Staging Of Stomach Cancer

The stomach wall has 4 major layers that will be mentioned below for staging purposes. The cancer starts in the superficial lining called "mucosa", which is the first layer. The next layer below it is called "submucosa". It contains lots of vessels and lymphatic drainage channels that become important for the spreading of stomach cancer. The third layer is the muscle layer (=medical term "muscularis propria"), which contracts when you feel a "knot in your stomach".

The fourth layer on the outside of the stomach is called "serosa". It is a shiny membrane attached to the outside of the stomach thus facing the abdominal cavity. This layer becomes inflamed when cancer invades it, becomes sticky and adheres to neighboring structures such as the transverse colon or the small intestine. This explains how fistula to neighboring organs form in the advanced stages of stomach cancer.

Here is a simplified summary of the staging for stomach cancer:

*Staging of stomach cancer*
Stage:	Description of extent of cancer:
I	confined to mucosa and submucosa
II	suspected serosa invasion and perigastric LN *
III	confirmed serosa invasion, LN around arteries of stomach, liver and spleen.
IV	adjacent organs involved, LN as above and also in area of pancreas, back of upper abdomen and paraaortic region. Liver metastases also present

* LN stands for lymph node metastases

Briefly, stage I is confined to the mucosa lining and at the most invasion into the submucosa layer. With stage II the invasion likely goes through the whole stomach wall, but is still confined to a local area.

With stage III the tumor cells have invaded the serosa layer and have migrated further through the lymphatic system along the arteries of the stomach, liver and spleen. Spread has occurred even more with stage IV, where the cancer has metastasized into the liver and into the lymph glands of the upper abdomen. At the later stages of stage IV there can be metastases in every major organ system through spread via the blood stream.

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Stomach cancer

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter on Cancer of the stomach.

2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on Cancer of the stomach.

3. J Sun et al. Eur J Cancer Prev 2001 Feb;10(1):61-67.

4. SS Mirvish et al. Nutr Cancer 1998;31(2):106-110.

5. JM van Maanen et al. Cancer Detect Prev 1998;22(3):204-212.

6. JM van Maanen et al. Environ Health Perspect 1996 May;104(5):522-528.

7. B. Sears: "The age-free zone".Regan Books, Harper Collins, 2000.

8. B. Sears: "Zone perfect meals in minutes". Regan Books, Harper Collins, 1997.

9. K Murakami et al. Am J Clin Pathol 2001 Feb;115(2):224-34.

10. Y Tsubono et al. N Engl J Med 2001 Mar 1;344(9):632-636.

Last Modified: Jan. 27, 2008