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How is staging determined?
If the biopsy shows that you have stomach cancer, your doctor needs to learn the stage (extent) of the disease to help you choose the best treatment.
Staging is a careful attempt to find out the following:
How deeply the tumor invades the wall of the stomach
Whether the stomach tumor has invaded nearby tissues
Whether the cancer has spread and, if so, to what parts of the body.
When stomach cancer spreads, cancer cells may be found in nearby lymph nodes, the liver, the pancreas, esophagus, intestine, or other organs. Your doctor may order blood tests and other tests to check these areas:
Chest x-ray: An x-ray of your chest can show whether cancer has spread to the lungs.
CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive an injection of dye. The dye makes abnormal areas easier to see. Tumors in your liver, pancreas, or elsewhere in the body can show up on a CT scan.
Endoscopic ultrasound: Your doctor passes a thin, lighted tube (endoscope) down your throat. A probe at the end of the tube sends out sound waves that you cannot hear. The waves bounce off tissues in your stomach and other organs. A computer creates a picture from the echoes. The picture can show how deeply the cancer has invaded the wall of the stomach. Your doctor may use a needle to take tissue samples of lymph nodes.
PET Scan: A small amount of radioactive sugar is injected into a vein. A
short time later, a series of pictures are taken to look for the
radioactivity. Cancer cells use sugar differently that normal tissues and
can concentrate the radioactive sugar. The test is usually done in
conjunction with a CT scan to help define the extent of the stomach cancer.
Laparoscopy: A surgeon makes small incisions (cuts) in your abdomen. The surgeon inserts a thin, lighted tube (laparoscope) into the abdomen. The surgeon may remove lymph nodes or take tissue samples for biopsy.
Sometimes staging is not complete until after surgery to remove the tumor and nearby lymph nodes.
When stomach cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if stomach cancer spreads to the liver, the cancer cells in the liver are actually stomach cancer cells. The disease is metastatic stomach cancer, not liver cancer. For that reason, it is treated as stomach cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease.
These are the stages of stomach cancer:
Stage 0: The tumor is found only in the inner layer of the stomach. Stage 0 is also called carcinoma in situ.
Stage I is one of the following:
The tumor has invaded only the submucosa. Cancer cells may be found in up to 6 lymph nodes.
Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have not spread to lymph nodes or other organs.
Stage II is one of the following:
The tumor has invaded only the submucosa. Cancer cells have spread to 7 to 15 lymph nodes.
Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 1 to 6 lymph nodes.
Or, the tumor has penetrated the outer layer of the stomach. Cancer cells have not spread to lymph nodes or other organs.
Stage III is one of the following:
The tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 7 to 15 lymph nodes.
Or, the tumor has penetrated the outer layer. Cancer cells have spread to 1 to 15 lymph nodes.
Or, the tumor has invaded nearby organs, such as the liver, colon, or spleen. Cancer cells have not spread to lymph nodes or to distant organs.
Stage IV is one of the following:
Cancer cells have spread to more than 15 lymph nodes.
Or, the tumor has invaded nearby organs and at least 1 lymph node.