Español
Questions About Cancer? 1-800-4-CANCER
  • View entire document
  • Print
  • Email
  • Facebook
  • Twitter
  • Google+
  • Pinterest

Esophageal Cancer Treatment (PDQ®)

Stage Information for Esophageal Cancer

The stage determines whether the intent of the therapeutic approach will be curative or palliative.

Definitions of TNM

The AJCC has designated staging by TNM classification to define cancer of the esophagus and esophagogastric junction.[1]

Table 1. Primary Tumor (T)a,b
aReprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 103-15.
b(1) At least maximal dimension of the tumor must be recorded, and (2) multiple tumors require the T(m) suffix.
cHigh-grade dysplasia includes all noninvasive neoplastic epithelia that was formerly called carcinoma in situ, a diagnosis that is no longer used for columnar mucosae anywhere in the gastrointestinal tract.
TX Primary tumor cannot be assessed.
T0 No evidence of primary tumor.
Tis High-grade dysplasia.c
T1 Tumor invades lamina propria, muscularis mucosae, or submucosa.
T1a Tumor invades lamina propria or muscularis mucosae.
T1b Tumor invades submucosa.
T2 Tumor invades muscularis propria.
T3 Tumor invades adventitia.
T4 Tumor invades adjacent structures.
T4a Resectable tumor invading pleura, pericardium, or diaphragm.
T4b Unresectable tumor invading other adjacent structures, such as aorta, vertebral body, trachea, etc.
Table 2. Regional Lymph Nodes (N)a,b
aReprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 103-15.
bNumber must be recorded for total number of regional nodes sampled and total number of reported nodes with metastasis.
NX Regional lymph nodes cannot be assessed.
N0 No regional lymph node metastasis.
N1 Metastases in 1–2 regional lymph nodes.
N2 Metastases in 3–6 regional lymph nodes.
N3 Metastases in ≥7 regional lymph nodes.
Table 3. Distant Metastasis (M)a
aReprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 103-15.
M0 No distant metastasis.
M1 Distant metastasis.
Table 4. Anatomic Stage/Prognostic Groupsa
Squamous Cell Carcinoma b
HGD = high-grade dysplasia.
aReprinted with permission from AJCC: Esophageal and esophagogastric junction. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 103-15.
bOr mixed histology, including a squamous component or not otherwise specified.
cLocation of the primary cancer site is defined by the position of the upper (proximal) edge of the tumor in the esophagus.
Stage T N M Grade Tumor Locationc
0 Tis (HGD) N0 M0 1, X Any
IA T1 N0 M0 1, X Any
IB T1 N0 M0 2–3 Any
T2–3 N0 M0 1, X Lower, X
IIA T2–3 N0 M0 1, X Upper, middle
T2–3 N0 M0 2–3 Lower, X
IIB T2–3 N0 M0 2–3 Upper, middle
T1–2 N1 M0 Any Any
IIIA T1–2 N2 M0 Any Any
T3 N1 M0 Any Any
T4a N0 M0 Any Any
IIIB T3 N2 M0 Any Any
IIIC T4a N1–2 M0 Any Any
T4b Any M0 Any Any
Any N3 M0 Any Any
IV Any Any M1 Any Any
Adenocarcinoma
Stage T N M Grade
0 Tis (HGD) N0 M0 1, X
IA T1 N0 M0 1–2, X
IB T1 N0 M0 3
T2 N0 M0 1–2, X
IIA T2 N0 M0 3
IIB T3 N0 M0 Any
T1–2 N1 M0 Any
IIIA T1–2 N2 M0 Any
T3 N1 M0 Any
T4a N0 M0 Any
IIIB T3 N2 M0 Any
IIIC T4a N1–2 M0 Any
T4b Any M0 Any
Any N3 M0 Any
IV Any Any M1 Any

The current staging system for esophageal cancer is based largely on retrospective data from the Japanese Committee for Registration of Esophageal Carcinoma. It is most applicable to patients with squamous cell carcinomas of the upper third and middle third of the esophagus, as opposed to the increasingly common distal esophageal and gastroesophageal junction adenocarcinomas.[2] In particular, the classification of involved abdominal lymph nodes as M1 disease has been criticized. The presence of positive abdominal lymph nodes does not appear to carry as grave a prognosis as metastases to distant organs.[3] Patients with regional and/or celiac axis lymphadenopathy should not necessarily be considered to have unresectable disease caused by metastases. Complete resection of the primary tumor and appropriate lymphadenectomy should be attempted when possible.

References

  1. Esophagus and esophagogastric junction. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 103-11.
  2. Iizuka T, Isono K, Kakegawa T, et al.: Parameters linked to ten-year survival in Japan of resected esophageal carcinoma. Japanese Committee for Registration of Esophageal Carcinoma Cases. Chest 96 (5): 1005-11, 1989. [PUBMED Abstract]
  3. Korst RJ, Rusch VW, Venkatraman E, et al.: Proposed revision of the staging classification for esophageal cancer. J Thorac Cardiovasc Surg 115 (3): 660-69; discussion 669-70, 1998. [PUBMED Abstract]
  • Updated: February 18, 2015