Esophageal cancer (staging)

A.Prof Frank Gaillard ◉ ◈ et al.

Esophageal cancer 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