The 5 Stages of Stomach Cancer

With gastric cancer, finding out if it has spread to lymph nodes is key.

A diagram showing stomach cancer.
A diagram showing stomach cancer. SCIEPRO/Getty Images

The diagnosis is stomach cancer, now what? Time to pinpoint whether the cancer cells have spread within the stomach or traveled to other parts of the body. Knowing this information will determine the stage of the disease and help determine your treatment plan.

The Staging Process

To find out where the cancer resides in you body, you will have to undergo some tests. The following six tests help gather the information needed to determine what stage your gastric cancer is in.

ß-hCG, CA-125, and CEA assays: These tests measure the levels of ß-hCG (beta-human chorionic gonadotropin), CA-125, and CEA (carcinoembryonic antigen) in the blood. These substances are released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, they can be a sign of gastric cancer or other conditions.

Chest X-ray: You may be most familiar with this test. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. This one targets the organs and bones inside the chest.

Endoscopic ultrasound: A thin, lighted tube called an endoscope is inserted into the body and creates high-energy sound waves — also known as ultrasound — that bounce off internal tissues or organs, and makes echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.

CT scan or CAT scan: Imagine a computer linked to an x-ray machine taking series of detailed pictures of areas inside the body from different angles. Add dye that may be injected into a vein or swallowed to help the organs or tissues show up more clearly, and that's a CT scan. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Laparoscopy: Small cuts or incisions are made in the wall of the abdomen and a laparoscope — a thin, lighted tube — is inserted into one of the incisions to look at the organs inside the abdomen and check for signs of disease. Other instruments may be inserted through the same, or other, incisions to remove lymph nodes or take tissue samples for biopsy.

PET scan: This procedure, called a positron emission tomography scan or PET scan, finds malignant tumor cells in the body by injecting a small amount of radionuclide glucose or sugar, is injected into a vein. Then a PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.

The Stages of Gastric Cancer

After undergoing the procedures above, your physician will determine which of the following stages your stomach cancer will fall into.

Stage 0 (aka Carcinoma in Situ): Cancer found only in the inside lining of the mucosal, or innermost, layer of the stomach wall is stage 0.

Stage I: Depending on where the cancer has spread determines whether a stage I gastric cancer is either a stage IA or a stage IB. When cancer has spread completely through the mucosal, or innermost, layer of the stomach wall, it a stage IA gastric cancer.

Stage IB is when the cancer has spread completely through the mucosal layer of the stomach wall and is found in up to 6 lymph nodes near the tumor; or to the muscularis, or middle, layer of the stomach wall.

Stage II: When the stomach cancer has spread:

  • completely through the mucosal layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor; or
  • to the muscularis, or middle, layer of the stomach wall and is found in up to 6 lymph nodes near the tumor; or
  • to the serosal, or outermost, layer of the stomach wall but not to lymph nodes or other organs.

Stage III: Depending on where the cancer has spread will determine whether the gastric cancer is either stage IIIA or stage IIIB.

Stage IIIA cancer has spread to:

  • the muscularis, or middle, layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor; or
  • the serosal, or outermost, layer of the stomach wall and is found in 1 to 6 lymph nodes near the tumor; or
  • organs next to the stomach but not to lymph nodes or other parts of the body.

Stage IIIB cancer has spread to the serosal layer of the stomach wall and is found in 7 to 15 lymph nodes near the tumor.

Stage IV: Cancer receives this classification when it has spread to organs next to the stomach and to at least one lymph node; or more than 15 lymph nodes; or other parts of the body.

More information on stomach cancer

What is Stomach Cancer?

Symptoms of Stomach Cancer

Diagnosing Stomach Cancer

Treating Stomach (Gastric) Cancer

Information adapted from the National Cancer Institute.

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