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- Stomach Cancer Stages
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View Clinical TrialsStomach Cancer Stages
A cancer’s stage refers to how large the primary tumor is and how far the cancer has spread in the patient’s body. Knowing the stage helps the care team understand the disease and develop an appropriate treatment plan. It also impacts the patient’s prognosis, or chance for a successful treatment.
TNM stages
The TNM staging system is used for most cancers.
TNM staging describes cancer based on three main factors:
- The size of the primary tumor (T) and whether it has invaded nearby tissues.
- The cancer’s spread to nearby lymph nodes (N).
- Whether the cancer has metastasized (M), or spread, to distant parts of the body.
Each TNM factor is assigned a number that reflects the extent of the cancer. Tumors (T) are scored between 1-4, nodes (N) 1-3, and metastasis (M) 0-1.
After all diagnostic and staging procedures are performed, your doctor should know the TNM stage of your cancer and be able to explain how this stage impacts your treatment and prognosis.
0 to IV stages
Often, TNM staging can be simplified into stages four stages (I-IV). For some cancers, there is also a stage 0. Larger numbers mean the cancer is more advanced and is generally more difficult to treat.
- Stage 0 reflects the presence of abnormal cells that have not spread to tissue that is immediately nearby. Stage 0 is considered precancerous, though it could become cancer in the future. This stage is also called “in-situ,” which means “in its original place.” Not all cancers have a stage 0.
- Stage I cancers are typically small and confined to the area where they began.
- Stage II and Stage III cancers have spread to nearby tissue and/or lymph nodes.
- Stage IV cancer has spread to distant areas of the body. This is also called metastatic cancer. Stage IV cancer often cannot be cured, but frequently can be managed like a chronic disease.
Stomach cancer 0-IV stages
Source: National Cancer Institute
Stage 0 stomach cancer
Stage 0 refers to carcinoma in situ. This means that abnormal cells are found in the mucosa. These abnormal cells may become cancer and spread into nearby normal tissue.
Stage I stomach cancer
Stage I is divided into stages IA and IB.
- In stage IA,
- cancer has formed in the mucosa and may have spread to the submucosa.
- In stage IB,
- cancer has formed in the mucosa and may have spread to the submucosa and has spread to 1 or 2 nearby lymph nodes; or
- cancer has formed in the mucosa and has spread to the muscle layer.
Stage II stomach cancer
Stage II is divided into stages IIA and IIB.
- In stage IIA,
- cancer may have spread to the submucosa and has spread to 3 to 6 nearby lymph nodes; or
- cancer has spread to the muscle layer and to 1 or 2 nearby lymph nodes; or
- cancer has spread to the subserosa.
- In stage IIB,
- cancer may have spread to the submucosa and has spread to 7 to 15 nearby lymph nodes; or
- cancer has spread to the muscle layer and to 3 to 6 nearby lymph nodes; or
- cancer has spread to the subserosa and to 1 or 2 nearby lymph nodes; or
- cancer has spread to the serosa.
Stage III stomach cancer
Stage III is divided into stages IIIA, IIIB, and IIIC.
- In stage IIIA,
- cancer has spread to the muscle layer and to 7 to 15 nearby lymph nodes; or
- cancer has spread to the subserosa and to 3 to 6 nearby lymph nodes; or
- cancer has spread to the serosa and to 1 to 6 nearby lymph nodes; or
- cancer has spread to nearby organs, such as the spleen, colon, liver, diaphragm, pancreas, abdomen wall, adrenal gland, kidney, or small intestine, or to the back of the abdomen.
- In stage IIIB,
- cancer may have spread to the submucosa or to the muscle layer and has spread to 16 or more nearby lymph nodes; or
- cancer has spread to the subserosa or to the serosa and has spread to 7 to 15 nearby lymph nodes; or
- cancer has spread to nearby organs, such as the spleen, colon, liver, diaphragm, pancreas, abdomen wall, adrenal gland, kidney, or small intestine, or to the back of the abdomen. Cancer has also spread to 1 to 6 nearby lymph nodes.
- In stage IIIC,
- cancer has spread to the subserosa or to the serosa, and to 16 or more nearby lymph nodes; or
- cancer has spread to nearby organs, such as the spleen, colon, liver, diaphragm, pancreas, abdomen wall, adrenal gland, kidney, or small intestine, or to the back of the abdomen. Cancer also has spread to 7 or more nearby lymph nodes.
