[Staging of gastric carcinoma]

The controversies over the patterns of gastric cancer staging in western countries (UICC-AJCC), Japan (JRSGC) and more recently Hawaii (1984) are analysed with reference to the problems of definition and assignment of values to the single elements: T,N,M, location and stage grouping that were not homogeneously established in the patterns mentioned. Problems about T mainly regard T1 and T4. T1 incorporates tumours (T1m and T1sm) with quite different prognosis and therefore represents, in spite of several changes made, a dyshomogeneous group. The same can be said about T4 where prognoses are considerably different according to contiguous structures involved in the tumour and they are not held in due consideration by the various staging systems. In all these, the different lymph nodes are gathered into homogeneous groups (N1,N2,N3) progressively numbered according to the prognostic value. These groups are based, however, on inadequate information and in fact constitute heterogenous umbrellas. The greatest problems about parameter M concern subclinical M1 that, missed at the time of the tumours staging before or during operations, reveal themselves shortly after operations considered radical. Finally new views about the relationship between cancer biology and prognosis (cytofluorometry, immunohistochemistry, etc.) are examined.