Gastric Cancer Stages and Types
Measuring subtypes and stage
After a biopsy or surgery confirms , a pathologist will look at the cell type and perform tests. Additional tests will be ordered to look for cancer spread through the local tissue or to distant organs. Together, these tests provide clues on how to best treat the cancer.
How stages are measured
The refers to whether the cancer has spread beyond the stomach, and if so, where in the body it has spread. Measuring the and subtype of helps doctors decide how to treat it. Doctors measure the of by looking at the following:
- How deep the cancer has grown into the wall of the stomach. Most cancers start in the innermost layer, known as the mucosa, and can grow deeper from there.
- Whether the cancer has spread to nearby , and if so, how many.
- Whether it has spread further, to more distant or other organs elsewhere in the body and, if so, where and how many sites are involved.
Doctors use several tools to determine the .
- Endoscopy, which involves passing a thin scope down into the stomach, to let doctors see the tumor directly and take samples.
- Endoscopic (EUS), which uses a scope with an probe to measure how deeply the cancer has grown into the stomach wall and check nearby .
- Imaging of the chest, abdominal and pelvis, using CT, , and/or PET scans to learn if the cancer has spread to distant organs or .
- For some patients, doctors also recommend a laparoscopy. This is a minor surgery using small incisions and a camera to look directly at the lining of the abdomen (peritoneum) and take fluid samples for testing. This step can find small areas of spread that don’t show up on the scans, and the results can change the recommended treatment plan.
Gastric cancer stages
In , stages range from 0 to 4. information is based on how deeply the cancer has grown into the stomach wall, whether it has spread to nearby and whether it has spread to distant parts of the body.
You may hear your care team refer to your "clinical " or "pathological ." Clinical is based on imaging and endoscopy findings and is used to plan initial treatment, while pathological is based on what is found in the tissue removed during surgery. It's common for the to be refined after surgery, once the pathology findings are known, so don't be alarmed if the you were given initially changes slightly.
Cancers that start at the gastroesophageal junction (GEJ), where the esophagus meets the stomach, or in the cardia, the top part of the stomach closest to the esophagus, are categorized a bit differently. Depending on exactly where and how they grow, these cancers may be staged and treated more like esophageal cancer or more like stomach cancer. Doctors use something called the Siewert classification to describe where these tumors are centered relative to the GEJ, which helps determine which approach applies. Tumors centered mostly on the esophagus side or straddling the junction are generally staged as esophageal cancer, while tumors centered father down into the stomach are staged as . Your care team will use imaging and endoscopy findings to determine which approach applies to your cancer.
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Description |
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0 cancers are non-invasive, also called "in situ." |
Abnormal cells are found only in the innermost lining of the stomach, known as the mucosa. These cells have not grown into deeper layers of the stomach wall. |
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1 |
The cancer has grown into the inner layers of the stomach wall and may have spread to a small number of nearby . It has not spread to distant parts of the body. |
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2 |
The cancer has grown more deeply into the stomach wall or has spread to nearby . It has not spread beyond the stomach and nearby . |
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3 |
The cancer has grown through more layers of the stomach wall, may have reached nearby structures or organs and/or has spread to more nearby . It has not spread to distant parts of the body. |
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4 or |
The cancer has spread to distant parts of the body, such as the liver, lungs, distant or the lining of the abdomen, known as the peritoneum. |
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Subtype |
Description |
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The most common type of . Adenocarcinomas start in glandular cells in the innermost lining of the stomach that make mucus and digestive juices. Most information for is based on . mutations in several genes may increase the risk for gastric , including genes (, , , and ), , , SMAD4 and BMPR1A. |
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Diffuse gastric cancers and signet ring cell carcinomas |
Diffuse-type cancers can spread within the stomach wall and may be harder to see on imaging or endoscopy. Some diffuse gastric cancers have cells called signet ring cells, which look like rings under a microscope because mucus pushes the cell nucleus to one side. These cancers may be called signet ring cell carcinomas. Some diffuse or signet ring gastric cancers are linked to inherited mutations in or, less commonly, CTNNA1. |
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Gastroesophageal junction cancer (GEJ) |
These cancers start where the esophagus meets the stomach. Depending on exactly where the cancer starts and how far it extends into the stomach or esophagus (described using the Siewert classification), doctors may and treat it like or esophageal cancer. |
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Gastrointestinal stromal tumors (GISTs) |
GISTs are uncommon tumors that can start in the wall of the stomach or other parts of the gastrointestinal tract. They are staged and treated differently from gastric . Most GISTs are not inherited, but in rare families, mutations in genes such as KIT, PDGFRA or the SDH genes may be linked to GISTs. |
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Neuroendocrine tumors |
Neuroendocrine tumors start in hormone-making cells. They can begin in the stomach, but they are not usually treated the same way as gastric . Neuroendocrine cancers of the stomach may be caused by inherited mutations in CDKN1B, MEN1, and . |
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Primary gastric |
is a cancer of immune system cells. When starts in the stomach, it is staged and treated differently from gastric . |
Additional tests, such as tests and genetic tests can help guide the choice of or .