can also show if the cancer has spread to nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding on treatment.

The place where cancer starts is called the primary site. Stomach cancer can spread from the primary site (in the stomach) to other parts of your body. Cancer that has spread is called metastatic cancer. When a cancer spreads, it’s said to have metastasized.

To better understand staging, it helps to know the names of the layers that make up the stomach wall. From the inside to the outside, the layers are:

  • Mucosa (the innermost lining)

  • Submucosa

  • Muscularis propria (the muscle layer)

  • Subserosa

  • Serosa (the lining that covers the outside of the stomach)

Stomach cancer starts in the inner lining, or mucosa, of the stomach. As it grows, it can grow through the layers of the wall of the stomach. Then it can spread (metastasize) to other parts of the body.

The TNM system for stomach cancer

The most commonly used system to stage stomach cancer is the TNM system from the American Joint Committee on Cancer (AJCC). Staging is very complex. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

The first step is to find the value for each part of the TNM system. Here's what the letters stand for in the TNM system:

  • T tells how far the main tumor has spread into the lining of your stomach and nearby tissue.

  • N tells if the lymph nodes near the primary tumor have cancer in them.

  • M tells if the cancer has spread ( metastasized) to distant organs in the body, like the liver, lungs, or lining of your belly or abdomen (called the peritoneum).

Numbers or letters after T, N, and M provide more details about each of these factors. There are also two other values that can be assigned:

  • X means the provider does not have enough information to tell the extent of the primary tumor, or if the lymph nodes have cancer cells in them.

  • 0 means no sign, such as no sign of cancer in lymph nodes (N0).

What are the stage groupings of stomach cancer?

The T, N, and M values from the TNM system are used to put these cancers into stage groupings. These groupings give an overall description of your cancer. A stage grouping can have a value of 0 or Roman numerals I (1), II (2), III (3), or IV (4). The higher the number, the more advanced your cancer is.

These are the stage groupings of stomach cancer and what they mean:

Stage 0 (also called carcinoma in situ). Very abnormal looking cells (called high grade dysplasia) that will likely become cancer or cancer is found, but only in the mucosa.

Stage I. The cancer has not spread to distant organs. But it has grown in 1 of these ways:

  • Stage IA. The cancer has spread deeper into the stomach wall to the submucosa layer under the mucosa. But it's not in the lymph nodes.

  • Stage IB. This stage can be either of these:

    • The cancer has grown into layers of the wall deeper than the mucosa and has spread to 1 or 2 nearby lymph nodes.

    • The cancer has grown into the muscle layer of the stomach (the muscularis propria). But it has not spread to lymph nodes.

Stage II. The cancer has not spread to distant organs. But it has grown in 1 of these ways:

  • Stage IIA. This stage can be any of these:

    • The cancer has spread through the lining (mucosa) to the submucosa and has spread to 3 to 6 nearby lymph nodes.

    • The cancer has spread to the muscle layer of the stomach (muscularis propria) and has spread to 1 or 2 nearby lymph nodes.

    • The cancer has spread through all the layers of the stomach but not through the lining outside the stomach (the serosa). It has not spread to lymph nodes.

  • Stage IIB. This stage can be any of these:

    • The cancer has grown into the submucosa and has spread to 7 to 15 nearby lymph nodes.

    • The cancer has grown into the muscle layer of the stomach (the muscularis propria) and has spread to 3 to 6 nearby lymph nodes.

    • The cancer has gone through all the layers of the stomach, but not through the lining outside the stomach (the serosa). It has spread to 1 or 2 nearby lymph nodes.

    • The cancer has grown through all the layers of the stomach, including the serosa. But it’s not in nearby lymph nodes or other organs or tissues.

Stage III. The cancer is not in distant organs and has grown in 1 of these ways:

  • Stage IIIA. This stage can be any of these:

    • The cancer has grown into the muscle layer of the stomach (the muscularis propria) and has spread to 7 to 15 nearby lymph nodes.

    • The cancer has grown through the layers of the stomach but not through the lining outside the stomach (the serosa). It has spread to 3 to 6 nearby lymph nodes.

    • The cancer has grown through all the layers of the stomach and is in the serosa or the lining of your belly (called the peritoneum). It's in 1 to 6 nearby lymph nodes, but it’s not in any other nearby organs or tissues.

    • The cancer has gone through all the layers of the stomach, including the serosa, and into nearby organs and tissues (like the intestines, spleen, liver, or kidney). It has not spread to nearby lymph nodes.

  • Stage IIIB. This stage can be any of these:

    • The cancer has grown through the inside layers as far as the muscle layer (muscularis propria) of the stomach and has spread to 16 or more nearby lymph nodes.

    • The cancer has grown into the subserosa layer of the stomach but not the serosa. It has spread to 7 to 15 nearby lymph nodes.

    • The cancer has gone through all the layers of the stomach and is in the serosa or the lining of your belly (called the peritoneum). It's in 7 to 15 nearby lymph nodes, but it’s not in any other nearby organs or tissues.

    • The cancer has gone through all the layers of the stomach and into nearby organs and tissues (like the intestines, spleen, liver, or kidney). It has spread to 1 to 6 nearby lymph nodes.

  • Stage IIIC. This stage can be any of these:

    • The cancer has grown as far as the serosa layer of the stomach and has spread to 16 or more nearby lymph nodes, but it’s not in any other nearby organs or tissues.

    • The cancer has gone through all the layers of the stomach and into nearby organs and tissues (like the intestines, spleen, liver, or kidney). It has spread to 7 or more nearby lymph nodes.

Stage IV. The cancer has grown into any layers of the stomach and may or may not have spread to lymph nodes. It has spread beyond the stomach to distant parts of the body, such as the lungs, liver, or brain.

Talking with your healthcare provider

Once your cancer is staged, talk with your healthcare provider about what the stage means for you. Ask any questions and talk about your concerns.

Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: L Renee Watson MSN RN
Online Medical Reviewer: Todd Gersten MD
Date Last Reviewed: 4/1/2021
© 2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare provider's instructions.