T, N, M and Overall classification of upper GI malignant tumours guidance

Adapted from: TNM Classification of Malignant Tumours - 8th Edition UICC

Jump to:

• Oesophageal tumours
• Stomach tumours
• Duodenal tumours

Oesophageal tumours

T stage

• X: Primary tumour cannot be assessed
• 0: No evidence of primary tumour
• is: Carcinoma in situ/high grade dysplasia
• 1a: Tumour invades lamina propria or muscularis mucosae
• 1b: Tumour invades submucosa
• 2: Tumour invades muscularis propria
• 3: Tumour invades adventitia
• 4a: Tumour invades pleura, pericardium, azygos vein, diaphragm, or peritoneum
• 4b: Tumour invades other adjacent structures such as aorta, vertebral body, or trachea

N stage

• X: Regional lymph nodes cannot be assessed
• 0: No regional lymph node metastasis
• 1: Metastasis in 1 to 2 regional lymph nodes
• 2: Metastasis in 3 to 6 regional lymph nodes
• 3: Metastasis in 7 or more regional lymph nodes

M stage

• 0: No distant metastasis
• 1: Distant metastasis

Overall stage

Oesophageal squamous cell carcinoma

Overall	T	N	M
0	is	0	0
1	1	0,1	0
2	2	0,1	0
2	3	0	0
3	1,2	2	0
3	3	1,2	0
4a	4a,4b	Any	0
4a	Any	3	0
4b	Any	Any	1

Oesophageal adenocarcinoma

Overall	T	N	M
0	is	0	0
1	1	0	0
2a	1	1	0
2b	2	0	0
3	1	2	0
3	2	1,2	0
3	3,4a	0,1	0
4a	4b	0,1	0
4a	Any	2,3	0
4b	Any	Any	1

Stomach tumours

T stage

• X: Primary tumour cannot be assessed
• 0: No evidence of primary tumour
• is: Carcinoma in situ: intraepithelial tumour without invasion of the lamina propria, high grade dysplasia
• 1a: Tumour invades lamina propria or muscularis mucosae
• 1b: Tumour invades submucosa
• 2: Tumour invades muscularis propria
• 3: Tumour invades subserosa
• 4a: Tumour perforates serosa
• 4b: Tumour invades adjacent structures a, b
• Note: The adjacent structures of the stomach are the spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine and retroperitoneum.
• Note: Intramural extension to the duodenum or oesophagus is classified by the depth of greatest invasion in any of these sites including stomach.
• Note: Tumour that extends into gastrocolic or gastrohepatic ligaments or into greater or lesser omentum, without perforation of visceral peritoneum, is T3.

N stage

• X: Regional lymph nodes cannot be assessed
• 0: No regional lymph node metastasis
• 1: Metastasis in 1 to 2 regional lymph nodes
• 2: Metastasis in 3 to 6 regional lymph nodes
• 3a: Metastasis in 7 to 15 regional lymph nodes
• 3b: Metastasis in 16 or more regional lymph nodes

M stage

• 0: No distant metastasis
• 1: Distant metastasis

Overall stage

Overall	T	N	M
1	1	2	0
2a	1,2	1,2,3	0
2b	3,4a	0	0
3	3,4a	1,2,3	0
4a	4b	Any	0
4b	Any	Any	1

Duodenal tumours

T stage

• X: Primary tumour cannot be assessed
• 0: No evidence of primary tumour
• is: Carcinoma in situ
• 1a: Tumour invades lamina propria or muscularis mucosae
• 1b: Tumour invades submucosa
• 2: Tumour invades muscularis propria
• 3: Tumour invades subserosa or non peritonealized perimuscular tissue (mesentery or retroperitoneum [1]) without perforation of the serosa
• 4: Tumour perforates visceral peritoneum or directly invades other organs or structures (includes other loops of small intestine, mesentery, or retroperitoneum and abdominal wall by way of serosa; for duodenum only, invasion of pancreas)

[1] The non peritonealized perimuscular tissue is, for jejunum and ileum, part of the mesentery and, for duodenum in areas where serosa is lacking, part of the retroperitoneum.

N stage

• X: Regional lymph nodes cannot be assessed
• 0: No regional lymph node metastasis
• 1: Metastasis in 1 to 2 regional lymph nodes
• 2: Metastasis in 3 or more regional lymph nodes

M stage

• 0: No distant metastasis
• 1: Distant metastasis

Overall stage

Overall	T	N	M
0	is	0	0
1	1,2	0	0
2a	3	0	0
2b	4	0	0
3a	Any	1	0
3b	Any	2	0
4	Any	Any	1