What is the T staging for gastric cancer, including a diagram?

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Last updated: May 18, 2026 • View editorial policy

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T Staging for Gastric Cancer

The T staging for gastric cancer is based on the depth of tumor invasion through the gastric wall layers, progressing from Tis (carcinoma in situ) through T4b (invasion of adjacent organs), with critical subdivisions at T1 (mucosa/submucosa), T2 (muscularis propria), T3 (subserosal connective tissue), and T4a/b (serosa and beyond). 1

T Category Definitions

The current staging system (7th edition AJCC, harmonized with esophageal staging) defines T categories as follows 1:

Tis (Carcinoma in situ)

  • Intraepithelial tumor without invasion of the lamina propria
  • Previously designated as high-grade dysplasia (HGD)
  • Candidates for endoscopic mucosal resection (EMR) at experienced centers

T1: Tumor confined to mucosa or submucosa

This category has critical therapeutic implications and is subdivided:

  • T1a: Invasion of lamina propria or muscularis mucosae (confined to mucosa)

    • May be considered for EMR if meeting strict criteria: well-differentiated (G1-2), non-ulcerated, <2 cm 2
  • T1b: Invasion into the submucosa

    • Requires gastrectomy with modified D2 lymphadenectomy due to significant risk of lymphatic spread 1

T2: Tumor invades muscularis propria

  • Penetrates into but not through the muscularis propria layer
  • Treatment varies: some centers prefer primary surgery ± adjuvant therapy, others prefer neoadjuvant therapy 1

Important caveat: A tumor may penetrate the muscularis propria with extension into gastrocolic/gastrohepatic ligaments or omentum WITHOUT perforation of visceral peritoneum—this remains T2, not T3 2

T3: Tumor invades subserosal connective tissue

  • Penetrates through muscularis propria into subserosal tissue
  • Does NOT penetrate the visceral peritoneum
  • If visceral peritoneum covering gastric ligaments or omentum is perforated, classify as T3 2
  • Medically fit patients should undergo neoadjuvant therapy after laparoscopy staging 1

T4: Tumor invades serosa or adjacent structures

Critical subdivision introduced in 7th edition with major treatment implications 1:

  • T4a: Invades serosa (visceral peritoneum)

    • Considered resectable
    • Should undergo neoadjuvant therapy followed by restaging and possible surgical resection
  • T4b: Invades adjacent organs

    • Includes: spleen, transverse colon, liver, diaphragm, pancreas, abdominal wall, adrenal gland, kidney, small intestine, retroperitoneum 1, 2, 1
    • Generally considered unresectable, though selected cases may be considered

Visual Representation of Gastric Wall Layers

Lumen
  ↓
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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.