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Thank you for your trust in the past. Ray Schilling, MD
**Closure of my websites askdrray.com and nethealthbook.com**

These websites will be taken down on **April 30, 2025** and no further updates will be provided.
I hope you enjoyed the content of these websites. You can continue to read Dr. Schilling’s blogs which I publish daily on Quora

My home page there is: ** https://www.quora.com/profile/Ray-Schilling**

Click on this: Under my image there is a heading “Profile”. Right underneath this you find a search box entitled “search content”. Type in any term you are interested in. You will get several answers I have written (I have written more than 15,000 answers).

On Quora you can also write comments that I will answer.

Thank you for your trust in the past. Ray Schilling, MD
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Staging Of Stomach Cancer

The stomach wall has 4 major layers that will be mentioned below for staging of stomach cancer.

The cancer starts in the superficial lining called “mucosa”, which is the first layer. The next layer below it is called “submucosa”. It contains lots of vessels and lymphatic drainage channels that become important for the spreading of stomach cancer. The third layer is the muscle layer (=medical term “muscularis propria”), which contracts when you feel a “knot in your stomach”.

The fourth layer on the outside of the stomach is called “serosa”. It is a shiny membrane attached to the outside of the stomach thus facing the abdominal cavity. This layer becomes inflamed when cancer invades it, becomes sticky and adheres to neighboring structures such as the transverse colon or the small intestine. This explains how fistula to neighboring organs form in the advanced stages of stomach cancer.

Here is a simplified summary of the staging for stomach cancer:

Staging of stomach cancer

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Stage:        Comments:

I :      confined to mucosa and submucosa.

II :    suspected serosa invasion and perigastric lymph node metastases.

III :  confirmed serosa invasion, lymph node metastases around arteries of stomach, liver and spleen.

IV :  adjacent organs involved, lymph node metastases as above and also in area of pancreas, back of upper abdomen and paraaortic region. Liver metastases also present.

_________________________________________________

Briefly, stage I is confined to the mucosa lining and at the most invasion into the submucosa layer. With stage II the invasion likely goes through the whole stomach wall, but is still confined to a local area.

With stage III the tumor cells have invaded the serosa layer and have migrated further through the lymphatic system along the arteries of the stomach, liver and spleen. Spread has occurred even more with stage IV, where the cancer has metastasized into the liver and into the lymph glands of the upper abdomen. At the later stages of stage IV there can be metastases in every major organ system through spread via the blood stream.

In the following image the patient has developed bowel obstruction because of an invading stomach cancer. The typical X-ray findings are dilated bowel loops with fluid levels in them. This cancer would be stage IV.

Staging Of Stomach Cancer

Staging Of Stomach Cancer (bowel obstruction)

 

References:

1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter on Cancer of the stomach.

2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on Cancer of the stomach.

3. J Sun et al. Eur J Cancer Prev 2001 Feb;10(1):61-67.

4. SS Mirvish et al. Nutr Cancer 1998;31(2):106-110.

5. JM van Maanen et al. Cancer Detect Prev 1998;22(3):204-212.

6. JM van Maanen et al. Environ Health Perspect 1996 May;104(5):522-528.

7. B. Sears: “The age-free zone”.Regan Books, Harper Collins, 2000.

8. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.

9. K Murakami et al. Am J Clin Pathol 2001 Feb;115(2):224-34.

10. Y Tsubono et al. N Engl J Med 2001 Mar 1;344(9):632-636.

11. Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

12. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc

Last modified: October 21, 2014

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.