TNM classification of gastric tumours
TNM classification
T-primary Tumours
M-DIstant Metastasis
TX
Primary tumour cannot be assessed
MX
Distant metastasis cannot be assessed
T0
No evidence of primary tumour
M0
No distant metastasis
Tis
Carcinoma in situ: intraepithelial tumour without
M1
Distant metastasis
invasion of the lamina propria
T1
Tumour invades lamina propria or submucosa
T2
Tumour invades muscularis propria or subserosa2
T3
Tumour penetrates serosa(visceral peritoneum)
without invasion of adjacent structure2,3,4,5
T4
Tumour invades adjacent structure2,3,4,5
Stage Grouping
Stage 0
Tis
N0
M0
N-Regional Lymph Nodes
Stage IA
T1
N0
M0
NX
Regional lymph nodes cannot be assessed
Stage IB
T1
N1
M0
N0
No regional lymph node metastasis
T2
N0
M0
N1
Metastasis in 1 to 6 regional lymph nodes
T1
N2
M0
N2
Metastasis in 7 to 15 regional lymph nodes
T2
N1
M0
N3
Metastasis in more than 15 regional lymph node
T3
N0
M0
T2
N2
M0
T3
N1
M0
T4
N0
M0
Stage IIIB
T3
N2
M0
Stage IV
T4
N1,N2,N3
M0
T1,T2,T3
N3
M0
Any T
Any N
M1
Stage II
Stage IIIA
1
1,66. This classification applies only to carcinomas.
2
A help desk for specific questions about the TNM classification is available at
http://tnm.uicc.org
3
A tumour may penetrate muscularis propria with extension into the gastrocolic or gastrohepatic
ligaments or the greater and lesser omentum without perforation of the visceral peritoneum
covering these structures. In this case, the tumour is classified as T2. If these is perforation of
the visceral peritoneum covering the gastric ligaments or omenta, the tumour is classicfied as T3.
4
The adjacent structures of the stomach are the spleen, transverse colon, liver, diaphragm,
pancrease, abdominal wall, adrenal gland, kidney, small intestin, and retroperitoneum.
5
Instramural extension to the duodenum or oesophagus is classifed by the depth of greatest
invasion in any of these sites including stomach.
Lymph node groups by location of tumor
1군
2군
3군
원격전이
LMU
1, 2, 3, 4sa
7, 8a, 9, 10,
8p, 12bp, 13,
14a, 15, 16a1
MUL
4sb, 4d, 5,
11p, 11d, 12a,
16a2, 16b1
16b2, 17, 18,
MLU
6
14v
19, 20
110, 111, 112
3, 4d, 5, 6
1, 7, 8a, 9, 11p
4sa, 8p, 12bp,
2, 4sa, 10, 11d,
12a, 14v
13, 16a2, 16b1
14a, 15, 16a1,
UML
LD/L
16b2, 17, 18, 19,
20, 110, 111, 112
LM
1, 3, 4sb, 4d
7, 8a, 9, 11p,
2, 4sa, 8p, 10,
13, 14a, 15, 16a1,
M
5, 6
12a
11d, 12bp, 13,
16b2, 17, 18, 19,
14v, 16a2, 16b1
20, 110, 111, 112
8p, 12bp, 14v,
13, 14a, 15, 16a1,
ML
MU
1, 2, 3, 4sa
7, 8a, 9, 10,
UM
4sb, 4d, 5, 6
11p, 11d, 12a
U
E
16a2, 16b1,
16b2, 17, 18, 110,
19, 20
111, 112
1, 2, 3, 4sa
4d, 7, 8a, 9, 10,
5, 6, 8p, 12a,
13, 14v, 14a, 15,
4sb
11p, 11d
12bp, 16a2,
16a1, 16b2, 17,
16b1, 19, 20
18, 110, 111, 112
20
19
110, 111, 112
No. 1
Right paracardial LN
No. 2
Left paracardial LN
No. 3
LN along the lesser curvature
No. 4sa
LN along the short gastric vessels
No. 4sb
LN along the left gastroepiploic vessels
No. 4d
LN along the right gastroepiploic vessels
No. 5
Suprapyloric LN
No. 6
Infrapyloric LN
No. 7
LN along the left gastric artery
No. 8a
LN along the common hepatic artery (Anterosuperior group)
No. 8p
LN along the common hepatic artery (Posterior group)
No. 9
LN around th celiac artery
No. 10
LN at the splenic hilum
No. 11p
LN along the proximal splenic artery
No. 11d
LN along the distal splenic artery
No. 12a
LN in the hepatoduodenal ligament (along the hepatic artery)
No. 12b
LN in the hepatoduodenal ligament (along the bile duct)
No. 12p
LN in the hepatoduodenal ligament(behind the portal vein)
No. 13
LN on the posterior surface of the pancreatic head
No. 14v
LN along the superior mesenteric vein
No. 14a
LN along the superior mesenteric artery
No. 15
LN along the middle colic vessels
No. 16a1
Ln in the aortic hiatus
No. 16a2
LN around the abdominal aorta (from the upper margin of the celiac trunk to the lower
margin of the left renal vein)
No. 16b1
LN around the abdominal aorta (from the upper margin of the left renal vein to the
upper margin of the inferior mesenteric artery)
No. 16b2
LN around the abdominal aorta (from the upper margin of the inferior mesenteric artery
to the aortic bifurcation)
No. 17
LN on the anterior surface of the pancreatic head
No. 18
LN along the inferior margin of the pancreas
No. 19
Infradiaphragmatic LN
No. 20
LN in the esophageal hiatus of the diaphragm
No. 110
Paraesophageal LN in the lower thorax
No. 111
Supradiaphragmatic LN
No. 112
Posterior mediastinal LN