Stage IV stomach cancer
In stage IV, cancer has spread to other parts of the body, such as the lungs, liver, distant lymph nodes, and the tissue that lines the abdomen wall.
‘How I knew I had stomach cancer’: Six survivors share their symptoms
Abdominal pain, heartburn and fatigue can sometimes be symptoms of stomach cancer. But they can also be the result of overeating, untreated acid reflux or insomnia.
So, how do you know which category your symptoms fall into and when to see a doctor?
“Most stomach cancers don’t cause any symptoms until they’re more advanced, and they can mimic indigestion or reflux,” says Paul Mansfield, M.D., a surgical oncologist who specializes in stomach cancer and other gastrointestinal cancers. “So, it’s easy to dismiss the signs of stomach cancer as having overeaten or eaten the wrong foods or putting on too much weight. However, anything that changes and persists is usually something to get checked out, especially if it lasts for more than two or three weeks.”
Here’s how six of our patients knew they had stomach cancer, in their own words.
Abdominal pain
“I started having a burning, gnawing pain in the center of my stomach,” says Janine Somma, a stay-at-home mom from New York who was only 28 when she was diagnosed with early-stage stomach cancer. “I went to my GI doctor, but he brushed it off as acid reflux and prescribed an antacid.”
“I had some really weird abdominal pains that stretched up and across my chest,” adds Erica Hunkin, a psychiatric nurse practitioner from Georgia who was 35 when she was diagnosed with stage I stomach cancer. “I thought it was heart-related, but a stress test and EKG didn’t find anything.”
Heartburn and indigestion
“I started getting really bad heartburn after eating almost anything,” recalls Craig Galati, an architect from Nevada who was 62 when he was diagnosed with stage III stomach cancer. “That was really surprising because I don’t usually have heartburn. Sometimes, I’d also develop this really weird hiccup when I’d eat too much or too quickly. It turned out I had a golf-ball-sized tumor at the very top of my stomach, right near the flap.”
Fatigue
“I was under a lot of stress right before I was diagnosed,” remembers Sylvia Coe, a retired art gallery director in Florida who was 54 at the time. “So, I attributed my fatigue, shortness of breath and dizziness to that. But when I walked into a restaurant for brunch on Easter Sunday and swooned, I knew something was wrong. It turned out to be a tumor that was bleeding heavily.”
“Fatigue is what finally drove me to the doctor,” adds Ralph Lilja, a rancher and realtor from Kansas who was 57 when he was diagnosed with stage IV stomach cancer. “It got to where I couldn’t hardly go up the stairs. My local physician discovered I was anemic due to blood loss from the tumor. Once he started giving me transfusions, I felt better.”
Unusual hunger pangs
“I remember trying to catch some sleep between my shifts at the hospital and feeling hungry, even though I knew I shouldn’t be,” says Joe Einspahr, M.D., a hospitalist from Nebraska who was 55 when he was diagnosed with stage II stomach cancer. “I’d only notice it during those quiet times, but it was a nagging sensation, just a gnawing hunger, and eating never seemed to impact it.”
Watch for these red-flag stomach cancer symptoms
Other stomach cancer symptoms include unintentional weight loss, feeling full quickly, and losing your appetite. But if you experience any of the following, seek medical attention right away.
- Vomiting blood: Any amount is considered too much.
- Bloody stools: These are often described as looking black or tarry and smelling like steel or metal.
- Severe abdominal pain: Anything you might rank as an “8,” “9” or higher on a scale of 1 to 10 is considered severe.
“Throwing up can also be a sign of an obstruction or blockage, which is usually associated with advanced disease,” notes Mansfield. “So, if you can’t keep anything down or you vomit and see something you ate three days ago, go to the emergency room immediately.”
The key to early detection: listening to your body
Most patients Mansfield sees in his practice don’t have any symptoms of stomach cancer. That’s because they usually come to him only for risk-reducing stomach surgery after having learned they carry the CDH1 genetic mutation.
“But a big part of early detection is just listening to your body,” he notes. “Some people will have symptoms and ignore them. Others are very in tune with themselves and seek help right away at the first signs of trouble. A study out of England showed that just being curious and checking out patients with an endoscopic exam the first time they have symptoms can significantly increase the percentage of patients found with early gastric cancer.”
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