Stomach cancers

Carcinoma of the stomach click to access explanations in the original CAP template

Please also seen notes on Japanese Gastric Cancer Treatment Guidelines 7th edition (2025).

Microscopic descriptions:

- Tumor histology and immunohistochemical studies:

- Adenocarcinoma (WHO 2019):
+ Lauren:
- Other histologic types:
- Histologic grade:
+ Histologic grade (JCGC 15e):
- Tumor extension:
- Sub-mucosal Invasion (pT1 only): - please use Japanese guidelines	Depth of Sub-mucosal Invasion
	Extent of Sub-mucosal Invasion
+ Ulceration (UL):
- Lymphatic invasion (Ly):
- Venous invasion (V):
+ Perineural invasion:
- Treatment effect:

Japanese Classication of Gastric Cancers 15e (2017):

The tumor biopsy specimens and endoscopically resected tumors are classified histologically into either the differentiated type or the undifferentiated type. The former includes malignant epithelial tumor, general type, of papillary adenocarcinoma (pap) and tubular adenocarcinoma (tub1, tub2), and the latter includes that of poorly differentiated adenocarcinoma (por1, por2) and signet ring cell carcinoma (sig) according to the Japanese Classification of Gastric Carcinoma 15th edition. When mucinous adenocarcinoma (muc) is found at the submucosal layer, the resected specimen is handled as undifferentiated type, regardless of whether it is considered to derive from the differentiated or undifferentiated type.

Surgical margins for stomach resection specimens:

- Proximal margin:
- Distal margin:
- Omental (radial) margin:
- Other margin(s) (specify: ):

Surgical margins for endoscopic resection:

- Mucosal margin (horizontal margin HM):
- Deep margin (Vertical margin VM):
- Other margin(s) (specify: ):

Regional lymph nodes:

- Number of regional lymph nodes examined:
- Number of lymph nodes involved:
- Extranodal extension:
- Size of largest metastatic deposit (mm), specify site:
- Size of largest lymph node involved (mm), specify site:

Distant Metastasis: Not applicable Not identified Non-regional lymph node(s) (specify): Liver (specify): Other (specify): Cannot be determined:

Pathologic Stage Classification (AJCC 8e):

- TNM Descriptors:	m (multiple primary tumors) r (recurrent) y (post treatment)
- Primary tumor (pT):
- Regional lymph nodes (pN):
- Distant metastasis (pM):

Curability of endoscopic resection eCura:

Based on the cumulative points, patients are divided into three risk categories for lymph node metastasis (LMN) that guide post-ESD management:

- Low Risk (0--2 points): ≈ 2.5% LNM risk. Additional surgery may be unnecessary; close endoscopic follow-up is generally acceptable.

- Intermediate Risk (3--4 points): ≈ 6.7% LNM risk. Treatment requires case-by-case evaluation.

- High Risk (5--7 points): ≈ 23% LNM risk. Additional radical/salvage surgery is strongly recommended.

Please also seen notes on Japanese Gastric Cancer Treatment Guidelines 7th edition (2025)

- Lymphatic invasion (Ly):
- Tumor size more than 30 mm:
- Positive vertical margin (VM):
- Venous invasion (V):
- Submucosal invasion more than or equal to 500 μm (SM2):

eCURA

+ Additional pathologic findings:

Intestinal metaplasia Low-grade dysplasia High-grade dysplasia Helicobacter pylori-type gastritis Autoimmune atrophic chronic gastritis Other polyps (type[s]):

- Other (specify):

- Additional notes: