Esophagus
General
Staging
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Staging[TI] esophageal carcinoma[TI]
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Pathologic TNM staging of carcinomas of the esophagus, AJCC 8th edition
Definition / general
- All carcinomas of the esophagus, including poorly differentiated neuroendocrine carcinomas, are covered by this staging system
- Esophagus cancers are defined as having an epicenter within the esophagus, within the gastroesophageal junction or no more than 2 cm into the proximal stomach
- Well differentiated neuroendocrine tumors of the true esophagus are extremely rare and do not have a separate staging system, unlike other gastrointestinal organs
- Well differentiated neuroendocrine tumors of the gastroesophageal junction and cardia are staged using the stomach neuroendocrine system
ICD coding
- C15.9: Malignant neoplasm of esophagus, unspecified
Primary tumor (pT)
- TX: Tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: High grade dysplasia, defined as malignant cells confined to the epithelium by the basement membrane
- T1: Tumor invades the lamina propria, muscularis mucosae or submucosa
- T1a: Tumor invades the lamina propria or muscularis mucosae
- T1b: Tumor invades the submucosa
- T2: Tumor invades the muscularis propria
- T3: Tumor invades adventitia
- T4: Tumor invades adjacent structures
- T4a: Tumor invades the pleura, pericardium, azygos vein, diaphragm or peritoneum
- T4b: Tumor invades other adjacent structures, such as the aorta, vertebral body or airway
Regional lymph nodes (pN)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Metastasis in 1 or 2 regional lymph nodes
- N2: Metastasis in 3 - 6 regional lymph nodes
- N3: Metastasis in 7+ regional lymph nodes
- Notes:
regional lymph nodes include lower cervical paratracheal, upper / lower paratracheal, subcarinal, upper / middle / lower thoracic paraesophageal, pulmonary ligament, diaphragmatic, paradarcial, left gastric, common hepatic, splenic, celiac and cervical periesophageal level VI / VII nodes
Location (squamous cell carcinoma only)
- X: Location unknown
- Upper: Cervical esophagus to lower border of azygous vein
- Middle: Lower border of azygous vein to lower border of inferior pulmonary vein
- Lower: Lower border of inferior pulmonary vein to stomach, including gastroesophageal junction
Prefixes
- y: Preoperative radiotherapy or chemotherapy
- r: Recurrent tumor stage
- m: Multiple / skip lesions
Stage grouping
| Squamous cell carcinoma, clinical (cTNM)
|
| Stage 0: | cTis | cN0 | cM0
|
| Stage I: | cT1 | cN0 - 1 | cM0
|
| Stage II: | cT2 | cN0 - 1 | cM0
|
| | cT3 | cN0 | cM0
|
| Stage III: | cT3 | cN1 | cM0
|
| | cT1 - 3 | cN2 | cM0
|
| Stage IVA: | cT4 | cN0 - 2 | cM0
|
| | any cT | cN3 | cM0
|
| Stage IVB: | any cT | any cN | cM1
|
| Squamous cell carcinoma, pathological (pTNM)
|
| Stage 0: | pTis | pN0 | pM0 | G N/A | any location
|
| Stage IA: | pT1a | pN0 | pM0 | G1, GX | any location
|
| Stage IB: | pT1a | pN0 | pM0 | G2 - 3 | any location
|
| | pT1b | pN0 | pM0 | G1 - 3, GX | any location
|
| | pT2 | pN0 | pM0 | G1 | any location
|
| Stage IIA: | pT2 | pN0 | pM0 | G2 - 3, GX | any location
|
| | pT3 | pN0 | pM0 | any G | lower
|
| | pT3 | pN0 | pM0 | G1 | upper / middle
|
| Stage IIB: | pT3 | pN0 | pM0 | G2 - 3 | upper / middle
|
| | pT3 | pN0 | pM0 | GX | any location
|
| | pT3 | pN0 | pM0 | any G | location X
|
| | pT1 | pN1 | pM0 | any G | any location
|
| Stage IIIA: | pT1 | pN2 | pM0 | any G | any location
|
| | pT2 | pN1 | pM0 | any G | any location
|
| Stage IIIB: | pT2 | pN2 | pM0 | any G | any location
|
| | pT3 | pN1 - 2 | pM0 | any G | any location
|
| | pT4a | pN0 - 1 | pM0 | any G | any location
|
| Stage IVA: | pT4a | pN2 | pM0 | any G | any location
|
| | pT4b | pN0 - 2 | pM0 | any G | any location
|
| | any pT | pN3 | pM0 | any G | any location
|
| Stage IVB: | any pT | any pN | pM1 | any G | any location
|
Squamous cell carcinoma, postneoadjuvant therapy (ypTNM)
| Stage I: | ypT0 - 2 | ypN0 | ypM0
|
| Stage II: | ypT3 | ypN0 | ypM0
|
| Stage IIIA: | ypT0 - 2 | ypN1 | ypM0
|
| Stage IIIB: | ypT3 | ypN1 | ypM0
|
| | ypT0 - 3 | ypN2 | ypM0
|
| | ypT4a | ypN0 | ypM0
|
