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Stomach cancer stages

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on May 23, 2022.


Making an educated treatment decision begins with determining the stage, or progression, of the disease. The stage of stomach cancer is one of the most important factors in evaluating treatment options.

TNM staging system and stomach cancer

The American Joint Committee on Cancer developed the TNM staging system for evaluating the extent and spread of stomach cancer, also called gastric cancer. The staging process is a basis for selecting stomach cancer treatment options and helping doctors communicate potential outcomes (prognosis). The TNM system considers three important factors:

T (tumor): This describes the size and growth of the primary stomach tumor.

N (node): This provides information about stomach cancer found in regional lymph nodes.

M (metastasis): This indicates whether the cancer has metastasized, or spread to other areas. Metastatic stomach cancer is most commonly found in the liver, but it may also be in the lungs, lymph nodes or the peritoneum, or the lining of the abdominal cavity.

Stomach cancer stage grouping

Each of these categories are rated on a numbered scale, with the higher numbers indicating increased severity. These categories are then grouped into stomach cancer stages from 0-4:

Stage 0 stomach cancer

Early-stage stomach cancer may also be referred to as carcinoma in situ, because the cancer has not spread into any nearby tissue. In this stage, the gastric cancer has not yet spread to the inner layer of cells that line the stomach.

Stage 1 stomach cancer

This stage of stomach cancer is divided into two categories:

  • Stage 1A stomach cancer occurs when the cancer has grown beneath the top layer of cells in the mucosa but has not grown into the main muscle layer of the stomach. The cancer has not spread to any lymph nodes or anywhere else.
  • Stage 1B stomach cancer occurs when one of the following conditions are met:
    • The conditions of stage 1A are met, and the cancer has also spread to one or two lymph nodes near the stomach, but not to any other tissues or organs.
    • The cancer has grown into the main muscle layer of the stomach wall, but has not spread to nearby lymph nodes, tissues or organs.

Stage 2 stomach cancer

Stage 2 stomach cancer is divided into two categories:

  • Stage 2A stomach cancer occurs when one of the following conditions are met:
    • The cancer has grown beneath the top layer of cells. It has not reached the main muscle layer, but it has spread to between three and six lymph nodes near the stomach. Distant sites have not been affected.
    • The cancer has grown into the main muscle layer of the stomach. It has spread to one or two nearby lymph nodes but has not spread to distant sites.
    • The cancer has grown through the main muscle layer into the subserosa but has not grown through all the layers to the outside of the stomach. It has not spread to any nearby lymph nodes, tissues, or organs outside of the stomach.
  • Stage 2B occurs when one of the following conditions are met:
    • The cancer has grown beneath the top layer of cells but not into the main muscle layer. It has spread to seven or more lymph nodes near the stomach. Tissues and organs outside the stomach remain unaffected.
    • The cancer has grown into the main muscle layer. It has spread to between three and six lymph nodes near the stomach, but it has not spread to any tissues or organs outside the stomach.
    • The cancer has grown into the subserosa layer, but not completely through all the layers to the outside of the stomach. It has spread to one or two nearby lymph nodes, but has not spread to tissues or organs outside the stomach.
    • The cancer has grown completely through all the layers of stomach wall into the outer covering of the stomach but has not started growing into other nearby organs or tissues. It has not spread to any nearby lymph nodes or distant sites.

Stage 3 stomach cancer

This stage of stomach cancer is divided into three categories:

  • Stage 3A occurs when one of the following conditions are met:
    • The cancer has grown into the main muscle layer of the stomach. It has spread to seven or more lymph nodes but has not spread to tissues or organs outside the stomach.
    • The cancer has grown into the subserosa layer, but not completely through all the layers to the outside of the stomach. It has spread to between three and six nearby lymph nodes but has not spread to tissues or organs outside the stomach.
    • The cancer has grown completely through all the layers of the stomach wall into the outer covering of the stomach but has not started growing into nearby organs or tissues. It has spread to one or two nearby lymph nodes but has not spread to distant sites.
  • Stage 3B occurs when one of the following conditions are met:
    • The cancer has grown into the subserosa layer, but not completely through all the layers to the outside of the stomach. It has spread to seven or more nearby lymph nodes but has not spread to distant sites.
    • The cancer has grown completely through all the layers of the stomach wall into the serosa but has not started growing into nearby organs or tissues. It has spread to three to six nearby lymph nodes but has not spread to distant sites.
    • The cancer has grown through the stomach wall and into nearby organs or structures. It may also have spread to up to two nearby lymph nodes. It has not spread to distant sites.
  • Stage 3C occurs when one of the following conditions are met:
    • The cancer has grown completely through all the layers of the stomach wall into the serosa but has not started growing into nearby organs or tissues. It has spread to seven or more nearby lymph nodes (N3) but has not spread to distant sites.
    • The cancer has grown through the stomach wall and into nearby organs or structures. It has spread to three or more nearby lymph nodes. It has not spread to distant sites.

Stage 4 stomach cancer

This is the most advanced form of the disease. In stage 4, the cancer has metastasized, or spread, beyond the stomach into other areas of the body. About four out of five stomach cancers in the United States are diagnosed after the cancer has spread to other areas of the body. 

Stomach cancer can be considered stage 4 even if it hasn’t reached nearby lymph nodes or spread into the stomach wall’s layers. If the cancer has spread to faraway sites, including the lungs, liver, brain, or the tissue surrounding abdominal organs (the peritoneum), it is classified as stage 4 stomach cancer, also known as metastatic stomach cancer.

Stomach cancer survival rate

Doctors usually use five-year relative survival rates to communicate cancer survival odds. These rates represent the likelihood that someone with a particular cancer will survive five years or longer after diagnosis, compared with patients who don’t have that cancer. While survival statistics can provide useful knowledge, they are only estimates, and a lot of variability can occur from one patient to the next. Also, these numbers are based on patients who were diagnosed in the past, so they can’t account for changes in treatment options or outcomes.

The overall five-year relative survival rate for stomach cancer is 35.7 percent, based on patients diagnosed between 2013 and 2019, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. This means that people with any stage of stomach cancer are, on average, about 35.7 percent as likely as people without stomach cancer to live five years or longer after being diagnosed. SEER also calculates survival rates based on the cancer’s stage. However, rates are not provided for all four stomach cancer stages. Instead, SEER uses three general stages:

  • Localized (cancer hasn’t spread beyond where it started)
  • Regional (cancer has spread to nearby lymph nodes, tissues or organs)
  • Distant (cancer has spread to distant body parts)

Below are the five-year relative survival rates for stomach cancer, according to SEER stages.

  • Localized: 74.7 percent
  • Regional: 34.6 percent
  • Distant: 6.6 percent

Next topic: How is stomach cancer diagnosed?

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