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Esophageal Cancer Treatment (PDQ®)

Health Professional Version
Last Modified: 10/07/2014

Stage Information for Esophageal Cancer

Definitions of TNM

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
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisHigh-grade dysplasia.c
T1Tumor invades lamina propria, muscularis mucosae, or submucosa.
T1aTumor invades lamina propria or muscularis mucosae.
T1bTumor invades submucosa.
T2Tumor invades muscularis propria.
T3Tumor invades adventitia.
T4Tumor invades adjacent structures.
T4aResectable tumor invading pleura, pericardium, or diaphragm.
T4bUnresectable tumor invading other adjacent structures, such as aorta, vertebral body, trachea, etc.

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.

Table 2. Regional Lymph Nodes (N)a,b
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Metastases in 1–2 regional lymph nodes.
N2Metastases in 3–6 regional lymph nodes.
N3Metastases in ≥7 regional lymph nodes.

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.

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.
M0No distant metastasis.
M1Distant metastasis.

Table 4. Anatomic Stage/Prognostic Groupsa
Squamous Cell Carcinoma b  
Stage  T N M Grade Tumor Locationc 
0Tis (HGD)N0M01, XAny
IAT1N0M01, XAny
IBT1N0M02–3Any
T2–3N0M01, XLower, X
IIAT2–3N0M01, XUpper, middle
T2–3N0M02–3Lower, X
IIBT2–3N0M02–3Upper, middle
T1–2N1M0AnyAny
IIIAT1–2N2M0AnyAny
T3N1M0AnyAny
T4aN0M0AnyAny
IIIBT3N2M0AnyAny
IIICT4aN1–2M0AnyAny
T4bAnyM0AnyAny
AnyN3M0AnyAny
IVAnyAnyM1AnyAny
Adenocarcinoma
Stage T N M Grade
0Tis (HGD)N0M01, X
IAT1N0M01–2, X
IBT1N0M03
T2N0M01–2, X
IIAT2N0M03
IIBT3N0M0Any
T1–2N1M0Any
IIIAT1–2N2M0Any
T3N1M0Any
T4aN0M0Any
IIIBT3N2M0Any
IIICT4aN1–2M0Any
T4bAnyM0Any
AnyN3M0Any
IVAnyAnyM1Any

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.

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]