Esophagus
Miscellaneous
Staging of esophageal carcinoma

Author: Feriyl Bhaijee, M.D. (see Authors page)
Editor: Israh Akhtar, M.D.

Revised: 1 February 2018, last major update December 2013

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Staging[TI] esophageal carcinoma[TI]

Cite this page: Bhaijee, F. Staging of esophageal carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/esophagusstaging.html. Accessed May 27th, 2018.
Definition / general
  • Based on Edge: AJCC Cancer Staging Manual, 7th edition, 2009
  • Nonmucosal cancers are excluded
  • It is advisable to use the exact words in the basis of staging (e.g. "tumor invades submucosal" instead of just "T1b") because classification systems change over time and vary between institutions
  • Based on risk adjusted random survival forest analysis of worldwide data
  • Summary of changes from AJCC 6th to 7th editions
    • Tumor location is simplified and esophagogastric junction and proximal 5 cm of stomach are included
    • Tis is redefined and T4 is subclassified
    • Regional lymph nodes are redefined
    • N is subclassified according to the number of regional lymph nodes containing metastasis
    • M is redefined
    • Separate stage groupings for squamous cell carcinoma and adenocarcinoma
    • Stage groupings are reassigned using T, N, M and G classifications
  • AJCC Cancer Staging Manual, 8th edition released in 2016: Amin: AJCC Cancer Staging Manual, 8th Edition, 2016
Rules for classification
  • Clinical staging (c prefix) based on evidence before primary treatment
    • Clinical reclassification during or after chemo / radiotherapy is designated by the yc prefix
  • Pathologic staging (p prefix) is based on evidence acquired before treatment and supplemented / modified by evidence acquired by pathologic evaluation of the surgical specimen after resection
    • Pathologic reclassification during or after surgery that is preceded by chemo / radiotherapy is designated by the yp prefix
Definitions of TNM
  • Primary tumor (T)
    • TX: Primary tumor cannot be assessed
    • T0: No evidence of primary tumor
    • Tis: High 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 GI tract)
    • 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.
  • Notes:
    • Maximal dimension of tumor must be recorded
    • Multiple tumors require the T(m) suffix
Diagrams / tables

Images hosted on other servers:

Stages of throat cancer

Various stages

Regional lymph nodes (N)
  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastases
  • N1: Metastasis in 1 - 2 regional lymph nodes
  • N2: Metastasis in 3 - 6 regional lymph nodes
  • N3: Metastasis in 7 or more regional lymph nodes
  • Notes:
    • Number must be recorded for total number of regional nodes sampled and total number of reported nodes with metastasis
Distant metastasis (M)
  • M0: No distant metastasis
  • M1: Distant metastasis
Grading
  • GX: Cannot be assessed (stage grouping as G1)
  • G1: Well differentiated
  • G2: Moderately differentiated
  • G3: Poorly differentiated
  • G4: Undifferentiated (stage grouping as G3 for squamous cell carcinomas)
Location
  • Upper: hypopharynx to azygous vein
    • 15 to < 25 cm from the incisors
  • Middle: lower border of azygous vein to inferior pulmonary vein
    • 25 to < 30 cm from the incisors
  • Lower: lower border of inferior pulmonary vein to 5 cm below esophagogastric junction
    • 30 - 45 cm from the incisors
Anatomic stage / prognostic groups
  • Squamous cell carcinoma
    • Stage 0
      • Tis (HGD) N0 M0, grade 1 or X, any location
    • Stage IA
      • T1 N0 M0, grade 1 or X, any location
    • Stage IB
      • T1 N0 M0, grade 2 - 3, any location
      • T2 - 3 N0 M0, grade 1 or X, lower or X location
    • Stage IIA
      • T2 - 3 N0 M0, grade 1 or X, upper or middle location
      • T2 - 3 N0 M0, grade 2 - 3, lower or X location
    • Stage IIB
      • T2 - 3 N0 M0, grade 2 - 3, upper or middle location
      • T1 - 2 N1 M0, any grade, any location
    • Stage IIIA
      • T1 - 2 N2 M0 or T3 N1 M0, any grade, any location
      • T4a N0 M0, any grade, any location
    • Stage IIIB
      • T3 N2 M0, any grade, any location
    • Stage IIIC
      • T4a N1 - 2 M0, any grade, any location
      • T4b any N M0, any grade, any location
      • Any T N3 M0, any grade, any location
    • Stage IV
      • Any T any N M1, any grade, any location
  • Notes:
    • Or mixed histology including a squamous component or NOS
    • Location of the primary cancer site is defined by the position of the upper (proximal) edge of the tumor in the esophagus

  • Adenocarcinoma
    • Stage 0
      • Tis (HGD) N0 M0, grade 1 or X
    • Stage IA
      • T1 N0 M0, grade 1 - 2 or X
    • Stage IB
      • T1 N0 M0, grade 3
      • T2 N0 M0, grade 1 - 2 or X
    • Stage IIA
      • T2, N0 M0, grade 3
    • Stage IIB
      • T3 N0 M0, any grade
      • T1 - 2 N1 M0, any grade
    • Stage IIIA
      • T1 - 2 N2 M0, any grade
      • T3 N1 M0, any grade
      • T4a N0 M0, any grade
    • Stage IIIB
      • T3 N2 M0, any grade
    • Stage IIIC
      • T4a N1 - 2 M0, any grade
      • T4b any N M0, any grade
      • Any T N3 M0, any grade
    • Stage IV
      • Any T any N M1, any grade