| Stage IVA: | ypT4a | ypN1 - 2, X | ypM0
|
| | ypT4b | ypN0 - 2 | ypM0
|
| | any ypT | ypN3 | ypM0
|
| Stage IVB: | any ypT | any ypN | ypM1
|
| Adenocarcinoma, clinical (cTNM)
|
| Stage 0: | cTis | cN0 | cM0
|
| Stage I: | cT1 | cN0 | cM0
|
| Stage IIA: | cT1 | cN1 | cM0
|
| Stage IIB: | cT2 | cN0 | cM0
|
| Stage III: | cT2 | cN1 | cM0
|
| | cT3 | cN0 - 1 | cM0
|
| | cT4a | cN0 - 1 | cM0
|
| Stage IVA: | cT1 - 4a | cN2 | cM0
|
| | cT4b | cN0 - 2 | cM0
|
| | any cT | cN3 | cM0
|
| Stage IVB: | any cT | any cN | cM1
|
| Adenocarcinoma, pathological (pTNM)
|
| Stage 0: | pTis | pN0 | pM0 | G N/A
|
| Stage IA: | pT1a | pN0 | pM0 | G1, GX
|
| Stage IB: | pT1a | pN0 | pM0 | G2
|
| | pT1b | pN0 | pM0 | G1 - 2, GX
|
| Stage IC: | pT1 | pN0 | pM0 | G3
|
| | pT2 | pN0 | pM0 | G1 - 2
|
| Stage IIA: | pT2 | pN0 | pM0 | G3, GX
|
| Stage IIB: | pT1 | pN1 | pM0 | any G
|
| | pT3 | pN0 | pM0 | any G
|
| Stage IIIA: | pT1 | pN2 | pM0 | any G
|
| | pT2 | pN1 | pM0 | any G
|
| Stage IIIB: | pT2 | pN2 | pM0 | any G
|
| | pT3 | pN1 - 2 | pM0 | any G
|
| | pT4a | pN0 - 1 | pM0 | any G
|
| Stage IVA: | pT4a | pN2 | pM0 | any G
|
| | pT4b | pN0 - 2 | pM0 | any G
|
| | any pT | pN3 | pM0 | any G
|
| Stage IVB: | any pT | any pN | pM1 | any G
|
Adenocarcinoma, postneoadjuvant therapy (ypTNM)
(same as for squamous cell carcinoma)
|
| Stage I: | ypT0 - 2 | ypN0 | ypM0
|
| Stage II: | ypT3 | ypN0 | ypM0
|
| Stage IIIA: | ypT0 - 2 | ypN1 | ypM0
|
| Stage IIIB: | ypT3 | ypN1 | ypM0
|
| | ypT0 - 3 | ypN2 | ypM0
|
| | ypT4a | ypN0 | ypM0
|
| Stage IVA: | ypT4a | ypN1 - 2, X | ypM0
|
| | ypT4b | ypN0 - 2 | ypM0
|
| | any ypT | ypN3 | ypM0
|
| Stage IVB: | any ypT | any ypN | ypM1
|
Registry data collection variables
- Squamous cell carcinoma:
- Clinical staging modalities (endoscopy and biopsy, EUS, EUS-FNA, CT, PET / CT)
- Tumor length
- Depth of invasion
- Number of nodes involved, clinical
- Number of nodes involved, pathological
- Location of nodal disease, clinical
- Location of nodal disease, pathological
- Sites of metastases, if applicable
- Presence of skip lesions: T(m)
- Perineural invasion
- LVI (lymphatic, vascular, both)
- Extranodal extension
- Type of surgery
- Chemotherapy
- Chemoradiation therapy (for ypTNM)
- Surgical margin (negative, microscopic, macroscopic)
- Adenocarcinoma:
- Clinical staging modalities (endoscopy and biopsy, EUS, EUS-FNA, CT, PET / CT)
- Tumor length
- Depth of invasion
- Number of nodes involved, clinical
- Number of nodes involved, pathological
- Location of nodal disease, clinical
- Location of nodal disease, pathological
- Sites of metastases, if applicable
- Presence of skip lesions: T(m)
- Perineural invasion
- LVI (lymphatic, vascular, both)
- Extranodal extension
- HER2 status (positive or negative)
- Type of surgery
- Chemotherapy
- Chemoradiation therapy (for ypTNM)
- Surgical margin (negative, microscopic, macroscopic)
Histologic grade
- GX: Grade not available
- G1: Well differentiated
- G2: Moderately differentiated
- G3: Poorly differentiated
Histopathologic type
- Squamous:
- Squamous cell carcinoma
- Basaloid squamous cell carcinomas
- Adenosquamous carcinoma
- Spindle cell (squamous) carcinoma
- Verrucous (squamous) carcinoma
- Undifferentiated carcinoma with squamous component
- Adenocarcinoma:
- Adenocarcinoma
- Adenoid cystic carcinoma
- Mucoepidermoid carcinoma
- Mixed adenoneuroendocrine carcinoma
- Undifferentiated carcinoma with glandular component
- Other:
- Neuroendocrine tumor, G1
- Neuroendocrine tumor, G2
- Neuroendocrine carcinoma
- Large cell neuroendocrine carcinoma
- Small cell neuroendocrine carcinoma
Residual tumor
- R0: No evidence of residual tumor
- R1: Microscopic tumor at margins (including at inked radial margin)
- R2: Macroscopically visible tumor at margins
Diagrams / tables
Images hosted on other servers:
Illustration of T category and N category staging
Stages of throat cancer
Various stages
Board review style question #1
Which of the following variables has no impact on staging esophageal squamous cell carcinoma?
- Histologic grade
- Margin status
- Neoadjuvant therapy use
- Tumor location within esophagus
Board review style answer #1
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