Japanese classification of gastric carcinoma: 3rd English edition

Gastric cancer findings are categorized and recorded using the upper case letters T, H, etc. The extent of disease for each parameter is expressed by Arabic numerals following the letter (e.g., T3 H1); where the extent of disease is unknown, X is used. The clinical and pathological classifications are derived from information acquired from various clinical, imaging, and pathological sources (listed in Table 1). The clinical classification (c) is derived at the conclusion of pretreatment assessment before a decision is made regarding the appropriateness of surgery. This classification is an essential guide to treatment selection and enables the evaluation of therapeutic options. The pathological classification (p) is based on the clinical classification supplemented or modified by additional evidence acquired from pathological examination. This informs decision-making regarding additional therapy and provides prognostic information. Where there is doubt regarding the T, N, or M category, the less advanced category should be used. Histological tumor findings are recorded in the following order: tumor location, macroscopic type, size, histological type, depth of invasion, cancer–stroma relationship, pattern of infiltration, lymphatic invasion, venous invasion, lymph node metastasis, and resection margins. For example: L, Less, Type 2, 50 9 20 mm, tub1 [ tub2, pT2, int, INFb, ly1, v1, pN1 (2/13), pPM0, pDM0 (see subsequent text for an explanation of the abbreviations).