Gastric Cancer Staging with Radiologic Imaging Modalities and UICC Staging System

Abstract

There are two major stage classification systems for gastric cancer: the tumor-node-metastasis (TNM) stages by the International Union against Cancer (UICC) and the Japanese Classification of Gastric Carcinoma by the Japanese Gastric Cancer Association (JGCA). Preoperative stage classification using either of these systems is essential for deciding on the treatment strategy in the era of various multimodal therapeutic options. Evolution of multidetector computerized tomography with isotropic volumetric imaging and various 3D images has increased the accuracy of T and N staging in patients with gastric cancer, although detection of peritoneal deposits and nodal metastasis in the absence of lymphadenopathy remain problematic with the imaging tools currently available. The TNM and JGCA classifications have undergone revisions independent of each other, and the discrepancies were not helpful when international comparisons and cooperation were needed. More recently, the JGCA and TNM classifications were merged to have identical T and N categories, in addition to the more straightforward M categories that indicate the presence of distant metastasis. The result of these efforts is that researchers in Japan and the rest of the world are now looking at a similar disease when they discuss cancer that belongs to the same stage. A nomogram that incorporates other established prognostic determinants in addition to the TNM component may be a future direction for a more sophisticated means of predicting outcome. The increasing incidence of junctional (esophagogastric junction) cancer in the Far East has spurred researchers from this region to adequately stage the disease and to consider suitable treatment modalities for this disease entity, whereas Western researchers are more inclined to treat this disease as esophageal cancer. This could be an area for future international debate. For the next more accurate staging, we suggest the collaboration between Eastern and Western high-volume centers in gastric cancer because the inconsistency of surgical approaches, especially with respect to nodal resection, remains a barrier to mutual understanding.

Microrna-136 promotes proliferation and invasion ingastric cancer cells through Pten/Akt/P-Akt signaling pathway

“…Li et al (24) reported that in gastric cancer, PTEN expression is low in tumor tissues and was associated with advanced clinical stage and poor prognosis of patients with gastric cancer. Zheng et al (43) identified that decreased PTEN expression was significantly associated with depth of invasion, lymphatic invasion, lymph node metastasis, liver metastasis and Union Internationale Contre le Cancer staging of gastric cancer (44). Functional experiments indicated tumor suppressive functions for PTEN in cell apoptosis, cell cycle arrest, proliferation, invasion and metastasis in gastric cancer cells (25)(26)(27).…”

Human Epidermal Growth Factor Receptor 2 Expression in Unresectable Gastric Cancers: Relationship with CT Characteristics

“…Tumor margin was defined as either a well-defined or an ill-defined margin. cTNM staging was assessed similar to prior studies ( 16 17 ). The CT criteria for T staging are summarized in Table 1 .…”

CT differentiation of poorly-differentiated gastric neuroendocrine tumours from well-differentiated neuroendocrine tumours and gastric adenocarcinomas

“…Maximum tumour size was measured on the axial CT scan and tumour margin was defined as either a well-defined margin or an ill-defined margin. TNM staging was assessed in the same manner as in prior studies (17,18). The degree of enhancement was evaluated as high attenuation, iso-attenuation, or low attenuation on arterial, portal, and delay phases, referencing the enhancement of the normal gastric mucosa.…”