Esophageal cancer (staging)

Esophageal cancer staging uses the international TNM system. The staging can depend slightly on whether the tumor is squamous cell or adenocarcinoma subtype. Due to the lack of a serosal layer, esophageal cancer often tends to have mediastinal spread at the time of diagnosis.

Staging

TNM staging

• T staging
  • Tx: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • Tis: high-grade dysplasia
  • T1: invades lamina propria, muscularis mucosae or submucosa
    • T1a: invades lamina propria or muscularis mucosae
    • T1b: invades submucosa
  • T2: invades muscularis propria
  • T3: invades adventitia
  • T4: direct extension into adjacent structures
    • T4a: (resectable) invades pleura, pericardium or diaphragm
    • T4b: (unresectable) invades other structures, e.g. aorta, trachea
• N staging
  • Nx: regional nodes cannot be assessed
  • N0: no regional lymph node metastases
  • N1: 1-2  regional nodes involved
  • N2: 3-6 regional nodes involved 
  • N3: >7 regional nodes involved
• M staging
  • Mx: metastatic disease cannot be assessed
  • M0: no distant metastases
  • M1: distant metastases

AJCC staging groups

Staging is dependent on histological subtype, e.g. squamous cell carcinoma or adenocarcinoma. G refers to the grade of tumor and the location is in brackets. As with the TNM classification, X indicates inability to determine grade or location.

Squamous cell carcinoma

• stage 0: Tis N0 M0 G1, X
• stage I
  • stage Ia: T1 N0 M0 G1, X
  • stage Ib:
    • T1 N0 M0 G2-3
    • T2-3 N0 M0 G1,X (lower, X)
• stage II
  • stage IIa
    • T2-3 N0 M0 G1,X (upper, middle)
    • T2-3 N0 M0 G2-3 (lower, X)
  • stage IIB
    • T2-3 N0 M0 G2-3 (upper, middle)
    • T1-2 N1 M0
• stage III
  • stage IIIA
    • T1-2 N2 M0
    • T3 N1 M0
    • T4a N0 M0
  • stage IIIB
    • T3 N2 M0
  • stage IIIC
    • T4a N1-2 M0
    • T4b N- M0
    • T- N3 M0
• stage IV: T- N- M1