Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
1998 by
International and
Japanese Gastric
Cancer Associations
Special article
Japanese Classification of Gastric Carcinoma - 2nd English Edition Japanese Gastric Cancer Association
Association office, First Department of Surgery, Kyoto Prefectural University of Medicine, Kawaramachi, Kamigyo-ku, Kyoto, 602-0841, Japan
Preface
The first edition of the General Rules for Gastric Cancer Study
was published by the Japanese Research Society for Gastric
Cancer (JRSGC) in 1963. The first English edition [1] was
based on the 12th Japanese edition and was published in 1995.
In 1997, the JRSGC was transformed into the Japanese Gastric
Cancer Association and this new association has maintained
its commitment to the concept of the Japanese Classification.
This second English edition was based on the 13th Japanese
edition [2].
The aim of this classification is to provide a common
language for the clinical and pathological description of gastric
cancer and thereby contribute to continued research and
improvements in treatment and diagnosis.
Key words: gastric cancer, classification, manual, surgery,
pathology
I. General principles
Findings are recorded using the upper case letters T
(depth of tumor invasion), N (lymph node metastasis),
H (hepatic metastasis), P (peritoneal metastasis) and M
(distant metastasis). The extent of each finding is
expressed by Arabic numerals following each upper case
letter. X is used in unknown cases. Four categories of
findings, namely Clinical, Surgical, Pathological, and
Final Findings, are identified using the lower case c,
Operative findings
Intraoperative diagnostic
imaging
Intraoperative cytology
Frozen sections
Pathological examination
of materials obtained only
by surgical, endoscopic,
or laparoscopic resection
Comprehensive summary
of findings based on
Clinical, Surgical and
Pathological Findings.
11
A Primary lesions
1. Number and size of lesions
The two greatest dimensions should be recorded for each
lesion.
2. Tumor Location
Type 0 I :
Type 0 IIa :
Type 0 IIb :
Type 0 IIc :
Type 0 III :
Protruded type
Superficial elevated type
Flat type
Superficial depressed type
Excavated type
12
Fig. 3.
Fig. 4.
Note :
Fig. 5.
Fig. 6.
13
Fig. 7.
Fig. 8.
s Type 0 IIc+III, T2
p Type 0 IIc+III, T2(MP)
f Type 0 IIc+III, T2
Fig. 9.
14
15
Table 2.
No. 1
No. 2
No. 3
No. 4sa
No. 4sb
No. 4d
No. 5
No. 6
No. 7
No. 8a
Right paracardial LN
Left paracardial LN
LN along the lesser curvature
LN along the short gastric vessels
LN along the left gastroepiploic vessels
LN along the right gastroepiploic vessels
Suprapyloric LN
Infrapyloric LN
LN along the left gastric artery
LN along the common hepatic artery
(Anterosuperior group)
LN along the common hepatic artery(Posterior
group)
LN around the celiac artery
LN at the splenic hilum
LN along the proximal splenic artery
LN along the distal splenic artery
LN in the hepatoduodenal ligament (along the
hepatic artery)
LN in the hepatoduodenal ligament (along the
bile duct)
LN in the hepatoduodenal ligament (behind the
portal vein)
LN on the posterior surface of the pancreatic head
LN along the superior mesenteric vein
LN along the superior mesenteric artery
LN along the middle colic vessels
LN in the aortic hiatus
LN around the abdominal aorta (from the upper
margin of the celiac trunk to the lower margin
of the left renal vein)
LN around the abdominal aorta (from the lower
margin of the left renal vein to the upper margin
of the inferior mesenteric artery)
LN around the abdominal aorta (from the upper
margin of the inferior mesenteric artery to the
aortic bifurcation)
LN on the anterior surface of the pancreatic head
LN along the inferior margin of the pancreas
Infradiaphragmatic LN
LN in the esophageal hiatus of the diaphragm
Paraesophageal LN in the lower thorax
Supradiaphragmatic LN
Posterior mediastinal LN
No. 8p
No. 9
No. 10
No. 11p
No. 11d
No. 12a
No. 12b
No. 12p
No. 13
No. 14v
No. 14a
No. 15
No. 16a1
No. 16a2
No. 16b1
No. 16b2
No. 17
No. 18
No. 19
No. 20
No. 110
No. 111
No. 112
16
17
LD / L
LM / M / ML
2
M
1
M
3
1
1
1
2
2
3
2
M
2
M
2
3
3
2
M
M
M
3
M
M
M
M
M
M
M
M
1
3
1
3
1
1
1
1
2
2
3
2
3
2
3
2
3
3
3
M
M
M
3
M
M
M
M
M
M
M
M
MU / UM
1
1
1
1
1
1
1
1
2
2
3
2
2
2
2
2
3
M
3
M
M
M
3
M
M
M
3
3
M
M
M
E+
1
1
1
1
1
2
3
3
2
2
3
2
2
2
2
3
3
M
M
M
M
M
3
M
M
M
3
3
M
M
M
2
1
3
3
3
18
H0 : No liver metastasis
H1 : Liver metastasis
HX : Unknown
Lymph nodes
Pulmonary
Pleura
Bone marrow
Osseous
Brain
Meninges
Skin
Others
C. Stage
Fig. 19. Cytology CY0 (Papanicolaou staining)
Table 4.
Stage grouping
N0
N1
N2
T1
IA
IB
II
T2
IB
II
IIIA
T3
II
IIIA
IIIB
T4
IIIA
IIIB
N3
IV
H1, P1, CY1, M1
1. Approaches
Intraluminal endoscopy
Laparoscopy
Laparotomy
Thoraco-laparotomy
Others
2. Operative procedures
Mucosectomy
Wedge resection
Segmental resection
Proximal gastrectomy
Pylorus preserving gastrectomy
Distal gastrectomy
Total gastrectomy
Other resections
Bypass without resection
Exploratory (non-therapeutic) laparotomy
Gastrostomy or other stoma formation
Other palliative operations
19
3. Combined resection
A. Surgical specimens
All structures resected together with the main tumor
should be recorded, e.g. spleen, liver, pancreas,
transverse colon, transverse mesocolon, gallbladder,
adrenal gland, ovary, etc. Resection of the greater or
lesser omentum, the anterior sheet of the transverse
mesocolon, the abdominal esophagus, and the first
portion of the duodenum, are not included in this
category.
4. Involvement of the resection margins
20
(pap)
(tub 1)
(tub 2)
21
3. Cancer-stroma relationship
med Medullary type ;
sci
Scirrhous type :
Stroma is scanty.
Stroma is abundant.
int
22
4.
INF
INF
6. Venous invasion
The degree of invasion within veins of the gastric wall
should be classified as follows :
v0 :
v1 :
v2 :
v3 :
No venous invasion
Minimal venous invasion
Moderate venous invasion
Severe venous invasion
5. Lymphatic invasion
ly0 :
ly1 :
ly2 :
ly3 :
No lymphatic invasion
Minimal lymphatic invasion
Moderate lymphatic invasion
Marked lymphatic invasion (Fig. 34)
23
Note
The Japanese 13th edition of the Classification of Gastric
Carcinoma [2] contains the following additional
information which has been omitted from this text for
reasons of brevity:
2. Histological examination
The histological type and the size of the largest
dimension of the tumor, the presence or absence of
ulceration (UL), lymphatic invasion (ly) and venous
24
References
1.
2.
University of Erlangen-Nrnberg,
Germany
G. Bruce Mann
University of Melbourne,
Australia
David D. Kerrigan University Hospital Aintree, Liverpool,
U.K.