I. Treatment flow of gastric cancer
This is the general procedure formulated by the Ministry of Health Gastric Cancer Treatment Standard (2011 version), not surgery upon admission. The standardized treatment is still far from enough in our country.
II. Staging of gastric cancer
Nowadays, TNM staging is mostly used for tumor staging. T—- refers to the depth of primary tumor infiltration into stomach wall, N—- refers to lymph node metastasis, and M—- refers to distant metastasis, including left supraclavicular lymph node metastasis, hematogenous metastasis and abdominal implantation. TNM staging is a comprehensive staging of the disease combining these three aspects.
The common one now is the 2010 AJCC TNM staging of gastric cancer (7th edition), which divides gastric cancer into stages I, II, III and IV. Stage I is early gastric cancer, and stages II, III and IV are collectively called progressive gastric cancer. It is hard to read for people who are not in the medical industry. It is okay to not understand, just ask your doctor.
After all the preoperative examinations are completed, the doctor will evaluate the condition of the gastric cancer patient and there is usually a clinical stage, which is written in the medical record as cTNM stage. If the patient undergoes surgery, the surgical specimen will be examined, and after the results are available, there will be a pathological stage (pTNM), which is the most accurate stage.
Patients and families are most concerned about “how long I can live”, a question that doctors have no way to answer. There is no way for doctors to predict the survival time of each patient, all the information is from literature analysis, and the 5-year survival rate is commonly used as an indicator to measure the outcome. 5-year survival rate of stage I gastric cancer can exceed 90%. With the correct treatment modality, the treatment outcome is directly related to the stage, and the earlier the detection and treatment, the better the outcome.
Attachment: 2010 AJCC TNM Staging of Gastric Cancer (7th edition)
Primary tumor(T)
TX: Primary tumor cannot be evaluated
T0: No tumor found in the resected specimen
Tis: carcinoma in situ: the tumor is located in the epithelium and does not invade the mucosal lamina propria
T1a: tumor invaded mucosal lamina propria or mucosal muscle layer
T1b: tumor invaded the submucosal layer
T2: Tumor invades the intrinsic muscular layer
T3: tumor penetrates the connective tissue of the subplasma layer without invading the dirty peritoneum or adjacent structures
T4a: tumor invaded the plasma membrane (visceral peritoneum)
T4b: tumor invaded adjacent tissue structures
Regional lymph nodes(N)
NX: Regional lymph nodes could not be evaluated
N0: No metastasis in regional lymph nodes
N1: 1-2 regional lymph nodes with metastasis
N2: 3-6 regional lymph nodes with metastasis
N3: 7 and more regional lymph nodes with metastasis
N3a: 7-15 regional lymph nodes with metastasis
N3b: 16 (or more) regional lymph nodes with metastasis
Distant metastasis (M)
M0: no distant metastasis
M1: presence of distant metastasis
Stage 0 TisN0M0
Stage IA T1N0M0
Stage IB T1N1M0, T2N0M0
Stage IIA T1N2M0, T2N1M0, T3N0M0
Phase IIB T1N3M0, T2N2M0, T3N1M0, T4aN0M0
Phase IIIA T2N3M0, T3N2M0, T4aN1M0
Phase IIIB T3N3M0, T4aN2M0, T4bN0M0, T4bN1M0
Phase IIIC T4aN3M0, T4bN2M0, T4bN3M0
Phase IV Any T, any N, M1